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CAQ Review

Dermatology Issues in Sports

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

Author Information
Current Sports Medicine Reports: 7/8 2017 - Volume 16 - Issue 4 - p 219-220
doi: 10.1249/JSR.0000000000000372
  • Free

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.

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.
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