Common Dermatological Conditions in Sports: a Review of Environmental, Traumatic, and Infectious Causes MARK J

Common Dermatological Conditions in Sports: A Review of Environmental, Traumatic, and Infectious Causes MARK J. LESKI, MD • University of South Carolina

KeyKey Points Athletic participa- Environmental Lesions tion can be rewarding Sun-Related Disorders Most dermatological conditions in both mentally and sports can be prevented with good physically, and it There are several skin disorders related to sun hygiene and properly fitted should be an enjoyable exposure. The most common are sunburn and equipment and clothing. activity. Oftentimes, drug-induced photosensitivity. Both can be however, there are set- very painful and prevent athletic participation Dermatological conditions with backs in participation because of pain or interference with heat- contraindications for participation in as a result of injuries dissipating mechanisms resulting from fever. contact sports include active herpes and illnesses. Some of Sunburn can also be disfiguring. It is usually infection and molluscum these conditions caused by exposure to UVB rays during their contagiosum. present themselves in greatest intensity from 10 a.m. to 3 p.m. Burns the form of dermato- can range from first-degree erythema to third- Athletes training in the sun should logical disorders. Der- degree with blisters and ulcerations. Systemic wear a good sports sunscreen matological problems symptoms might include fever, chills, nausea, containing both UVA and UVB in sports result from and prostration. The best prevention is by lib- protection. several causes includ- eral application of a waterproof sunscreen of ing environmental, SPF 15 or greater that screens both UVA and Blisters should be left intact when traumatic, and infec- UVB, avoiding sun exposure during peak hours, possible because the roof provides a protective barrier to the environment tious factors. In this and taking 300 mg aspirin 1–2 hr before ex- and bacteria. article, some of the posure (Batts, 1995). If burns do occur, treat more common derma- with cool compresses and topical anesthetic/ Any athlete with a dermatological tological entities in steroid sprays and lotions. Nonsteroidal anti- condition that appears infectious sports and their treat- inflammatory drugs can be helpful if used im- should be referred to a physician. ments are discussed. mediately after sun exposure. Athletes with When specific invasive third-degree sunburns should be referred to a Key Words: dermatology, skin, procedures or pre- physician for evaluation and treatment with sunburn, dermatitis, herpes, warts, scription medications an antibacterial cream, such as Silvadene, and impetigo, athlete’s foot, frostbite, are indicated, the pa- bandaged. acne tient should be re- Drug-induced photosensitivity is a skin re- ferred to a physician. action to the sun resulting from prescription

© 2002 Human Kinetics • ATT 7(3), pp. 8-15 8 ❚ MAY 2002 ATHLETIC THERAPY TODAY medications such as tetracycline, sulfonylureas, and or near-freezing temperatures with significant wind- thiazides (Fitzpatrick, Johnson, Wolff, & Suurmond, chill. The most common areas affected are the face 1997). They might present as severe sunburn with and ears. It presents as painful, erythematous areas variable pruritus, or they might be urticarial (whelps) of exposed skin that might be numb and eventually or maculopapular (flat plaques with bumps). Most re- form blisters. An athlete with frostnip should return actions are caused by UVA exposure. Therefore, ap- to a warm environment and quickly rewarm the af- plying a sunscreen that provides UVA protection is fected area (Batts, 1995). Shaving and bathing should necessary to prevent these reactions while one is tak- be delayed until the end of the day’s outdoor activi- ing sensitizing medications. Treatment consists of ties. Application of sunscreen can be helpful in pre- using topical or oral corticosteroids, eliminating the vention. offending agent, and avoiding sun exposure (Fitz- patrick et al.). Frostbite Frostbite is actual freezing of the epidermis, dermis, Cholinergic Urticaria and subcutaneous tissues (Figure 2). On freezing, the Cholinergic urticaria is an acetylcholine-mediated re- extracellular ice crystals denature cell proteins and en- sponse induced by heat, emotion, and exertion. It zymes. Affected areas have a waxy appearance, and presents with 1- to 2-mm urticarial wheals surrounded blisters develop 24–36 hr after skin damage. Treatment by a red flare (Figure 1). Symptoms can include sweat- consists of rewarming in a 38 ° C bath and transfer to a ing, abdominal cramps, bradycardia, dizziness, and facility experienced in frostbite management (Batts, wheezing. There is no cure, and therefore, athletes 1995). Analgesics are helpful for pain control. One with this condition often give up training for indefi- should never rub ice or snow on affected areas, and nite periods. Antihistamines and H2 blockers might thawing should be avoided if refreezing is likely. relieve symptoms. Cold Urticaria Exercise-Induced Urticaria Cold urticaria is the most common acquired urticaria This entity can be a variant of cholinergic urticaria. It in athletes. It results from nonallergic release of his- presents with giant whelps and angioedema. Other tamine from mast cells in response to cold exposure symptoms might include wheezing and hypotension. and presents as localized or generalized urticarial The treatment of choice is subcutaneous administra- wheals. The cold exposure might be environmental tion of epinephrine. Inhaled cromolyn sodium, 20 mg, or result from local treatments involving ice therapy. three to four times a day can be beneficial in prevent- Cyproheptadine and small doses of oral corticoste- ing recurrence. Antihistamines and H2 blockers can roids have been found helpful in the treatment of this also be helpful in prevention (Landry, 1999). problem.

Miliaria (Prickly Heat) Raynaud’s Phenomenon Miliaria is caused by retained sweat that is extrava- Raynaud’s phenomenon can be either an idiopathic sated into different levels in the skin and usually de- cold hypersensitivity or secondary to a systemic velops during activity in hot, humid environments. It connective-tissue disease such as lupus. It presents presents as a red bumpy rash that might be painful as vascular spasm with pallor and cyanosis that can or itchy. There is no treatment, but avoiding occlu- be painful. Gangrene of the affected digits can result sive topical ointment and close-fitting, poorly absor- in severe cases. Treatment is primarily with calcium- bent fabrics can aid in prevention. channel blockers. Proper protection of the hands and feet with battery-heated gloves and boots is para- Frostnip mount in prevention. Smoking is absolutely prohib- Frostnip is the most common superficial cold-induced ited because of the associated vasoconstriction and injury. It is caused by prolonged exposure to below- relative hypoxia (Fitzpatrick et al., 1997).

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