1 / 55

Sports Dermatology

Sports Dermatology. Military Sports Medicine Fellowship. Kevin deWeber, MD, FAAFP Director Primary Care Sports Medicine Fellowship. “Every Warrior an Athlete”. Objectives. Review common dermatologic problems and how they affect athletes Discuss skin disorders specific to athletes

aleron
Download Presentation

Sports Dermatology

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Sports Dermatology Military Sports Medicine Fellowship Kevin deWeber, MD, FAAFP Director Primary Care 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. Definitions Feet Groin Buttocks Hands Face General Chest and Back Introduction

  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 SchoolsCommunicable 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

More Related