Cutaneous Friction Injuries and Blister Prevention in Athletes: From Stratum Corneum Mechanics to Smart-Textile Solutions: A Systematic Review

BACKGROUND Friction blisters and chafing are among the most common dermatologic causes of time loss and performance decline in sports; however, preventive practices often lag behind emerging tribological and textile science. OBJECTIVE To synthesize contemporary evidence on the pathophysiology, epidemiology, and prevention of frictional dermatoses in athletes, with emphasis on engineered fabrics and barrier interventions. METHODS We conducted a narrative review of MEDLINE via PubMed, SPORTDiscus Web of Science (1980–May 2025) with manual reference tracking. Inclusion focused on randomized controlled trials (RCTs), prospective cohorts, bench-tribology studies, and technology reports. RESULTS Incidence varies from 20–60% in marathoners and >70% in ultradistance hikers. Shear stress ≥ 30 N/cm−2 applied to a hydrated stratum corneum initiates intra-epidermal clefting; anatomical hotspots differ by sport (plantar foot in running, palmar digits in rowing, perineum in cycling). Acrylic or synthetic-blend socks reduce blister risk compared to cotton in RCTs of soldiers and marathoners, while double-layer and toe socks reduce skin-to-skin shear. Tribological tests revealed that the knit architecture modulates the coefficient of friction (COF) more significantly than the raw fiber type. Topical petrolatum-based lubricants reduce blister incidence by 30–40% when reapplied every 4 hours. Hydrocolloid dressings and kinesiology tape offer about 50% protection during multi-day marches. Early prototypes of smart socks integrate pressure-heat sensors to detect “hot spots” before vesiculation. CONCLUSIONS A multimodal regimen, including an optimized sock/footwear interface, targeted lubricants or dressings, moisture control, and athlete education, remains best practice. Research should converge bench COF thresholds with athlete-centered outcomes and explore sustainable, self-lubricating yarns paired with real-time wearable analytics.