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Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
Sports Dermatology
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Sports Dermatology

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  • 1. Sports Dermatology Kevin deWeber, MD, FAAFP Director Primary Care Sports Medicine Fellowship Military Sports Medicine Fellowship “Every Warrior an Athlete”
  • 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. Introduction  Definitions  Feet  Groin  Buttocks  Hands  Face  General  Chest and Back
  • 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. 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. 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. Impact of skin infections in NCAA wrestlers  15% of practice time-loss injuries
  • 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. Corns  Hyperkeratotic pressure area  hard conical papule with translucent center  TX: modify foot wear to change pressure, soften lesion, remove
  • 10. Plantar Warts  HPV  thickened plantar papules, shave reveals “black dots”  TX: keratolytic solutions, podophyllin, cryotherapy
  • 11. “Black Heel”  Traumatic micro- hemorrhages  small asymptomatic black macules  no treatment needed
  • 12. Blisters  excessive friction  vesicles and bullae  TX: prevention, drainage (leave the roof), hydrocolloid dressing (duoderm)
  • 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. 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. 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. 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. Scabies  mite Sarcopetes scabiei  exquisitely pruritic papules, excoriations; DX: scraping  TX: topical permethrin or crotamiton overnight  NCAA - verification of treatment and negative scrapings
  • 18. Genital Warts  Condyloma acuminata  HPV, smooth or verrucous papules  genital and perianal regions, cluster  TX: cryotherapy; topical podophyllox, imiquimod 5% cream
  • 19. Genital Herpes  Small, grouped vesiclespainful ulcers;  DX: Tzanck prep  TX: acyclovir, valacyclovir  NCAA: see Herpes Infections
  • 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. Tinea Cruris  AKA “jock itch”  Dermatophyte infection  Erythematous w/ advancing border, pruritic; DX: KOH prep  TX: topical antifungals  NCAA: see Tinea Infections
  • 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. 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. 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. 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. Jogger’s Nipples  irritation and friction, long distance runners  painful, fissured, eroded nipples  TX: soft fiber shirts, adhesive bandages, petroleum jelly
  • 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. Herpetic Whitlow  Tender erythematous vesicles near fingertip  TX: oral antivirals  NCAA – See Herpes Infections, recurrent
  • 29. Dyshydrotic Eczema  unknown etiology, not infectious  eczematous eruption of pruritic vesicles on fingers  TX: keep hands dry, lotions, topical steroids
  • 30. Dermatophytid Reaction  distant site fungal infection  vesicular  treat distant site, consider prednisone  NCAA: see tineas
  • 31. Paronychia  bacterial infection  tender inflammation of nail fold  TX: warm soaks, I&D, +/- oral abx  NCAA: see Bacterial Infections
  • 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. 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. Acne Vulgaris  Acne Mechanica, “football acne”  TX: topical Retin-A, benzoyl peroxide, abx; oral abx  Not a contraindication to sports
  • 35. Herpes Gladiatorum  HSV on area of friction/trauma  TX: oral antivirals  NCAA – see Herpes Infections
  • 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. 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. 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. 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. Furuncles  More severe hair follicle abscess with Staph  acute, tender, erythematous nodule  TX: warm compresses, abx, I&D  NCAA – see Bacterial Infections
  • 41. Carbuncle  More extensive abscess than furuncle; Staph  TX: I&D, oral or IV abx  NCAA: see Bacterial Infections
  • 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. 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. 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. 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. Miliaria Rubra “prickly heat”  sweat duct occlusion  fine erythematous papules  TX: dry clothing, hydrophilic ointments
  • 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. 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. Sunburn  UV radiation  mild to intense erythema  analgesics, cool compresses, topical steroids or lotions
  • 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. Striae Distensae  rupture of elastic fibers from rapid growth; steroids?  perpendicular to lines of tension; shoulders, back, thigh  no good treatment proven
  • 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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