Dermatology Issues in SportsBannerman, Elana MD; Stevenson, John Herbert MD, CAQCurrent Sports Medicine Reports: July/August 2017 - Volume 16 - Issue 4 - p 219–220 doi: 10.1249/JSR.0000000000000372 CAQ Review Author Information Article Outline Address for correspondence: University of Massachusetts, 281 Lincoln Street, Worcester, MA 01605; E-mail: Elana.Bannerman@umassmemorial.org. Column Editor: John R. Hatzenbuehler, MD; E-mail: email@example.com. References Mechanical Injuries (1,2) Abrasions ○ Wearing of skin due to scraping injury ○ Treatment: Cleanse wound with soapy water and apply topical antibacterial ointment ○ Consider: If actively bleeding, must be covered during National Collegiate Athletic Association (NCAA) participation. Blisters ○ Fluid-filled bullae caused by friction ○ Treatment: Moleskin donuts, sterile drainage ○ Consider: Primary prevention includes anti-chafing products, well-fitted footwear. Corns and calluses ○ Calluses are hyperkeratotic, nonpainful lesions caused by friction. Corns also are caused by friction, but contain a painful central core. ○ Treatment: Pare down with pumice stone or scalpel. ○ Consider: Orthotics might prevent return by redis-tributing pressure. Piezogenic Papules ○ Fatty herniations through fascial tissue in the heels. Can be painful or asymptomatic. ○ Treatment: Observation. Consider orthotics, rest if painful. Chafing/Joggers Nipples ○ Wearing of epidermis and dermis due to repetitive friction of wet skin ○ Treatment: Utilize lubricating antichafing products or keep skin dry by using powder Acne Mechanica/Acne Keloidalis ○ Comedones/folliculitis caused by exogenous forces, including repetitive friction, trauma from uniforms and helmets. Can progress to form keloid-like scars. ○ Treatment: Discontinue irritant, then apply astringents, topical antibiotics Black Heel/Plantar Petechiae ○ Petechiae of epidermis of posterior heel caused by shearing forces associated with running, direction change ○ Treatment: Well-fitting shoes, heel cups, cushioned socks ○ Consider: Rule out melanoma by paring down heel. If black pigment is still present after all skin lines are shaved or if bleeding occurs, recommend biopsy. Environmental Injuries (1,2) Sunburn ○ Damage to epidermis and dermis due to prolonged exposure of ultraviolet light. Manifests as painful erythema, but blisters can occur as well. ○ Treatment: Aloe Vera, oral hydration, topical anesthetics, avoid sun exposure. Prevent by decreasing sun exposure, especially between 10 a.m. and 2 p.m., and sunscreen use with frequent applications. ○ Consider: Many medications can sensitize the skin to the sun, including tetracyclines, sulfa medications, phenothiazines, multiple acne medications. Miliaria ○ Fine red or skin-colored papules caused by blockage of eccrine glands due to sweating ○ Treatment: Breathable clothing, open occluded ducts with hydrophilic ointments, mild topical corticosteroids, gentle exfoliation Chilblain/Pernio ○ Blotchy red or purple lesions that present several hours after cold exposure ○ Treatment: Rewarm, protect from further cold exposure. Consider corticosteroids. Frostnip/frostbite ○ Frostnip is paresthesias of skin due to cold temperatures, reversible with rewarming ○ Frostbite is the freezing of tissue due to prolonged exposure in cold temperatures that may lead to permanent damage ○ Treatment: Rewarm rapidly in water bath. Do not massage or rub tissue while rewarming ○ Consider: Do not rewarm until no further chance of refreezing. Infectious Causes (1–4) Bacterial Furuncle ○ Abscess formed from staphylococcus infection of a hair follicle ○ Treatment: I&D and oral antibiotic therapy to treat staphylococcus. May need to treat for MRSA. ○ Consider: Highly contagious. Competing wrestlers must have completed >72 h of antibiotic therapy and have no open lesions. Impetigo ○ Erythematous, honey-crusted lesion caused by B-hemolytic streptococci ○ Treatment: Combination topical and oral therapy to treat streptococcus lesions ○ Consider: See furuncle. Erythrasma ○ Red-brown plaques involving skin folds. ○ Treatment: Topical or oral erythromycin ○ Consider: Can mimic tinea cruris; differentiate by coral appearance on Wood’s lamp exam. Fungal Tinea Pedis ○ Erythematous pruritic scales between the toes and on the plantar aspects and sides of the feet ○ Treatment: Topical antifungals such as clotrimazole or terbinafine for 3 wk for 1 wk after resolution of lesion ○ Consider: Prevent by wearing wicking socks and using foot powder to keep feet dry. Tinea Cruris ○ Acute, well-demarcated erythematous pruritic scaly plaque in skin folds of groin. Spares scrotum. ○ Treatment: Topical antifungal such as clotrimazole. ○ Consider: May compete with lesion if it is well-covered. Tinea Corporis ○ Pruritic, scaly annular lesion with central clearing ○ Treatment: Topical antifungals such as clotrimazole or terbinafine until lesion clears ○ Consider: Easily spread. Wrestlers may return to competition after 72 h of therapy. If lesion is on scalp, must be treated with 10 d of oral therapy. Tinea Versicolor ○ Asymptomatic, hypopigmented or hyperpigmented macules, commonly found on trunk. ○ Treatment: Selenium-based OTC or prescription shampoo applied daily on the lesion or ketoconazole cream. Treat refractory cases with oral antifungal. ○ Consider: OK to return immediately to play. Intertrigo ○ Chronic, erythematous plaques found in skin folds. Can involve scrotum. ○ Treatment: Topical antifungal such as clotrimazole ○ Consider: OK to return immediately to play. Viral Molluscum Contagiosum ○ Painless flesh-colored dome-shaped papules with umbilicated centers ○ Treatment: Cryotherapy, topical salicylate, curettage, excision. Visible lesions must be removed prior to wrestling competition. Herpes Labialis ○ Vesicles around lips which rupture to form crusted lesions ○ Treatment: Acyclovir ○ Consider: Return to play only after 5 d of antiviral treatment, no new lesions in the last 3 d, and all current lesions with firm crust. The authors declare no conflict of interest and do not have any financial disclosures.Back to Top | Article Outline References 1. Madden CC, Putukian M, Young CC, McCarty EC. Netter’s Sports Medicine. Philadelphia, PA: Saunders Elsevier; 2010. Cited Here... 2. O’Connor FG, Casa DJ, Davis BA, et al. ACSM’s Sports Medicine: A Comprehensive Review. Hong Kong: Wolters Kluwer Lippincott Williams & Wilkins; 2013. Cited Here... 3. Parsons J. 2014–15 NCAA Sports Medicine Handbook. [cited March 25, 2017]. Available from: http://www.ncaapublications.com/productdownloads/MD15.pdf. August 2014. Cited Here... 4. Zinder SM, Basler RS, Foley J, et al. National Athletic Trainers’ Association position statement: skin diseases. J. Athl. Train. 2010; 45:411–28. Cited Here... | PubMed | CrossRef Copyright © 2017 by the American College of Sports Medicine.