Mechanical Injuries (1,2)
- ○ 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.
- ○ Fluid-filled bullae caused by friction
- ○ Treatment: Moleskin donuts, sterile drainage
- ○ Consider: Primary prevention includes anti-chafing products, well-fitted footwear.
- ○ 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.
- ○ Fatty herniations through fascial tissue in the heels. Can be painful or asymptomatic.
- ○ Treatment: Observation. Consider orthotics, rest if painful.
- ○ 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)
- ○ 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.
- ○ 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
- ○ Blotchy red or purple lesions that present several hours after cold exposure
- ○ Treatment: Rewarm, protect from further cold exposure. Consider corticosteroids.
- ○ 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)
- ○ 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.
- ○ Erythematous, honey-crusted lesion caused by B-hemolytic streptococci
- ○ Treatment: Combination topical and oral therapy to treat streptococcus lesions
- ○ Consider: See furuncle.
- ○ 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.
- ○ 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.
- ○ 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.
- ○ 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.
- ○ 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.
- ○ Chronic, erythematous plaques found in skin folds. Can involve scrotum.
- ○ Treatment: Topical antifungal such as clotrimazole
- ○ Consider: OK to return immediately to play.
- ○ Painless flesh-colored dome-shaped papules with umbilicated centers
- ○ Treatment: Cryotherapy, topical salicylate, curettage, excision. Visible lesions must be removed prior to wrestling competition.
- ○ 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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