Transcript Contact Dermatitis

Chapter 17
Skin Conditions in Sports
Anatomy of the Skin
Anatomy of the Skin (cont.)
The skin is the largest organ of the body.
• Two major layers- dermis and epidermis.
• Skin thickness varies regionally; thickest skin is
on the soles of the feet and palms of the hands.
Anatomy of the Skin (cont.)
Skin’s functions:
• Protection from environment.
• Maintenance of body’s fluid balance.
• Protection against disease organisms.
• Temperature regulation.
• Housing for sensory nerves.
• Production of vitamin D.
Anatomy of the Skin (cont.)
Skin Damage
• Wounds
• Exposure to UV light
• Temperature extremes – hot or cold
• Pathogenic organisms – bacteria,
viruses, fungi, parasite
• Allergies
Other Skin Conditions
Ultraviolet Light–Related Skin Problems
• Summer/fall sports often expose large
areas of skin to harmful rays.
• Summer sportswear typically does NOT
cover arms and legs.
• Even a minor sunburn can be harmful.
Ultraviolet Light–Related Skin Problems
(cont.)
• UVA and UVB are both harmful, UVB
seems more related to the development of
skin problems.
• Individuals with lighter skin, red hair, and
freckles are at higher risk for skin damage.
• Exposure to sun at any time can result in
sunburn, but most dangerous times are
between 10:00 A.M. and 2:00 P.M.
Ultraviolet Light–Related Skin Problems
(cont.)
Sunburn has two clinical phases.
• Immediate erythema phase involves
reddening of the skin.
• Delayed erythema phase develops within a
few hours of exposure, peaking at 24
hours.
• Most cases involve mild discomfort.
• Severe forms include blister formation,
chills, and gastrointestinal distress.
Prevention and Care of Sunburn
The primary concern is to protect exposed skin
when outdoors.
• Apply sunscreen
–Ears, nose, lips, back of the neck,
forehead, forearms, and hands.
• Sunscreen products should have a sun
protection factor (SPF) rating of at least 15.
Prevention and Care of Sunburn (cont.)
• Sunscreen products contain chemicals which
absorb or reflect UVA or UVB.
• For best results, apply sunscreen in advance of
exposure and reapply every 60 minutes.
• Treatment of sunburn is symptomatic; apply
topical anesthetic as well as skin lotion to relieve
burning and dryness.
– In severe cases, medical referral is warranted.
Skin Infections
• Various organisms cause skin infections – including
fungi, bacteria, viruses, & parasites.
• May be symptoms of more serious infections or
allergic conditions – including Lyme disease,
herpes, or contact dermatitis.
Tinea
Tinea (ringworm) fungal infection that often
affects the groin (tinea cruris), feet (tinea
pedis), and scalp (tinea capitus).
• S/S- small brownish-red elevated lesions that
tend to be circular in shape.
• Itching and pain is with tinea pedis and tinea
cruris.
• Tinea pedis often includes cracking between
toes, oozing and crusting lesions, and scaly
skin.
Tinea Treatment
• Keep the affected area clean and dry.
• Apply over-the-counter topical treatment.
• Apply a moisture-absorbing powder to
the area.
• Wear clothing made of natural fibers
such as cotton.
Tinea Versicolor
Tinea versicolor (TV) is a fungal infection that
occurs most often during warm weather, and the
infection typically involves teenagers and young
adults.
• Signs and symptoms include circular lesions
that appear lighter or darker than adjacent
skin.
• TV lesions usually appear on upper trunk,
neck, and abdomen.
• Treatment involves prescription drugs with
weeks or months required for cure.
Bacterial Skin Infections
Bacterial infections common in sports with close
physical contact.
• Collectively called pyoderma (pus producinginfections/lesions of the skin).
• Athletes should be removed from
participation and referred to a physician
• Pyoderma are caused by Staphylococcus
aureus and Streptococcus infections, which are
common in sports with close physical contact.
CA-MRSA
• Community acquired methicillin-resistant
staphylococcus aureus
• Aka Staph.
• Small pimple like lesion
• Often mistaken for insect bite
• Usually occurs at the site of a previous wound
• Resistant to some antibiotics
CA-MRSA
• Treatment
– Antibiotics
– Often require hospitalization for IV
antibiotics
– Repeated occurrences warrant nasal swab
test to I.D. potential carriers
• Return to play
– No published guidelines
– Physicians call
CA-MRSA
CA-MRSA
• Prevention
– Wash hands thoroughly before and after
treating a wound
– Shower immediately after activity
– Athletes with open wounds should not be
in whirlpools or hot tubs
– Do not share towels, razors, athletic
clothing, or equipment
CA-MRSA
• Athletic clothes and towels should be properly
washed after each use
• Facilities and equipment kept clean
• Refer all athletes with active skin lesions that
do not respond to initial therapy
• Follow proper first aid procedures
• Suspicious lesions should be referred for
testing
• All skin lesions covered before sports
participation
Furuncles
• Boils
• Infected hair follicle
– Similar to folliculitis but infection is deeper
• Tender, red nodules
Carbuncles
• Clusters of boils
Furuncles and Carbuncles
• Treatment
– Warm moist compresses 3 per day, 10 min
each
– DO NOT POP
– Clean and dress opened pus pockets
– If it never comes to a head, physician may
need to open it
Furuncles and Carbuncles
• Return to play
– Not contagious
– Playing with them can cause further tissue
damage
– Can return after 5 days of antibiotics if no
new lesions occur within 48 hours
Folliculitis
• Staphylococcus aureus infection in hair
follicles
• May occur after shaving or hot tub exposure
• Papules and pustules around hair follicles
• Tx– OTC acne meds
– Topical or systemic antibiotics
Folliculitis
• Athletes may play with active folliculitis
Impetigo
• Caused by staphylococcus aureus bacteria
• Honey colored, crusted lesions
• Commonly on the face and other exposed
areas
• Common in wrestlers, swimmers, and
gymnasts
Impetigo
• Tx.
– Hydrogen peroxide
– 7-10 days of antibiotics
• topical or systemic
• Return to play
– Lesions are dried
– After 5 days of antibiotics
– No new lesions within 48 hours
Impetigo
Viral Skin Infections
• Common viral infections among athletes are
plantar warts, herpes, and molluscum
contagiosum.
• The spread of viral skin infections requires
direct skin contact
Warts
• Warts are common. Caused by human
papillomavirus (HPV)
• Infection is contagious.
• S/S- abnormal buildup of epidermis around
the region of infection
Warts
• Tx
– Donut pad to dissipate weight bearing
forces
– Can be pared down
– OTC wart removal meds (salicylic acid)
– Cryotherapy
– Excision
Warts
Plantar Warts
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Caused by HPV-1 and HPV-4
Found of the soles of the feet
Can occur within a callus
Grow into the foot rather than on the surface
Appear to have little seeds within the core of
the wart
• Tx- Direct application of chemicals and
removal by surgery.
Plantar Warts
Herpes Simplex Virus (HSV)
• Two types of HSV
– HSV-1
• Herpes labialis
• Herpes gladiatorum
– HSV-2
• Genital herpes
• HSV can go dormant and return later
Herpes Labialis
• Caused by HSV-1
• S/S
– single vesicle or cluster of vesicles
– Burning
– Tingling
Herpes Labialis
• Tx
– OTC ointments
– Oral antivirals
• Prevention
– Antivirals can be used to prevent return of
lesions during season
Herpes Labialis
• Return to play
– Athletes with direct skin-to-skin contact are
not allowed to participate with active
lesions
– Lesions must be crusted
– No new lesions within 3 days
– At least 5 days of antivirals
Herpes Labialis
Herpes Gladiatorum
• Herpes gladiatorum is caused by HSV-1.
• Lesions occur in area of existing open wounds
• Virus may remain dormant for months or years.
Herpes Gladiatorum
• S/S– Blister-like lesion.
– Open draining lesions, then crusted and begin to
heal.
– General fatigue, body aches, and inflammation of
lymph glands.
– Occurs most frequently on head, face, and
extremities
– Medical emergency if it spreads to eyes
Herpes Gladiatorum
• TX–Oral antivirals
• RTP
–Same as Herpes Labialis
Herpes Gladiatorum
Molluscum Contagiosum
• Caused by molluscum contagiosum virus
• S/S
– Dome shaped papules with a center dimple
– Can be individual papules or groups of
papules
Moluscum Contagiosum
• Tx
– Removal of lesions
• Laser
• Cryotherapy
• Salicylic acid
• Return to play
– Athletes can return once lesions have been
removed
– Wound area must be covered with gaspermeable dressing
Allergic Reactions
Allergies:
• Can result from exposure to a
wide variety of chemical agents.
• “Contact dermatitis” can result
from contact with plants,
particularly poison ivy, poison
sumac, and poison oak.
Contact Dermatitis
• Contact with poison ivy, poison oak, and
poison sumac results in allergic reactions in
90% of adults.
• Offending chemicals are in the sap.
• Average time from exposure to reaction is
24 to 48 hours.
• Healing requires 1 to 2 weeks.
Contact Dermatitis
• S/S– itching and redness of skin
– Blisters that often break open and become
crusted.
– Wet, weeping skin
Contact Dermatitis
• Susceptible athletes should learn to recognize
poison ivy, poison oak, and poison sumac.
• Avoid areas where these plants grow.
• Outdoor events, such as cross-country
running, should be staged away from high-risk
areas.
Contact Dermatitis
• Tx– Identify the irritant or allergen and eliminate
exposure
– Topical coritcosteroid ointments
– OTC antihistamines
Contact Dermatitis
Allergic Reactions
Allergies related to chemicals in clothing and sports
equipment have recently received attention.
• Allergies to rubber, latex, topical analgesics,
resins, and epoxy are common.
• Some people are allergic to synthetic rubber
that is in sports shoes, swim caps, goggles,
and earplugs.
An athlete suspected of having an allergic
dermatitis should be referred to a
dermatologist.