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Common Skin Conditions

Affecting Athletes

Dr. Ashley D. Zapf, M.D., CAQSM

Case 1

• An athlete comes to you for an evaluation stating that his arm has been hurting him over the past few days and today he noticed redness near his elbow.

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Cellulitis

• Skin redness without a discrete border

• Localized pain and tenderness

• May develop a fever

• May develop swelling

• May develop abscesses and blisters

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Cellulitis

• Caused by an infection of the skin, usually from Staph aureus (possibly MRSA) or group A Strep

• In football players, the elbow has been found to be the most common site

infected with MRSA

• Infection can develop in normal skin or at a minor wound site (iefrom a bug bite or cut)

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Treatment

• Outline the area of redness on the skin• Rest and elevate the affected limb• Treat with oral antibiotics (If no improvement, may need a different

antibiotic or IV antibiotics)

• Return to play:• After at least 72 hours of antibiotics

• No new lesions for 48 hours

• No moist, exudative, or draining lesions

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Prevention

• Hand washing• Good hygiene • Avoid whirlpools• Avoid sharing equipment• Maintain clean equipment and facilities• Immediate evaluation of any skin condition

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Case 2

• An athlete comes to you for an evaluation stating that he noticed diffuse red spots on his chest and back last week. He spent the weekend in the sun and thought maybe that would help clear up his rash. The rest of his skin tanned, but the spots persisted and have now turned white.

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Tinea Versicolor

• Small, circular, flat, discolored areas of skin• May start out as red/pink or white lesions

• Athletes with light complexion may not notice lesions in the winter, but may notice after they tan

• Lesions are hypopigmented on tan skin (pink on untanned skin)

• Usually on chest and back

• May itch

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Tinea Versicolor

• Common infection caused by overgrowth of normal skin flora• Yeast (Pityrosporum orbiculare)

• Heat and humidity predispose the overgrowth

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Treatment

• Shower with Zinc Pyrithione soap (ie Head and Shoulders Shampoo)

• Leave on for several minutes then rinse off

• Selenium Sulfide lotion (ie Selsun Blue)

• Leave on for 20 minutes then rinse off

• Most effective after sweating or working out

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Treatment

• Rx topical antifungal 2x per day for 2-4 weeks• Rx oral antifungal

• Those who do not respond to topical treatment or those with recurrence

• Dyspigmentation persists for several weeks after treatment• Sun exposure helps blend skin

• Recurrence common

Case 3

• An athletes comes to you for an evaluation stating that he noticed a new rash on his face. At first he thought he was having an acne breakout, but the rash has worsened and looks like “little scabs.”

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Impetigo

• Honey-colored crusts (scabs) with red base

• Painless (unlike cold sores)

• May start off as small blisters

• Most commonly occurs on the face

• Associated with warm, humid climates and poor hygiene

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Impetigo

• Caused by an infection of the skin, usually from Staph aureus (possibly MRSA) and/or group A Strep

• Infection can develop in normal skin, from a minor wound site (iefrom a bug bite), or within lesions from another dermatitis

• Highly contagious

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Treatment

• Rx topical antibiotic (ie Bactroban) • Rx oral antibiotic (preferred when multiple lesions are present

and may shorten time to return to play)

• Return to play:• After at least 72 hours of antibiotics

• No new lesions for 48 hours

• No moist, exudative, or draining lesions

• Simply covering the lesions is not acceptable for return to play

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Case 4

• An athlete comes to you for an evaluation stating that he has an itchy circular rash on his abdomen.

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Tinea Corporis (Ringworm)

• Circular lesion(s) with well defined border

• Central clearing, scaly border

• May be itchy

• More common in warm climates

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Tinea Corporis (Ringworm)

• Superficial fungal infection• Contagious

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Treatment

• Rx topical antifungal (ie Terbinafine) for small lesion(s)• Rx oral antifungal preferred for larger infections• Treatment for at least 2 weeks, continue treatment for at least 1

week after infection resolves

• Return to play:• After at least 72 hours of antifungal treatment

• No new lesions

• Cover lesions

• Athletes with extensive skin involvement may need to be disqualified

• If an epidemic, may need to treat throughout the season for prevention

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Tinea Infections

• Tinea Pedis (“athlete’s foot”)• Fungal infection of the foot

• Usually between toes or plantar aspect foot

• Tinea Cruris (“jock itch”)• Fungal infection of the groin

• Treat with topical antifungals• Generally no restriction from sports

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General rule of thumb

• Most skin infections require 72 hours of treatment and no new lesions for 48 hours prior to return to play

• Encourage early reporting for prompt evaluation

ReferencesHabif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy, Sixth Edition. Sauders, 2015.

Thomas BJ, Ho GWK, Yu TJ, Henne MI. Medical Issues in American Football: Eyes, Teeth, and Skin. American Journal of Orthopedics. 2016 Sept/Oct; 45(6):

380-381.

Parsons JT. 2014-2015 NCAA Sports Medicine Handbook. Indianapolis: National Collegiate Athletic Association, 2014.