Dermatologic aspects of sports medicine

The enemy of the feet: blisters in ultraendurance runners

BACKGROUND

Blisters are the most common dermatologic problem in ultraendurance runners. Their incidence, localization, pain scores, and risk factors in field conditions are poorly understood.

METHODS

We conducted an observational field-based cohort study during the 5-day multistage 2010 and 2011 Al Andalus Ultimate Trail (219 km). Daily postrace data on blister frequency, localization, severity, and preventive measures from 50 ultramarathon runners were collected through the direct interview technique.

RESULTS

After 4 days of running (182 km), blisters occurred in 76% of the participants (P < .001 versus stage 1) compared with 34% after day 1, 54% after day 2, and 72% after day 3 (P < .001 versus stage 1). Most of the blisters formed on the toes (65%) (P < .001), followed by blisters on other locations of the foot: the ball of the foot (16%), heel (14%), and sole (5%). Blisters were more painful toward the end of the race, and those on the sole and heel tended to be the most painful, although this did not reach statistical significance. Prophylactic measures studied (type and fabric of socks; application of antiperspirants, talcum powder, or lubricant to feet; and prophylactic taping) did not show any reduction in blister rates. The only predictive marker for reduced blister incidence was previous ultramarathon experience in men (r = -0.44, P < .05).

CONCLUSIONS

Blisters are extremely common in multistage ultramarathon races. Race experience in male ultramarathon runners is associated with reduced blister rates.

Characteristics of Sports-Related Dermatoses for Different Types of Sports: A Cross-Sectional Study

Skin lesions are common in athletes. Athletic activities may lead to new skin lesions or aggravate existing ones. We aimed to determine the effects of sport type and participation length on the occurrence of sports-related dermatoses and to identify the localization characteristics of these lesions. A total of 121 licensed athletes (42 swimmers, 23 handball players, 33 soccer players and 23 wrestlers) and 121 sedentary controls were included in the study. A consultant dermatologist examined all subjects. Lesion types, duration, and localization characteristics were noted. The lesions were categorized as viral, bacterial, traumatic, and non-traumatic. Traumatic lesions were frequently seen in soccer players and wrestlers; fungal infections were more commonly seen in swimmers and in soccer players. Lesion types and localizations varied by sport type. There were no significant relationships between sport type and the incidence of viral and bacterial lesions. The results suggest that athletic activity seems to be a predisposing factor, especially for fungal infections and acute or chronic traumatic lesions. Thus, regular dermatological screening of athletes is critical for rapid identification and treatment of dermatoses disrupting sport performance.

Contact dermatitis in athletes

Athletes face numerous hazards in their daily activities. An athlete's skin, in particular, endures repeated exposure to trauma, heat, moisture, and numerous allergens and chemicals. These factors combine with other unique and less well-defined genetically predisposing factors in the athlete's skin to cause both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). As with other cases of contact dermatitis, these eruptions in athletes present as a spectrum of acute to subacute to chronic dermatitis. Recognizing the unique environmental irritants and allergens encountered by athletes is paramount to facilitate appropriate therapy and prevention. This review comprehensively examines the literature on contact dermatitis in athletes. The different types of contact dermatitis have been classified under sport-specific subheadings. Furthermore, within each subheading, both ACD and ICD types are discussed.

Skin manifestations of running

As the United States comes increasingly closer to being the heaviest nation on earth, many people are turning to exercise, especially running, to lose weight. Most runners, whether novice or professional, will have a skin disorder that may prompt them to seek medical attention. Although case reports and sports reviews have discussed, in a cursory fashion, the nature of these skin lesions, to our knowledge there has never been an extensive review of the literature that specifically addresses the skin diseases of runners. In this article, we present the epidemiology, origin, clinical characteristics, treatment, and prevention of skin diseases inherent to runners.

The wear and tear of 26.2: dermatological injuries reported on marathon day

Whether it is to take on the challenge, to get in shape and lose weight, to relieve stress, or to enjoy the outdoors, people have increasingly turned to the marathon as their sporting event of choice. Although there are many health benefits, beginners should be aware that injuries are quite common in marathon runners. Among these are the wear and tear injuries to the skin. This is a review of the most commonly reported dermatological injuries on marathon day.

[Folliculitis barbae in herpes simplex infection]

A 60-year-old male athlete developed a folliculitis in the beard region after several competitions. After identification of herpes simplex antigen within the lesions, systemic therapy with acyclovir led to rapid improvement. In folliculitis resistant to antibiotic and anti-inflammatory therapy, viral and mycotic infections as well as eosinophilic folliculitis should be considered as differential diagnostic possibilities.

Common bacterial dermatoses: protecting competitive athletes

Athletes competing in a wide variety of sports are at risk of contracting and spreading bacterial skin infections. Bacteria proliferate in environments of wet, macerated skin that is repeatedly abraded against competing athletes, equipment, clothing, or objects in the field of play. Common infections include impetigo, folliculitis, furunculosis, pitted keratolysis, and otitis externa. Diagnosis and treatment are often straightforward and vary little from care for nonathletes. However, knowledge of preventive strategies and return-to-play criteria, as outlined by the National Collegiate Athletic Association, are paramount for clinicians who care for competitive athletes.

Cutaneous manifestations of disease in athletes

Various means of skin injury in athletes are examined, supplementing those discussed in Cutaneous Manifestations of Disease Part 1 (November/ December). Skin injury due to mechanical means such as corns, calluses, talon noir (calcaneal petechiae), tennis toe, joggers nipples, and piezogenic pedal papules will be discussed followed by a thorough discussion of environmental means of skin injury. There are a variety of ways that the environment may affect athletes both during competition and years after the competition is finished. The discussion will conclude with a look at performance-enhancing drugs and their effect on an athletes skin, and how the practitioner can better appreciate and perhaps prevent the long-term sequelae of drug abuse.

Dermatologic disorders of the athlete

The most common injuries afflicting the athlete affect the skin. The list of sports-related dermatoses is vast and includes infections, inflammatory conditions, traumatic entities, environmental encounters, and neoplasms. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete. Infections probably cause the most disruption to individual and team activities. Herpes gladiatorum, tinea corporis gladiatorum, impetigo, and furunculosis are sometimes found in epidemic proportions in athletes. Vigilant surveillance and early treatment help teams avoid these epidemics. Fortunately, several recent studies suggest that pharmacotherapeutic prevention may be effective for some of these sports-related infections. Inflammatory cutaneous conditions may be banal or potentially life threatening as in the case of exercise-induced anaphylaxis. Athletes who develop exercise-induced anaphylaxis may prevent outbreaks by avoiding food before exercise and extreme temperatures while they exercise. Almost all sports enthusiasts are at risk of developing traumatic entities such as nail dystrophies, calluses and blisters. Other more unusual traumatic skin conditions, such as talon noire, jogger's nipples and mogul's palm, occur in specific sports. Several techniques and special clothing exist to help prevent traumatic skin conditions in athletes. Almost all athletes, to some degree, interact with the environment. Winter sport athletes may develop frostbite and swimmers in both fresh and saltwater may develop swimmer's itch or seabather's eruption, respectively. Swimmers with fair skin and light hair may also present with unusual green hair that results from the deposition of copper within the hair. Finally, athletes are at risk of developing both benign and malignant neoplasms. Hockey players, surfers, boxers and football players can develop athlete's nodules. Outdoor sports enthusiasts are at greater risk of developing melanoma and non-melanoma skin cancer. Athletes spend a great deal of time outdoors, typically during peak hours of ultraviolet exposure. The frequent use of sunscreens and protective clothing will decrease the athlete's sun exposure. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete.

Contact dermatitis in students practicing sports: incidence of rubber sensitisation

BACKGROUND

Over the last few years, changes in cutaneous homoeostasis resulting from sports activities have been reported. In particular, alterations in sweating mechanisms, the hydrolipid barrier, and surface bacterial flora, together with exposure to atmospheric conditions and the need to use medicaments, detergents, and other topical substances, predispose subjects to allergic contact dermatitis.

OBJECTIVE

To evaluate the incidence of allergic contact dermatitis in a group of young people practising sports activities.

METHODS

Patch tests were performed to confirm the diagnosis of irritant or allergic dermatitis; in addition, the radioallergoabsorbent test (RAST) to latex was evaluated in the group studied.

RESULTS

Allergic contact dermatitis caused by thiourams (23.3%) and mercaptobenzothiazole (20.9%) was prevalent. Other haptens, such as benzocaine and nickel, which are contained in clothing, equipment, topical medicaments, and creams used for massage, were also allergenic. In two cases, RAST positivity to latex was registered.

CONCLUSIONS

-The results suggest that close contact with sports equipment may increase the incidence of allergic contact dermatitis. Students practising certain sports may have "professional" allergic contact dermatitis to additives used in the production of rubber.

Cutaneous manifestations of sports participation

As interest and participation in sports and recreational activities continue to increase, so do problems of the skin associated with sports participation. Primary care physicians and dermatologists may find the diagnosis of these sometimes unusual skin lesions difficult without knowledge of their association with sporting activities. Likewise, treatment of these skin lesions may be unsatisfactory without an understanding of the unique factors that contributed to the problem. This article reviews the cutaneous manifestations of sports participation. Traumatic and environmental skin injuries, skin infections, and exacerbation of preexisting dermatoses, as well as descriptions, predisposing conditions or causative agents, diagnosis, treatment, and prevention are discussed.

Stopping Skin Assailants: Fungi, Yeasts, and Viruses

In brief Activity can cause or exacerbate certain skin conditions. Sweaty skin is a warm, moist environment for fungi and yeasts, and sports participation may transmit or worsen a viral condition such as herpes simplex. Specialized medication regimens and topical treatments can sometimes prevent a flare-up or minimize activity interruptions.

Exercise-Related Skin Infection

In Brief Bacterial skin infections can be unpleasant side effects of exercise; among them are impetigo, folliculitis, cellulitis, and pitted keratolysis. Instituting the right combination of topical treatments and, when needed, systemic therapy can make a patient's skin safe for activity.

Foot ulceration: hypotheses concerning shear and vertical forces acting on adjacent regions of skin

During gait the plantar surface of the foot experiences distributed shear and compressive stresses due to tangential and vertical forces respectively. At any given point under a foot, the ratio of tangential/vertical forces gives a value (mu Rmin) for the minimum coefficient of friction required to prevent slipping. If mu Rmin is greater than the actual coefficient of friction (mu A), then localized slipping will occur. Three possible scenarios exist which could lead to skin ulceration: at a localized area the skin may tend to slip (i) towards, (ii) away from or (iii) parallel to a neighboring skin region where mu Rmin < or = mu A (i.e. a region that doesn't slip). The first of these possibilities is similar in concept to the loading conditions that lead to a carpet becoming 'wrinkled', i.e. one region of the carpet slips towards another that is stationary. The second and third possibilities would tend to cause tearing in the carpet or shearing of its fabric respectively. In terms of skin breakdown the relative importance of each of these biomechanical hypotheses needs to be determined.

From Acne to Black Heel: Common Skin Injuries in Sports

In brief Sports activity exposes the skin brief to various stresses, including friction and pressure from clothing and equipment; prolonged wetness from perspiration; and sunlight, cold, and heat. A variety of injuries can result. Briefly described here are the diagnosis, treatment, and prevention of some of the most common ones: sunburn and sun-induced aging, frostnip and frostbite, acne mechanica, calluses and corns, friction blisters, jogger's nipples, and black heel.

Skin injuries in sports medicine

From the origin of civilization the pursuit of beauty has exemplified the highest order of the human being's quest for achievement, and from the beginning, this pursuit has focused, in part, on perfecting the human form. Freed from much of the time-consuming burden of attending to elemental needs, the present generation seems committed as never before to the reshaping of its own physical proportions. Paradoxically, the skin, positioned at the interface between the organism and its environment, embodies the visible envelope that surrounds pleasingly restructured muscle groups; at the same time it exhibits unsightly lesions produced as a consequence of the fitness program.

Trauma, sports, and the skin

Dermatological disorders in athletes may occur as a result of repeated mechanical trauma, physical and chemical agents, climatic conditions, infections, infestations, and exacerbations of pre-existing skin disorders. These include black heel, tennis toe and other causes of subungual hemorrhage, friction blisters, abrasions, jogger's nipples, alopecia, calluses, and subcutaneous nodules. Contact dermatitis may occur from sports equipment, medications used to treat abrasions, and plants such as poison ivy and weeds. Herpes simplex and bacterial pyoderma may occur in wrestlers and rugby players, especially at sites of abrasion.