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Dermatology Issues in Sports

Bannerman, Elana MD; Stevenson, John Herbert MD, CAQ

doi: 10.1249/JSR.0000000000000372
CAQ Review

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: jhatz@intermed.com.

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.

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References

1. Madden CC, Putukian M, Young CC, McCarty EC. Netter’s Sports Medicine. Philadelphia, PA: Saunders Elsevier; 2010.
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.
3. Parsons J. 2014–15 NCAA Sports Medicine Handbook. [cited March 25, 2017]. Available from: http://www.ncaapublications.com/productdownloads/MD15.pdf. August 2014.
4. Zinder SM, Basler RS, Foley J, et al. National Athletic Trainers’ Association position statement: skin diseases. J. Athl. Train. 2010; 45:411–28.
Copyright © 2017 by the American College of Sports Medicine.