Doctors warn tight baby socks cause scarring

Tight socks could scar the legs of young children and babies, reported various news sources on September 17 2007.  The reports warn that wearing a pair of socks just once can cause ‘sock-line bands’ which are raised red marks around the leg or ankle and this could lead to permanent scarring.

The reports are based on a journal letter from two doctors who report a possible new condition found in children that they call “sock-line hyperpigmentation”. The condition reportedly causes permanent, but harmless, scarring from wearing tight socks.

It seems sensible not to put your child in socks that are too tight for them; however, there is a long way to go before we can conclude that this causes a serious risk for permanent scarring to the skin.

Where did the story come from?

The news reports are based upon a correspondence letter written by Drs Berk and Bayliss of the Departments of Internal Medicine and Paediatrics, Washington University Medical School, USA. The study was published in the peer-reviewed medical journal: British Journal of Dermatology .

What kind of scientific study was this?

In this article, the authors report a case series of their experience of hyperpigmentation of the skin (where patches of skin become darker in colour than the normal surrounding skin) caused by sock-line bands.

They report the case of an 11-month-old-girl who was found to have ‘raised skin-coloured bands’ on her legs after wearing some tight socks. The authors also mention other similar cases that they have seen.

What were the results of the study?

The case that the authors discussed involved a week old infant girl, who had developed red marks on her skin after wearing tight socks. The marks healed to leave raised skin-coloured bands on both legs that were still visible when the infant was examined again at eleven months.

The authors do not say whether the infant had continued to wear socks in the intervening period. The authors reported that this case differed from previous cases they had seen, in that the lines were skin-coloured, raised and bumpy, and not just a darker shade of colour.

The authors say that they have so far seen five cases of ‘sock-line hyperpigmentation’, and compare these to 10 cases they found reported elsewhere of ‘acquired raised bands of infancy’ which are diagonal raised lines on the arms, trunk or legs that may be caused by limb constrictions and complications during pregnancy.

What interpretations did the researchers draw from these results?

The authors put forward the theory that ‘tight elastic bands of socks or [trouser] legs’ may cause inflammation of the inner skin or fat, which may heal with ‘changes resembling sock lines’. The conclusion is that after healing, raised skin-coloured scars may be present. However, they say that the condition is not harmful and that further cases and follow-up are needed to understand the development of ‘sock-line hyperpigmentation’.

What does the NHS Knowledge Service make of this study?

This article presents the authors’ clinical experience of a few cases where raised lines on the skin have been caused by tight socks in children. This is very limited information on which to base conclusions. Relating to the news articles we can say the following:

• The few cases that have been seen have not been followed up over a long time-period and there is no suggestion that permanent scarring is caused.
• We do not know whether this problem is caused by wearing socks on one occasion or the use of socks over many months. We also do not know whether the problem may be related to use of a particular type of sock.
• It is unclear whether these children had eczema or dermatitis that may have predisposed them to irritation caused by tight elastic bands.
• Many more cases would be needed, with a much longer follow-up period, before we could provide further discussion on the newly proposed condition of “sock-line hyperpigmentation”.

At the current time, there would be no harm done in suggesting that parents put their children in socks that fit them.

Sir Muir Gray adds...

The letters pages in journals are notoriously known to be places to float ideas - many of which die a quick and painless death - and to get one's name in print. We all know tight clothes are less comfortable, so why would we put anything tight on a nipper when what parents want is a child that is relaxed or asleep?