Sports Dermatology
Kevin deWeber, MD, FAAFP
Director
Primary Care Sports Medicine Fellowship
Military Sports Medicine
Fell...
Objectives
 Review common dermatologic problems
and how they affect athletes
 Discuss skin disorders specific to
athlete...
Introduction
 Definitions
 Feet
 Groin
 Buttocks
 Hands
 Face
 General
 Chest and Back
Definitions
 Macule – not raised, 1 cm or less
 Patch – not raised, greater than 1 cm
 Papule - raised, 1 cm or less
 ...
Definitions
 Vesicle - fluid filled, 1 cm or less
 Bulla - fluid filled, greater than 1 cm
 Pustule - elevated, pus fil...
Definitions
 Crust - dried fluid, e.g. scab
 Comedones -plugged sebaceous follicles
 Scale - excess keratin
 Excoriati...
Impact of skin infections in NCAA
wrestlers
 15% of practice time-loss injuries
National Federation of High Schools
Communicable Disease Procedures
 HCP must evaluate skin lesions before
returning to c...
Corns
 Hyperkeratotic
pressure area
 hard conical papule
with translucent
center
 TX: modify foot
wear to change
pressu...
Plantar Warts
 HPV
 thickened plantar
papules, shave
reveals “black dots”
 TX: keratolytic
solutions,
podophyllin,
cryo...
“Black Heel”
 Traumatic micro-
hemorrhages
 small asymptomatic
black macules
 no treatment
needed
Blisters
 excessive friction
 vesicles and bullae
 TX: prevention,
drainage (leave the
roof), hydrocolloid
dressing (du...
Ingrown Toenail
 From improperly
fitting footwear
 usually great toe
 TX:
– pressure relief (go
shoeless, wider
shoes)
...
Black Toenails
 AKA “joggers toe”,
“skiers toe”, “tennis toe”
 From trauma or pressure
 TX:
– acute subungual
hematoma:...
Onychomycosis
 fungal infection of nail
 discoloration, scaling,
thickening
 culture before tx
 TX:
– Dermatophytes: S...
Molluscum Contagiosum
 “wrestler’s warts”
 poxvirus
 firm, skin colored,
umbilicated papules
 TX: spontaneous resoluti...
Scabies
 mite Sarcopetes scabiei
 exquisitely pruritic
papules, excoriations;
DX: scraping
 TX: topical permethrin
or c...
Genital Warts
 Condyloma acuminata
 HPV, smooth or
verrucous papules
 genital and perianal
regions, cluster
 TX: cryot...
Genital Herpes
 Small, grouped
vesiclespainful ulcers;
 DX: Tzanck prep
 TX: acyclovir, valacyclovir
 NCAA: see Herpe...
Herpes infections:
NCAA participation criteria
 Primary infection
– no systemic sxs
– no new lesions x 3 days
– all lesio...
Tinea Cruris
 AKA “jock itch”
 Dermatophyte infection
 Erythematous w/
advancing border,
pruritic; DX: KOH prep
 TX: t...
Tinea Infections:
NCAA participation criteria
 >72 hours treatment
 DQ if extensive lesions
 Cover lesions with OpSite ...
Erythrasma
 Corynebacterium
infection
 Uniformly brown and
scaly w/o advancing
border; coral-red under
Wood’s lamp
 TX:...
Hidradenitis Suppuritiva
 blockage of sweat glands
with secondary infection;
chronic sinus tracts can
form
 Erythematous...
Tinea Versicolor
 Pityrosporum ovale,
asymptomatic
 Hypo- or hyper-pigmented
macules; DX: Wood’s
lamp, KOH scrape
 TX: ...
Jogger’s
Nipples
 irritation and
friction, long
distance runners
 painful, fissured,
eroded nipples
 TX: soft fiber shi...
Warts, Verruca Vulgaris
 HPV; unsightly and
painful
 “black dots” after
shave-down
 TX: salicylic acid
patch, cryothera...
Herpetic Whitlow
 Tender erythematous
vesicles near fingertip
 TX: oral antivirals
 NCAA
– See Herpes Infections,
recur...
Dyshydrotic Eczema
 unknown etiology,
not infectious
 eczematous eruption
of pruritic vesicles
on fingers
 TX: keep han...
Dermatophytid Reaction
 distant site fungal
infection
 vesicular
 treat distant site,
consider prednisone
 NCAA: see t...
Paronychia
 bacterial infection
 tender inflammation
of nail fold
 TX: warm soaks,
I&D, +/- oral abx
 NCAA: see Bacter...
Bacterial Infections:
NCAA participation criteria
 No new lesions for 48 hours
 >72 hours of antibiotics completed
 No ...
Herpes Labialis
 “cold sore”
 Herpes simplex virus
 Vesiclesulcers near lip;
painful
 TX: topical or oral
antivirals,...
Acne Vulgaris
 Acne Mechanica,
“football acne”
 TX: topical Retin-A,
benzoyl peroxide,
abx; oral abx
 Not a
contraindic...
Herpes Gladiatorum
 HSV on area of
friction/trauma
 TX: oral antivirals
 NCAA – see Herpes
Infections
Cellulitis
 Infection of dermis and
sub-cu tissue
 Expanding erythema,
swelling, tenderness
 TX: rest, elevation, oral
...
Erysipelas
 Usually Gp A Strep
 Superficial infection
extending into the
lymphatics; systemic
sxs common
 More red, swo...
Impetigo
 superficial skin
infection with Strep,
Staph
 yellow crusted
lesions on red base
 TX: remove crust;
topical m...
Folliculitis
 Mild hair follicle
inflammation or infection,
usually Staph
– Pseudomonas in hot tubs
 Papules, pustules a...
Furuncles
 More severe hair follicle
abscess with Staph
 acute, tender,
erythematous nodule
 TX: warm compresses,
abx, ...
Carbuncle
 More extensive
abscess than
furuncle; Staph
 TX: I&D, oral or IV
abx
 NCAA: see Bacterial
Infections
Methicillin-Resistant Staph Aureus
“MRSA”
 Staph strains resistant to ß-lactam abx (e.g.
dicloxacillin, methicillin)
 Ma...
Methicillin-Resistant Staph Aureus
“MRSA”
 When to suspect
– Skin abscesses
– Infections resistant to initial abx
 Prope...
Methicillin-Resistant Staph Aureus
“MRSA”
 Prevention
– No participation of infected athletes until
cured
– Protect expos...
Varicella (chickenpox)
 Varicella zoster virus
 Lesions in various stages—
papules, vesicles, ulcers,
crusts on red base...
Miliaria Rubra
“prickly heat”
 sweat duct occlusion
 fine erythematous
papules
 TX: dry clothing,
hydrophilic
ointments
Contact Dermatitis
 direct chemical irritant
or allergic delayed rxn
 pruritic patches of
vesicles on weeping
base
 TX:...
Atopic Dermatitis
 dry easily irritated
skin, worsened by
heat and sweat
 pruritic erythematous
macules and patches,
fle...
Sunburn
 UV radiation
 mild to intense
erythema
 analgesics, cool
compresses, topical
steroids or lotions
Photosensitivity
Reactions
 reaction to sun or Rx
 eczema-like rash in
sun-exposed areas
 TX:
– stop offending med
– pr...
Striae Distensae
 rupture of elastic
fibers from rapid
growth; steroids?
 perpendicular to
lines of tension;
shoulders, ...
Conclusion
 Skin diseases in athletes can be sports
and regionally specific
 Recognize and treat early
 Know the rules ...
Sports Dermatology
Sports Dermatology
Sports Dermatology
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Sports Dermatology

  1. 1. Sports Dermatology Kevin deWeber, MD, FAAFP Director Primary Care Sports Medicine Fellowship Military Sports Medicine Fellowship “Every Warrior an Athlete”
  2. 2. Objectives  Review common dermatologic problems and how they affect athletes  Discuss skin disorders specific to athletes  Review diagnostic keys and treatments of athletic dermatologic concerns
  3. 3. Introduction  Definitions  Feet  Groin  Buttocks  Hands  Face  General  Chest and Back
  4. 4. Definitions  Macule – not raised, 1 cm or less  Patch – not raised, greater than 1 cm  Papule - raised, 1 cm or less  Plaque - flat elevation, greater than 1 cm  Nodule – rounded elevation, greater than 1 cm  Tumor – large nodule
  5. 5. Definitions  Vesicle - fluid filled, 1 cm or less  Bulla - fluid filled, greater than 1 cm  Pustule - elevated, pus filled  Wheal – firm edematous plaque, transient
  6. 6. Definitions  Crust - dried fluid, e.g. scab  Comedones -plugged sebaceous follicles  Scale - excess keratin  Excoriation - erosion from scratching  Erosion - partial thickness loss  Ulcer - erosion into dermis  Fissure - crack-like break into dermis
  7. 7. Impact of skin infections in NCAA wrestlers  15% of practice time-loss injuries
  8. 8. National Federation of High Schools Communicable Disease Procedures  HCP must evaluate skin lesions before returning to competition  Consider evaluating other team members  Follow state/local “return to competition” rules
  9. 9. Corns  Hyperkeratotic pressure area  hard conical papule with translucent center  TX: modify foot wear to change pressure, soften lesion, remove
  10. 10. Plantar Warts  HPV  thickened plantar papules, shave reveals “black dots”  TX: keratolytic solutions, podophyllin, cryotherapy
  11. 11. “Black Heel”  Traumatic micro- hemorrhages  small asymptomatic black macules  no treatment needed
  12. 12. Blisters  excessive friction  vesicles and bullae  TX: prevention, drainage (leave the roof), hydrocolloid dressing (duoderm)
  13. 13. Ingrown Toenail  From improperly fitting footwear  usually great toe  TX: – pressure relief (go shoeless, wider shoes) – cotton under nail – Antibiotics if infected – surgical excision
  14. 14. Black Toenails  AKA “joggers toe”, “skiers toe”, “tennis toe”  From trauma or pressure  TX: – acute subungual hematoma: pierce nail – Mild cases: no tx – Prevention: proper shoes, metatarsal pad
  15. 15. Onychomycosis  fungal infection of nail  discoloration, scaling, thickening  culture before tx  TX: – Dermatophytes: Systemic itraconazole or terbinafine 2-4 mos – Mold: topicals – Candida: topical or systemic
  16. 16. Molluscum Contagiosum  “wrestler’s warts”  poxvirus  firm, skin colored, umbilicated papules  TX: spontaneous resolution (months), curettage, topicals, cryotherapy  NCAA: – curette or remove lesions & – cover with gas-perm membrane AND tape
  17. 17. Scabies  mite Sarcopetes scabiei  exquisitely pruritic papules, excoriations; DX: scraping  TX: topical permethrin or crotamiton overnight  NCAA - verification of treatment and negative scrapings
  18. 18. Genital Warts  Condyloma acuminata  HPV, smooth or verrucous papules  genital and perianal regions, cluster  TX: cryotherapy; topical podophyllox, imiquimod 5% cream
  19. 19. Genital Herpes  Small, grouped vesiclespainful ulcers;  DX: Tzanck prep  TX: acyclovir, valacyclovir  NCAA: see Herpes Infections
  20. 20. Herpes infections: NCAA participation criteria  Primary infection – no systemic sxs – no new lesions x 3 days – all lesions crusted – on oral meds >120 hours ( 5 days) – Crusts covered  Recurrent infection – Ulcers dry, covered by FIRM ADHERENT CRUST – On oral meds for >120 hours – Crusts covered
  21. 21. Tinea Cruris  AKA “jock itch”  Dermatophyte infection  Erythematous w/ advancing border, pruritic; DX: KOH prep  TX: topical antifungals  NCAA: see Tinea Infections
  22. 22. Tinea Infections: NCAA participation criteria  >72 hours treatment  DQ if extensive lesions  Cover lesions with OpSite and tape after washing with Ketoconazole shampoo and applying antifungal cream
  23. 23. Erythrasma  Corynebacterium infection  Uniformly brown and scaly w/o advancing border; coral-red under Wood’s lamp  TX: oral or topical erythromycin  NCAA: see Bacterial Infections
  24. 24. Hidradenitis Suppuritiva  blockage of sweat glands with secondary infection; chronic sinus tracts can form  Erythematous papules, nodules, drainage  TX:  topical +/- oral abx  I&D  Surgical excision
  25. 25. Tinea Versicolor  Pityrosporum ovale, asymptomatic  Hypo- or hyper-pigmented macules; DX: Wood’s lamp, KOH scrape  TX: Selenium sulfide shampoo, -azole creams, terbinafine cream; itraconazole oral  NCAA: see Tinea Infections
  26. 26. Jogger’s Nipples  irritation and friction, long distance runners  painful, fissured, eroded nipples  TX: soft fiber shirts, adhesive bandages, petroleum jelly
  27. 27. Warts, Verruca Vulgaris  HPV; unsightly and painful  “black dots” after shave-down  TX: salicylic acid patch, cryotherapy, occlusion  NCAA: cover prior to competition
  28. 28. Herpetic Whitlow  Tender erythematous vesicles near fingertip  TX: oral antivirals  NCAA – See Herpes Infections, recurrent
  29. 29. Dyshydrotic Eczema  unknown etiology, not infectious  eczematous eruption of pruritic vesicles on fingers  TX: keep hands dry, lotions, topical steroids
  30. 30. Dermatophytid Reaction  distant site fungal infection  vesicular  treat distant site, consider prednisone  NCAA: see tineas
  31. 31. Paronychia  bacterial infection  tender inflammation of nail fold  TX: warm soaks, I&D, +/- oral abx  NCAA: see Bacterial Infections
  32. 32. Bacterial Infections: NCAA participation criteria  No new lesions for 48 hours  >72 hours of antibiotics completed  No moist, exudative or draining lesions  Active bacterial infections shall NOT be covered to allow participation if above criteria not met
  33. 33. Herpes Labialis  “cold sore”  Herpes simplex virus  Vesiclesulcers near lip; painful  TX: topical or oral antivirals, sunscreen to prevent; consider prophylactic valacyclovir  NCAA: see Herpes Infections
  34. 34. Acne Vulgaris  Acne Mechanica, “football acne”  TX: topical Retin-A, benzoyl peroxide, abx; oral abx  Not a contraindication to sports
  35. 35. Herpes Gladiatorum  HSV on area of friction/trauma  TX: oral antivirals  NCAA – see Herpes Infections
  36. 36. Cellulitis  Infection of dermis and sub-cu tissue  Expanding erythema, swelling, tenderness  TX: rest, elevation, oral abx; IV abx if severe or on face  NCAA: see Bacterial Infections
  37. 37. Erysipelas  Usually Gp A Strep  Superficial infection extending into the lymphatics; systemic sxs common  More red, swollen than cellulitis, some streaking  TX: penicillins, Azithro  NCAA: see Bacterial Infections
  38. 38. Impetigo  superficial skin infection with Strep, Staph  yellow crusted lesions on red base  TX: remove crust; topical mupirocin or oral abx  NCAA – see Bacterial Infections
  39. 39. Folliculitis  Mild hair follicle inflammation or infection, usually Staph – Pseudomonas in hot tubs  Papules, pustules around follicles  TX: wash with soap, topical mupirocin, oral abx  NCAA: see Bacterial Infections
  40. 40. Furuncles  More severe hair follicle abscess with Staph  acute, tender, erythematous nodule  TX: warm compresses, abx, I&D  NCAA – see Bacterial Infections
  41. 41. Carbuncle  More extensive abscess than furuncle; Staph  TX: I&D, oral or IV abx  NCAA: see Bacterial Infections
  42. 42. Methicillin-Resistant Staph Aureus “MRSA”  Staph strains resistant to ß-lactam abx (e.g. dicloxacillin, methicillin)  May be resistant to other abx  Cause skin infections usually – Cellulitis, folliculitis, furuncles, abscesses  Cause significant morbidity – 70% of athletes required IV abx  Spread directly person-to-person – Football linemen, rugby, fencing, wrestling – Through injured skin
  43. 43. Methicillin-Resistant Staph Aureus “MRSA”  When to suspect – Skin abscesses – Infections resistant to initial abx  Proper treatment – Culture all abscesses before tx – Susceptibility should guide abx choice  Community-acquired strains usually sensitive to SMX-TMP, fluoroquinolones, clindamycin, e- mycin
  44. 44. Methicillin-Resistant Staph Aureus “MRSA”  Prevention – No participation of infected athletes until cured – Protect exposed skin if high-risk sport – Properly clean/protect injured skin – Proper general hygiene – Report MRSA to PrevMed and CDC
  45. 45. Varicella (chickenpox)  Varicella zoster virus  Lesions in various stages— papules, vesicles, ulcers, crusts on red bases  TX: oral antivirals if early; supportive measures; itch creams  NCAA: no participation until ALL lesions crusted firmly, no secondary bacterial infection
  46. 46. Miliaria Rubra “prickly heat”  sweat duct occlusion  fine erythematous papules  TX: dry clothing, hydrophilic ointments
  47. 47. Contact Dermatitis  direct chemical irritant or allergic delayed rxn  pruritic patches of vesicles on weeping base  TX: calamine lotion, benadryl, topical steroids; Zanfel cream
  48. 48. Atopic Dermatitis  dry easily irritated skin, worsened by heat and sweat  pruritic erythematous macules and patches, flexor surfaces  TX: moisturizers, topical steroids, soap- free cleansing
  49. 49. Sunburn  UV radiation  mild to intense erythema  analgesics, cool compresses, topical steroids or lotions
  50. 50. Photosensitivity Reactions  reaction to sun or Rx  eczema-like rash in sun-exposed areas  TX: – stop offending med – protect skin from sun – topical &/or oral steroids
  51. 51. Striae Distensae  rupture of elastic fibers from rapid growth; steroids?  perpendicular to lines of tension; shoulders, back, thigh  no good treatment proven
  52. 52. Conclusion  Skin diseases in athletes can be sports and regionally specific  Recognize and treat early  Know the rules for participation
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