Dermatological Considerations in the Athlete Flashcards
What are the three basic layers of the skin?
- Epidermis
- Dermis
- Subcutaneous
What are the five layers of the epidermis?
- stratum corneum
- stratum lucidum
- stratum granulosum
- stratum spinosum
- stratum basale
- Contains no blood vessels or lymphatics and therefore relies on the more vascular dermis for its supply of nutrients
Describe the Dermis
- Irregular dense layer of collagen and elastin fibers containing blood vessels, eccrine and apocrine sweat glands, nerve endings, hair follicles, and sebaceous glands
What is a Blister?
- Shearing forces result in separation of the stratum
spinosum in the epidermal layer, causing it to fill with transudate or blood due to the hydrostatic pressure.
What is the clinical presentation of a blister?
- Sharp, burning sensations, or a feeling of a “hot spot.”
- Once the friction blister matures, appears as a painful, clear fluid filled lesion (bulla) surrounded by erythema.
How is a small blister treated?
- Monitor, should resolve in a day or two
How is a Large blister treated?
- Wash with antiseptic soap
- Small incision along edge
- Evacuate fluid with infection
- Clean again, cover with antiseptic ointment
- Apply donut pad
- Repeat as needed
What is Hyperkeratosis (Callus)?
- When skin is exposed to constant friction, epidermal layer can thicken in a hyperkeratotic response known as a callus
How can painful calluses be treated?
- Apply urea cream or salycytic acid
- Rub pumice stone or emery file
- Or pare with scalpel but be careful not to remove entire callus
What are Corns?
- Form of Hyperkeratosis
- Occur over bony prominences and form as a result of ill-fitting shoes or poor biomechanics
Describe Corns
- Soft corns frequently found between the toes and are macerated from the moist environment.
- Hard corns resemble calluses but are smaller and more focal. They are typically found on the tops of toes, related to toe deformity such as hammer toes.
- Unlike calluses, corns are painful and can cause disability
What is the management for Corns?
- Correct faulty footwear or poor mechanics
- Toe separators and Orthotics
- If doesn’t work, refer to podiatrist
What is best prevention for Corns?
- Properly fitted shoes
What is Infertrigo?
- Chafing
- inflammation of the skin in body folds as a result of two skin surfaces rubbing together in areas like the groin or axilla
What is management of Infertrigo?
- Clean with soap and water
- Corticosteroid creams
What is best prevention for Infertrigo?
- Talcum Powder
- Petroleum Jelly
What is Acne Mechanica?
- Form of acne caused by heat, excessive pressure, and repetitive forces on the skin
- Causes are tight uniforms, headgear, and equipment pads and straps
What is presentation of Acne Mechanica?
- Well defined pustules and papules in the area where the equipment or clothing has irritated the skin
What is management of Acne Mechanica?
- Remove irritating cause
- Refer to derm for topical treatment
What are the two most common bacteria causing skin infection?
- Staphylococcus
- Streptococcus
Differentiate Primary and Secondary Impetigo
- Primary: Infection in area of normal, healthy skin
- Secondary: Infection where skin was previously disturbed (Abrasion, etc)
What are the three variants of Impetigo?
- Non-bullous
- Bullous
- Ecthyma
Describe Non-Bullous Impetigo
- Most often seen in children between two and five years of age
- Most commonly affected areas are the face around the mouth and nose, and the extremities
- Evolves from red papules to vesicles to pustules that then break, creating a nonpainful, crusting, honey-colored lesion
- Caused by S. aureus or S. pyogenes.
Describe Bullous Impetigo
- Presents initially with a large thin walled bulla containing yellow-colored fluid
- Most commonly affected areas are the trunk and buttocks
- Often, bulla breaks, leaving a lesion in the shape of
an arch - Cause only by S. Aureus
Describe Ecthyma Impetigo
- Affects Dermis
- Painful, “punched-out” ulcerated lesion with a yellow crust.
- May be accompanied by systemic symptoms such as fever, pruritus (itchiness) or malaise
What is Treatment for Impetigo?
- Mupirocin topical two percent applied to affected skin and nostrils three times daily for ten days
- Retapamulin topical one percent applied twice daily for five days
- If unresponsive, oral antibiotics such as dicloxacillin or cephalexin
Describe Erysipelas
- Acute onset of a well-demarcated, indurated, edematous, erythematous plaque
- Warm to the touch with localized pain
- Accompanied by systemic manifestations like fever, malaise or chills
- Most common sites of infection are face and lower
extremities
What is treatment of Erysipelas?
- Antibiotics
- Preferably Penicillin
Describe Erythrasma
- Typically presents on skin folds
- Presents as reddish-brown, pruritic, scaly plaques
How is Erythrasma Diagnosed?
- Physical Exam
- Wood’s lamp, a diagnostic tool using ultraviolet (UV) light, will confirm the diagnosis by revealing the characteristic fluorescent coral red color of the organism
What is treatment for Erythrasma?
- Topical fusidic acid
- Topical antibiotics such as erythromycin, clarithromycin or clindamycin
- If does not respond, oral antibiotics
How does Folliculitis Manifest?
- Small cluster of pustules and papules in an erythematous base around hair follicles
What is Treatment for Folliculitis?
- Stop shaving
- Topical benzoyl peroxide twice daily
- Topical antibiotics such as mupirocin applied twice daily for ten days if the lesions persist
- If becomes wide-spread, oral antibiotics such as dicloxacillin or cephalexin should be added to topical therapy
What are Furuncles/ Carbuncles/ and Abscesses?
- Furuncle: an infection of the hair follicle that is more extensive than folliculitis, Deeper in the dermis, extending through the subcutaneous tissue, causing a small abscess
- Carbuncle: a collection of furuncles draining from multiple follicles
- Abscess: Pus collections within the dermis and into deeper tissue
How does a Furuncle Present Clinically?
- Usually follow an episode of folliculitis
- Erythematous, tender, pus-filled, elevated lesion
How does a Carbuncle Present Clinically?
- Amass of inflamed follicles with purulent drainage
- Area can be tender and erythematous
How does an Abscess Present Clinically?
- Painful, tender, erythematous, pus-filled lesion with or without indurated surrounding area
- Systemic manifestation such as malaise and fever could be present, depending on the severity of the infection.
How are Furuncles/ Carbuncles/ Abscesses Treated?
- Warm compress if small to encourage draining
- If large, incision and drainage with Oral Antibiotics
What is Hot Tub Folliculitis?
- Caused by Pseudomonas aeruginosa (Gram Negative)
- Typically develops 48 hours after exposure
- Pruritic, erythematous, tender, pustules and papules
- May complain of systemic manifestations such as malaise and fever
How is Hot Tub Folliculitis Treated?
- Should clear up in a week or so on its own
- Can treat with Benzoyl Peroxide
- Can use oral antibiotics such as ciprofloxacin
What is Paronychia?
- Inflammation of the surrounding tissue of a nail
- Typically caused by Staphylococcus, Streptococcus and fungal organisms
What is Treatment for Paronychia?
- Warm soaks with saline solution
- Topical antibacterials such as bacitracin (500 unit/g) or mupirocin two percent can be applied two or three times daily
- If purulent, incision and drainage
- In severe cases, Oral Antibiotics such as Clindamycin
What is Cellulitis?
- Bacterial infection of skin
- Typically occurs after a break in skin, such as cuts, blisters, cracks and insect stings, allowing a portal of entry for pathogen which colonizes within skin.
- Immunocompromised and diabetic individuals are at increased risk
What is Clinical Manifestation of Cellulitis?
- Poorly defined area of edematous, glossy-looking, erythematous tissue that is warm and painful to the touch. Systemic manifestation is common and includes fever, chills, malaise and myalgia
What is treatment for Cellulitis?
- Referral
- Empiric antibiotics should be started immediately
Describe Clinical Manifestation of Acne Vulgaris
- Mostly in Adolescents
- Ranges from mild comedones to severe nodulocystic acne
- Lesions include open comedons (blackheads), closed comedons (whiteheads), pustulas, papules, nodules and cysts
What is treatment for Acne Vulgaris?
- Referral to Derm
- Mild to moderate: Topical retinoid and topical azeliac acid
- Moderate to severe: oral antibiotic such as tetracycline is added
- Severe nodulocystic acne or acne resistant to treatment: oral retinoids and corticosteroids
Describe the Cinical Manifestation of Hydradenitis Suppurativa
- Not Bacterial
- Males: Perianal and buttock areas more commonly involved
- Females: More commonly axial and inguinal regions
- Insidious onset, initially a painful, deep, solitary nodule that persists from a week up to several months
- The nodules can rupture and form an
abscess and eventually drain purulent material
How do you diagnose and treat Hydradenitis Suppurativa?
- Bacterial culture is used to rule out furunculosis
- Treatment includes includes anti-androgens, antibiotics and glucocorticoids
What is Otitis Externa?
- Swimmers Ear
- Inflammation of the external auditory canal, or auricle, with or without infection.
- Sometimes confused with Otitis Media, infection of middle ear (cause of earache)
- Can be caused by water polluted with the Pseudomonas bacteria
What is the Clinical Manifestation of Otitis Externa?
- Pain in the outer ear, increases when the clinician
pulls on the ear - May have itchy ear canal, hearing may be decreased
- Yellow-green pus or fluid may leak from the outer ear
What is common treatment for Otitis Externa?
- ## Acetic acid or eardrops containing antibiotics/ steroids are typically prescribed for up to two weeks
What is treatment for Methycillin Resistant Staphylococcus Aureus?
- IV Antibiotics
What is Molluscus Contagiosum?
- Skin infection caused by the poxvirus
- Spread by skin to skin contact, towels
- Incubation from 2 to 7 weeks
- Infection can be months to a year
- Most commonly in children under 8
What is the clinical manifestation of Molluscus Contagiosum?
- Small, umbilicated, flesh colored, pearly papules
- Lesions can number in the hundreds, in athletes usually around 20
How do you confirm diagnosis of Molluscus Contagiosum?
- Usually appearance is enough
- Curettage biopsy may be used to confirm diagnosis; performing hematoxylin and eosin staining will show Henderson-Patterson bodies
How do you treat Molluscus Contagiosum?
- Can leave alone and it will go away in months to a year
- Can perform aggressive treatment if want it gone sooner
- Aggressive treatment includes: curettage (scraping), topical destructive agents such as cantharidin topical, tretinoin topical or cryotherapy (liquid nitrogen can be applied to all visible lesions)
What are Common Warts (Verrucae vulgaris, Verrucae
plantaris)?
- Caused by Human Papilloma Virus (HPV)
- Most commonly affects children and adolescents
- Factors like swimming and nail biting increase risk for developing
What is the clinical manifestation of common warts?
- Grow over weeks and months
- Appear as elevated, hyperkeratotic, round papules with dry, rough surfaces
- Can be painful if submitted to pressure or trauma
- One millimeter to several centimeters
How do you diagnose common warts?
- Visual Appearance
- If pared with blade, will appear to have black seeds underneath the surface
- Other diagnostic tests include skin biopsy, immunoperoxidase and skin culture
What are treatments for Common Warts?
- Debridement coupled with topical salicylic acid
- Cryotherapy
- Silver Nitrate
- Other possible options include surgery with a laser or cold-scalpel, electrocautery, or pharmaceuticals such as bleomycin, dinitrochlorobenzene or cantharidin
What is Herpes?
- Cuased by Herpes Simplex Virus
- Lays dormant in the Neural Ganglia in Latent Phase
- Transmitted on close contact with an infected area
- HSV Type 1 mainly causes herpes labialis and herpes gladiatorum
- HSV Type 2 mainly causes genital herpes
Describe the Clinical Manifestation for Herpes Labialis?
- Involve pharynx, oral or perioral mucosa
- May feel tingling, burning, pruritus or pain in affected area prior to the appearance of lesion, followed by a painful vesicular lesion that will later ulcerate
- Can be accompanied by systemic manifestations like fever or malaise, depending on the severity of the infection
Describe the Clinical Manifestation for Herpes Gladiatorum
- Sometimes referred to as “wrestler’s herpes” or “mat pox”, often involve the head, face, neck, ears, torso and upper extremities
- May present as red papules, clusters of blisters, or crusted plaques depending on the stage of evolution
- Can be accompanied by systemic manifestations like fever or malaise, depending on the severity of the infection
Describe the Clinical Manifestation for Genital Herpes
- Symptoms Highly Variable
- May present with painful genital ulcers, multiple pustular lesions, dysuria, fever and headaches
- May be asymptomatic
- Can be accompanied by systemic manifestations like fever or malaise, depending on the severity of the infection
How is Herpes Simplex Virus Diagnosed?
- May be done if lesions are present
- Include Tzanck smear, viral culture, viral direct immunofluorescence assay, HSV polymerase chain reaction (PCR) test and type-specific serologic assay
What is treatment for Herpes Simplex Virus (HSV)?
- Antiviral therapy started within 48 hours of prodromal symptoms
- Drugs used include acyclovir, valacyclovir or famciclovir
When should an individual be referred to physician for sunburn?
- Signs of infection, such as pus-like discharge, increasing redness, and temperature greater than 100.4 degrees F
Describe Tinea Capitis
- Involves scalp
- Transmitted by contact with affected area, hats, pillows or combs
- Associated with Poor Hygiene
Describe clinical manifestation of Tinea Capitis
- Areas of alopecia (baldness) that can have irregular
or well demarcated borders - Affected area will have black dots that are due to hairs that break off
How is Tinea Capitis Diagnosed?
- Visualization of branching hyphae and spores on KOH preparation
- If this is negative, Wood’s lamp examination or fungal culture may be done
How is Tinea Capitis Treated?
- Referral
- Preferably Oral Antibiotics; griseofuvin, terbinafine or itraconazole for 4-6 weeks
- Alternative treatments are selenium sulfide or ketoconazole shampoo
Describe Tinea Corporis (Ringworm)
- Ringworm
- Transmitted by direct contact with infected area
- Could be contaminated items like clothes, pool surfaces, shower tiles
What is the Clinical Manifestation of Tinea Corporis (Ringworm)
- Ring shaped, erythematous, pruritic, elevated border lesion that have a central clearing
How is Tinea Corporis (Ringworm) Diagnosed?
- Visual Appearance
- KOH Preparation or Culture
How is Tinea Corporis (Ringworm) Treated?
- No participation in sports
- Topical Antifungals
- Topical Terbinafine, Naftifine or Butenafine twice daily for 1-3 weeks
- Topical Miconazole or Clotrimazole twice daily for 2-4 weeks
Describe Tinea Cruris (Jock Itch)
- Jock Itch
- Warm Moist environments
- Transmitted by direct contact with affected skin or contact with infected clothes
What is Clinical Manifestation of Tinea Cruris (Jock Itch)?
- Begins with a pruritic and sometimes painful, erythematous patches in inner thighs
- May be unilateral or bilateral
- Lesions will have a well defined, raised border that will have a more intense red color
How is Tinea Cruris (Jock Itch) Diagnosed?
- Appearance
- KOH preparation or Fungal Culture
How is Tinea Cruris (Jock Itch) Treated?
- Topical antifungal twice daily for 2 weeks
- If this fails, then oral antifungal
Describe Tinea Unguium
- Nail Fungal Infection
- Cause of Onychomicosis
- Caused by Dermatophytes, Yeast and Mold
What is Clinical Manifestation of Tinea Unguium?
- Mostly Toenails
- Thickening of Nail, yellowish color, change in shape or lifting of the nail
- Pressure to the affected area may cause pain
How do you Diagnose Tinea Unguium?
- KOH preparation or Fungal Culture
What is Treatment for Tinea Unguium?
- Oral Antifungals
- Terbinafine, itraconazole or ketoconazole
- 12-16 weeks….may have side effects
- Should be monitored by physician
Describe Tinea Pedis (Athletes Foot)
- Acquired by contact with infected skin or infected objects such as floors tiles, stockings or shoes
What is the Clinical Manifestation of Tinea Pedis (Athletes Foot)?
- Pruritus or a burning sensation in the affected area
- Lesions commonly seen in interdigital areas and are often accompanied by fissures, scales or erosions
- Blisters and crust can also be present
- Can affect soles, heels or sides of the feet
How is Tinea Pedis (Athletes Foot) Diagnosed?
- Clinical Manifestation
- KOH Preparation
How is Tinea Pedis (Athletes Foot) Treated?
- Hygiene
- Topical antifungal cream like Terbinafine, Naftifine, Butenafine, Miconazole or Clotrimazole
What is the proper way to remove a tick?
- Use fine tweezers and get as close to the skin as possible, then pull the tick firmly and gently
When should an individual be referred to physician after Tick Bite?
- If they display signs of infection, systemic illness, neurological symptoms, paresthethia, or paralysis
What are some common treatments for Mosquito Bites?
- Benadryl and other topical antihistamines for relief
- In more serious cases, corticosteroids
What is treatment for bee sting?
- Stinger, or barb, should be removed and a cold compress can be applied to reduce pain and inflammation
- Topical Anesthetic
- If individual is allergic to bee sting, what symptoms would they present with? Treatment?
- Tachycardia, tachypnea, tightness of chest or difficulty breathing, and lightheadedness or loss of consciousness
- Treat for Anaphylactic Shock
- Epinephrine pen or send to ER if don’t have one
What are the two types of Contact Dermatitis?
- Allergic and Irritant
When does Allergic Contact Dermatitis occur?
- Skin comes in contact with allergen and triggers delayed hypersensitivity response
- Example is Poison Ivy
When does Irritant Contact Dermatitis occur?
- Skin is exposed to a chemical or substance that disrupts skin barrier, causing skin inflammation
What is the clinical manifestation of Allergic Contact Dermatitis?
- May start 24 to 48 hours after the skin is exposed to an allergen
- Presence of intense pruritus, comes accompanied by erythematous plaque lesions
- May also be scaling, bullas, or vesicles
What is the clinical manifestation of Irritant Contact Dermatitis?
- Acute and symptoms vary depending on the irritant
- Include erythema, pruritus, a burning sensation, chapped skin and fissuring of the skin
- Severe cases, may be edema and tenderness in the area
How do you diagnose Contact Dermatitis?
- History, Physical Examination
- Sometimes patch testing if Allergic Dermatitis
What is treatment for Allergic Contact Dermatitis?
- Removal of Irritant and wash with soap and water
- Topical corticosteroids, like topical hydrocortisone (2.5
percent), Desonide (0.05 percent), or Bethamethasone (0.15 percent) applied twice a day - If this treatment fails, treatment is calcineurin
inhibitors, such as topical tacrolimus or pimecrolimus - In severe cases, Oral corticosteroids may be added
What is treatment for Irritant Contact Dermatitis?
- application of moisturizers to the affected area
- Use of topical corticosteroids if needed
