What Certified Athletic Trainers and Therapists Need to Know Thomas M
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PHYSICIAN PERSPECTIVE Tracy Ray, MD, Column Editor Sports Dermatology: What Certified Athletic Trainers and Therapists Need to Know Thomas M. Dougherty, MD • American Sports Medicine Institute, Birmingham AL OST SPECIAL SKIN problems of athletes are ting shoes for all athletes and gloves for weight lifters M easily observable and can be recognized and racket-sport players can help. and treated early. Proper care can prevent Occlusive folliculitis, also known as acne mechanica disruption of the training or competition schedule. or “football acne,” is a flare of sometimes preexisting Various athletic settings expose the skin to a multi- acne caused by heat, occlusion, and pressure distrib- tude of infectious organisms while increasing its vul- uted in areas under bulky playing equipment (e.g., nerability to infection. A working knowledge of skin shoulders, forehead, chin in football players; legs, arms, disorders in athletes is essential for athletic trainers, trunk in wrestlers). Inflammatory papules and pustules who are often the first to evaluate athletes for medi- are present. A clean absorbent T-shirt should be worn cal problems. under equipment, and the affected areas should be cleansed after a workout. Direct Cutaneous Injury Follicular keloidalis is seen mostly in African-Ameri- can athletes and is a progression of occlusive folliculi- Calluses are the skin’s compensatory, protective re- tis with nontender, firm, fibrous papules around the sponse to friction, most commonly seen on the feet edges of the football helmet, especially at the posterior but also on the hands of golfers and in oar and racket neck and occipital scalp. Surgical treatment, if indicated, sports. Calluses lack the central core seen with corns. should be delayed until after the season is over. Pad Reducing the mass or bulk of calluses is usually only the equipment to reduce friction at involved points. necessary when attempting to prevent blisters, which Subungual hemorrhage, usually called “tennis often occur under calluses. At locations of shearing toe,” “skier’s toe,” or “jogger’s toe,” is caused by re- forces, especially on the feet, repeated friction leads peated jamming of the anterior nail plate against an- to a tender vesicle or bulla, which might be filled with terior parts of the shoe. Acutely, this can be painful, clear fluid or with blood. Ideal treatment is to leave but symptoms are usually minimal. Prevention re- the “roof” on the blister. If the roof has been removed, quires properly fitted shoes that allow some forward covering the blister with a friction-interface surface foot slippage without jamming of the toes. such as hydrocolloid gel or cotton padding will protect the skin. Chafing is usually caused by mechanical Bacterial Infections friction of fabric against skin. Lubricating ointments, friction-reducing powders, and lower friction fabrics Impetigo, or pyoderma (Figure 1), can reach epidemic are helpful. Black heel, often referred to as “talon noir,” proportions among wrestling teams or at large wres- is an asymptomatic blue-black punctate petechiae on tling meets. It is a hazard in all contact sports and the posterolateral aspect of the heel caused by shear- spreads by contact with an infected opponent. It is ing forces (e.g., planting, cutting, sudden stopping) caused by Staphylococcus or Streptococcus species of and is especially common in basketball and volley- bacteria. Impetigo usually presents with an erosion ball players. Prevention is unlikely, but properly fit- (sore), cluster of erosions, or small vesicles or pus- © 2003 Human Kinetics • ATT 8(3), pp. 46-48 46 ❚ MAY 2003 ATHLETIC THERAPY TODAY Figure 1 Impetigo. Figure 2 Plantar warts. tules that have an adherent or oozing honey-yellow crust. Cleanse with soap and apply a wet compress. Systemic antibiotics or topical mupirocin are the ap- propriate treatment, and the athlete must be prohib- ited from competition until the lesions are clear of crusting. Careful and regular sterilization of wrestling mats with bactericidal disinfectant is paramount. Pitted keratolysis, usually described as strongly mal- odorous, occurs on the bottom of the feet as a margin- ated area of macerated skin with distinct pits. Caused by Corynebacterium bacteria, treatment is with over- Figure 3 Molluscum contagiosum. the-counter 10% benzoyl-peroxide gels and topical pre- scription clindamycin or erythromycin. Applying aluminum chloride hexahydrate 20% (Drysol®) to the feet can help prevent it by decreasing perspiration. Viral Infections Plantar warts (Figure 2) are caused by the papilloma virus and are relatively common among athletes. If the wart is located over weight-bearing portions of the foot it might be symptomatic. Small black dots are usually seen at the center, especially after paring. Aggressive destructive therapies carry a significant risk Figure 4 Herpes gladiatorum. of permanent scarring and disability. Keeping feet dry and wearing flip-flops in the locker room are helpful preventive measures. There are no restrictions for Herpes gladiatorum (Figure 4) is often seen in participation, although coverage is recommended. wrestlers. Burning and tenderness often present be- Molluscum contagiosum (Figure 3) is commonly fore regular, often monthly, recurrences of vesicles seen in wrestlers and often seen in swimmers. Small, appear. The first outbreak is usually seen 1 week af- grouped waxy papules are characteristic. Individual ter exposure. Grouped vesicles on an erythematous papules often show a central dimple, or “umbilication.” base, with dermal edema usually present, are typi- Athletes with molluscum are prohibited from competi- cally seen on the head, neck, or upper extremities. It tion unless the lesions are adequately covered with is also seen in other contact sports such as rugby, dressing. where it is known as scrum pox (herpes rugbeiorum). ATHLETIC THERAPY TODAY MAY 2003 ❚ 47.