What is the ‘raisin’ on foreheads of pious Egyptian Muslim men and why does it appear?

'Zebiba’ develops due to repeated prostration and is much more common in Egypt than in other countries

Worshippers at Al Azhar mosque in Cairo during Ramadan. EPA

Worshippers offer the taraweeh night prayer at Al Azhar mosque during the holy month. Photo: EPA

Many Egyptian Muslim men develop a 'zebiba' - a dark, hardened patch of skin on the forehead caused by repeatedly prostrating themselves in prayer. EPA

But not all worshippers develop a zebiba - raisin in Arabic - or to the same degree. While Cairo garage attendant Mahmoud Nassar, 43, left, has a noticable mark, that on colleague Reda Abdelsalam, 47, is more faint. Nada El Sawy / The National

Mohammed Abu Bilal, 47, in downtown Cairo. The zebiba is a reaction to the friction of the skin against a harsh surface, such as a rough mat. Nada El Sawy / The National

Cairo Uber driver Mohammed Nour, 40, says he goes to the mosque to pray at least five or six times a day during Ramadan. Nada El Sawy / The National

Cairo accountant Ibrahim Abbas, 48, says his zebiba is due to praying frequently from a young age. Nada El Sawy / The National

Ahmed Abdel Fattah, 48, in downtown Cairo. The zebiba seems to be found mainly in Egypt and only in men. Nada El Sawy / The National

Egyptian President Abdel Fattah El Sisi also has a zebiba. Photo: Reuters

Former president Hosni Mubarak, left, pictured while vice president with then president Anwar Sadat in 1981. Only Sadat has a zebiba. Photo: AFP

As worshippers fill mosques for the last days of Ramadan, one cannot help but notice the prominent mark on the foreheads of many Egyptian men.

The “zebiba” — “raisin” in Arabic — is a dark, hardened patch of skin on the forehead that develops due to repeated prostration during the daily prayers.

It seems to appear mainly in Egypt and only in men, prompting questions of its religious and cultural origins, the dermatological causes and its social significance.

Some argue that worshippers deliberately rub the mark when their heads touch the ground in prayer to make it more pronounced, wearing it as a badge of piety. Others say it is a simple consequence of repeated prayer on worn-out carpets and rough mats.

Either way, the zebiba is a common sight in Egypt, from the common man on the street to President Abdel Fattah El Sisi.

Ahmed Abdel Fattah, 48, in downtown Cairo. The zebiba seems to be found mainly in Egypt and only in men. Nada El Sawy / The National

The scholarly view

“Egyptians are religious, whether they are Muslims, Christians or anything,” says Muhammad Abdel Haleem, director of the Centre of Islamic Studies at the University of London’s School of Oriental and African Studies (SOAS).

“Religion is at the heart of every Egyptian, right from the beginning of the ancient Egyptians.”

While the zebiba has been reported on Nigerian and Pakistani men, Mr Abdel Haleem says, “clearly it is very marked in Egypt”, where religion has been the cornerstone of civilisation for thousands of years.

Culturally, “they think it is a mark of them being in prostration much of the time and this means that they are pious”, he explains.

Some Muslims point to a specific verse in the Quran, at the end of Surah Al Fath, which refers to the companions of the Prophet Mohammed: “You see them kneeling and prostrating in prayer, seeking the bounty and pleasure of God. Their sign is in their faces from the effect of prostration.”

However, Mr Abdel Haleem, whose English translation of the Quran published by Oxford University is a bestseller, says this does not refer to the zebiba.

“The Quran says ‘on their faces’. It did not say ‘on their foreheads’. And the word for forehead is used elsewhere in the Quran,” he says.

“It suggests that [the Prophet’s companions] are much in prayer and the effect of that shows on their faces. Their faces are shining with the atmosphere of piety and prayer. As a linguist and teacher of Arabic and Quran, this is what it means to me.”

Those who think it means a mark on the forehead and deliberately seek it out risk “riya” (showing off) or “nifaq” (hypocrisy), which wipe out any good reward from acts of worship, according to the Quran, says Mr Abdel Haleem.

That said, he thinks that most people do not purposely press hard or use other methods to create the zebiba.

“Muslims have to pray daily and no less than 34 times every day, their forehead touches a mat. I suggest some individuals' skin on the forehead is more sensitive than others and that is how they get this mark,” Mr Abdel Haleem says.

The dermatological view

Dr Khaled El-Hoshy, a dermatologist and professor of dermatology at Cairo University, says the zebiba is caused by a reaction to the friction of the skin with a harsh surface.

“Similar to a callosity formation, it is a thickening of the outer layers of the skin and a bit of increased pigmentation,” Dr El-Hoshy explains. “It is definitely not a bacterial infection and not a fungal infection, as the myth goes.”

Coarse and irregular surfaces, such as straw mats called “haseer”, cause higher levels of irritation. Preventive methods include using softer surfaces and more cushioning as well as avoiding rubbing the skin and holding the prostration pose for too long, Dr El-Hoshy says.

“It is a reflex protective mechanism of the skin to protect the bones underneath,” he says. “The skin senses that there is danger … so it thickens to protect the underlying wall.”

The condition can be treated with creams and sometimes carbon dioxide laser therapy.

He also sees patients with what are called “Muslim prayer signs” on the knees and the outer side of the ankles, more common because of the added weight and pressure on those areas.

“People don’t complain about the zebiba. But people do complain about the ankles and knees, especially women,” Dr El-Hoshy says.

Egyptian women pray more often at home, which may partly explain why their “prayer signs” do not include the zebiba.

Ibrahim Abbas, 48, has prayed since grade three. Nada El Sawy / The National

The man-on-the-street view

Ibrahim Abbas, a 48-year-old accountant at a local newspaper, says of his zebiba: “Thank God, it’s from a lot of prayer.”

He has prayed since grade three and increases his prayers during Ramadan — especially in the last 10 days of the month, when Muslims believe Laylat Al Qadr takes place.

In addition to the five obligatory daily prayers, he performs the taraweeh that follows the last prayer of the day and the tahajjud that takes place in the middle of the night before dawn.

“There are people who say that we rub our foreheads on the haseer [mat]. No, I don’t do that,” he says.

Mohammed Nour, a 40-year-old Uber driver, says he goes to the mosque at least five or six times a day during Ramadan. His zebiba appeared in the last five years.

“Some skin is more sensitive than others and maybe some people are pressing harder than others,” Mr Nour says. “My skin is very sensitive.”

Mahmoud Nassar, a 43-year-old garage attendant at a residential building in Cairo, says he developed his prominent zebiba about 10 years ago.

“In 90 per cent of our mosques, the prayer rugs are rough. Even at home, the mat I pray on is not soft because of the frequency of use,” he says.

He points to the fact that it does not necessarily appear in all Muslims who pray regularly.

“The evidence is that there are very well-known sheikhs, like Sheikh El Shaarawy and Sheikh Mohammed El Ghazali and Sheikh Abdelhalim Mahmoud — they are Islamic scholars who have lived for 80 or 90 years, praying regularly. And they don’t have them,” he says.

“It goes back to the mats that we pray on and the economic circumstances.”

Reda Abdelsalam, who works in the same building, agrees and says his zebiba is faint because he often prays “on one spot and one prayer carpet”. He criticises those who place importance on the zebiba based on the Quran.

“There are people who misunderstand the Quranic verse,” says Mr Abdelsalam, 47.

“It doesn’t matter to me at all,” Mr Nassar says. “It appeared and there’s no way to get rid of it. If it didn’t appear, it also wouldn’t matter to me. I’m not happy about it and I’m not upset about it.”