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SCS > Dermatological Considerations in the Athlete > Flashcards

Dermatological Considerations in the Athlete Flashcards

1
Q

What are the three basic layers of the skin?

A
  • Epidermis
  • Dermis
  • Subcutaneous
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2
Q

What are the five layers of the epidermis?

A
  • 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
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3
Q

Describe the Dermis

A
  • Irregular dense layer of collagen and elastin fibers containing blood vessels, eccrine and apocrine sweat glands, nerve endings, hair follicles, and sebaceous glands
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4
Q

What is a Blister?

A
  • 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.

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5
Q

What is the clinical presentation of a blister?

A
  • 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.

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6
Q

How is a small blister treated?

A
  • Monitor, should resolve in a day or two
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7
Q

How is a Large blister treated?

A
  • Wash with antiseptic soap
  • Small incision along edge
  • Evacuate fluid with infection
  • Clean again, cover with antiseptic ointment
  • Apply donut pad
  • Repeat as needed
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8
Q

What is Hyperkeratosis (Callus)?

A
  • When skin is exposed to constant friction, epidermal layer can thicken in a hyperkeratotic response known as a callus
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9
Q

How can painful calluses be treated?

A
  • Apply urea cream or salycytic acid
  • Rub pumice stone or emery file
  • Or pare with scalpel but be careful not to remove entire callus
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10
Q

What are Corns?

A
  • Form of Hyperkeratosis

- Occur over bony prominences and form as a result of ill-fitting shoes or poor biomechanics

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11
Q

Describe Corns

A
  • 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
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12
Q

What is the management for Corns?

A
  • Correct faulty footwear or poor mechanics
  • Toe separators and Orthotics
  • If doesn’t work, refer to podiatrist
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13
Q

What is best prevention for Corns?

A
  • Properly fitted shoes
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14
Q

What is Infertrigo?

A
  • Chafing
  • inflammation of the skin in body folds as a result of two skin surfaces rubbing together in areas like the groin or axilla
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15
Q

What is management of Infertrigo?

A
  • Clean with soap and water

- Corticosteroid creams

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16
Q

What is best prevention for Infertrigo?

A
  • Talcum Powder

- Petroleum Jelly

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17
Q

What is Acne Mechanica?

A
  • Form of acne caused by heat, excessive pressure, and repetitive forces on the skin
  • Causes are tight uniforms, headgear, and equipment pads and straps
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18
Q

What is presentation of Acne Mechanica?

A
  • Well defined pustules and papules in the area where the equipment or clothing has irritated the skin
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19
Q

What is management of Acne Mechanica?

A
  • Remove irritating cause

- Refer to derm for topical treatment

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20
Q

What are the two most common bacteria causing skin infection?

A
  • Staphylococcus

- Streptococcus

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21
Q

Differentiate Primary and Secondary Impetigo

A
  • Primary: Infection in area of normal, healthy skin

- Secondary: Infection where skin was previously disturbed (Abrasion, etc)

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22
Q

What are the three variants of Impetigo?

A
  • Non-bullous
  • Bullous
  • Ecthyma
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23
Q

Describe Non-Bullous Impetigo

A
  • 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.
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24
Q

Describe Bullous Impetigo

A
  • 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
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25
Q

Describe Ecthyma Impetigo

A
  • Affects Dermis
  • Painful, “punched-out” ulcerated lesion with a yellow crust.
  • May be accompanied by systemic symptoms such as fever, pruritus (itchiness) or malaise
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26
Q

What is Treatment for Impetigo?

A
  • 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
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27
Q

Describe Erysipelas

A
  • 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
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28
Q

What is treatment of Erysipelas?

A
  • Antibiotics

- Preferably Penicillin

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29
Q

Describe Erythrasma

A
  • Typically presents on skin folds

- Presents as reddish-brown, pruritic, scaly plaques

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30
Q

How is Erythrasma Diagnosed?

A
  • 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
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31
Q

What is treatment for Erythrasma?

A
  • Topical fusidic acid
  • Topical antibiotics such as erythromycin, clarithromycin or clindamycin
  • If does not respond, oral antibiotics
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32
Q

How does Folliculitis Manifest?

A
  • Small cluster of pustules and papules in an erythematous base around hair follicles
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33
Q

What is Treatment for Folliculitis?

A
  • 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
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34
Q

What are Furuncles/ Carbuncles/ and Abscesses?

A
  • 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
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35
Q

How does a Furuncle Present Clinically?

A
  • Usually follow an episode of folliculitis

- Erythematous, tender, pus-filled, elevated lesion

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36
Q

How does a Carbuncle Present Clinically?

A
  • Amass of inflamed follicles with purulent drainage

- Area can be tender and erythematous

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37
Q

How does an Abscess Present Clinically?

A
  • 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.
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38
Q

How are Furuncles/ Carbuncles/ Abscesses Treated?

A
  • Warm compress if small to encourage draining

- If large, incision and drainage with Oral Antibiotics

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39
Q

What is Hot Tub Folliculitis?

A
  • 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
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40
Q

How is Hot Tub Folliculitis Treated?

A
  • Should clear up in a week or so on its own
  • Can treat with Benzoyl Peroxide
  • Can use oral antibiotics such as ciprofloxacin
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41
Q

What is Paronychia?

A
  • Inflammation of the surrounding tissue of a nail

- Typically caused by Staphylococcus, Streptococcus and fungal organisms

42
Q

What is Treatment for Paronychia?

A
  • 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
43
Q

What is Cellulitis?

A
  • 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
44
Q

What is Clinical Manifestation of Cellulitis?

A
  • 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
45
Q

What is treatment for Cellulitis?

A
  • Referral

- Empiric antibiotics should be started immediately

46
Q

Describe Clinical Manifestation of Acne Vulgaris

A
  • Mostly in Adolescents
  • Ranges from mild comedones to severe nodulocystic acne
  • Lesions include open comedons (blackheads), closed comedons (whiteheads), pustulas, papules, nodules and cysts
47
Q

What is treatment for Acne Vulgaris?

A
  • 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
48
Q

Describe the Cinical Manifestation of Hydradenitis Suppurativa

A
  • 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
49
Q

How do you diagnose and treat Hydradenitis Suppurativa?

A
  • Bacterial culture is used to rule out furunculosis

- Treatment includes includes anti-androgens, antibiotics and glucocorticoids

50
Q

What is Otitis Externa?

A
  • 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
51
Q

What is the Clinical Manifestation of Otitis Externa?

A
  • 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
52
Q

What is common treatment for Otitis Externa?

A
  • ## Acetic acid or eardrops containing antibiotics/ steroids are typically prescribed for up to two weeks
53
Q

What is treatment for Methycillin Resistant Staphylococcus Aureus?

A
  • IV Antibiotics
54
Q

What is Molluscus Contagiosum?

A
  • 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
55
Q

What is the clinical manifestation of Molluscus Contagiosum?

A
  • Small, umbilicated, flesh colored, pearly papules

- Lesions can number in the hundreds, in athletes usually around 20

56
Q

How do you confirm diagnosis of Molluscus Contagiosum?

A
  • Usually appearance is enough
  • Curettage biopsy may be used to confirm diagnosis; performing hematoxylin and eosin staining will show Henderson-Patterson bodies
57
Q

How do you treat Molluscus Contagiosum?

A
  • 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)
58
Q

What are Common Warts (Verrucae vulgaris, Verrucae

plantaris)?

A
  • Caused by Human Papilloma Virus (HPV)
  • Most commonly affects children and adolescents
  • Factors like swimming and nail biting increase risk for developing
59
Q

What is the clinical manifestation of common warts?

A
  • 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
60
Q

How do you diagnose common warts?

A
  • 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
61
Q

What are treatments for Common Warts?

A
  • 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
62
Q

What is Herpes?

A
  • 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
63
Q

Describe the Clinical Manifestation for Herpes Labialis?

A
  • 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
64
Q

Describe the Clinical Manifestation for Herpes Gladiatorum

A
  • 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
65
Q

Describe the Clinical Manifestation for Genital Herpes

A
  • 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
66
Q

How is Herpes Simplex Virus Diagnosed?

A
  • 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
67
Q

What is treatment for Herpes Simplex Virus (HSV)?

A
  • Antiviral therapy started within 48 hours of prodromal symptoms
  • Drugs used include acyclovir, valacyclovir or famciclovir
68
Q

When should an individual be referred to physician for sunburn?

A
  • Signs of infection, such as pus-like discharge, increasing redness, and temperature greater than 100.4 degrees F
69
Q

Describe Tinea Capitis

A
  • Involves scalp
  • Transmitted by contact with affected area, hats, pillows or combs
  • Associated with Poor Hygiene
70
Q

Describe clinical manifestation of Tinea Capitis

A
  • 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
71
Q

How is Tinea Capitis Diagnosed?

A
  • Visualization of branching hyphae and spores on KOH preparation
  • If this is negative, Wood’s lamp examination or fungal culture may be done
72
Q

How is Tinea Capitis Treated?

A
  • Referral
  • Preferably Oral Antibiotics; griseofuvin, terbinafine or itraconazole for 4-6 weeks
  • Alternative treatments are selenium sulfide or ketoconazole shampoo
73
Q

Describe Tinea Corporis (Ringworm)

A
  • Ringworm
  • Transmitted by direct contact with infected area
  • Could be contaminated items like clothes, pool surfaces, shower tiles
74
Q

What is the Clinical Manifestation of Tinea Corporis (Ringworm)

A
  • Ring shaped, erythematous, pruritic, elevated border lesion that have a central clearing
75
Q

How is Tinea Corporis (Ringworm) Diagnosed?

A
  • Visual Appearance

- KOH Preparation or Culture

76
Q

How is Tinea Corporis (Ringworm) Treated?

A
  • 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
77
Q

Describe Tinea Cruris (Jock Itch)

A
  • Jock Itch
  • Warm Moist environments
  • Transmitted by direct contact with affected skin or contact with infected clothes
78
Q

What is Clinical Manifestation of Tinea Cruris (Jock Itch)?

A
  • 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
79
Q

How is Tinea Cruris (Jock Itch) Diagnosed?

A
  • Appearance

- KOH preparation or Fungal Culture

80
Q

How is Tinea Cruris (Jock Itch) Treated?

A
  • Topical antifungal twice daily for 2 weeks

- If this fails, then oral antifungal

81
Q

Describe Tinea Unguium

A
  • Nail Fungal Infection
  • Cause of Onychomicosis
  • Caused by Dermatophytes, Yeast and Mold
82
Q

What is Clinical Manifestation of Tinea Unguium?

A
  • Mostly Toenails
  • Thickening of Nail, yellowish color, change in shape or lifting of the nail
  • Pressure to the affected area may cause pain
83
Q

How do you Diagnose Tinea Unguium?

A
  • KOH preparation or Fungal Culture
84
Q

What is Treatment for Tinea Unguium?

A
  • Oral Antifungals
  • Terbinafine, itraconazole or ketoconazole
  • 12-16 weeks….may have side effects
  • Should be monitored by physician
85
Q

Describe Tinea Pedis (Athletes Foot)

A
  • Acquired by contact with infected skin or infected objects such as floors tiles, stockings or shoes
86
Q

What is the Clinical Manifestation of Tinea Pedis (Athletes Foot)?

A
  • 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
87
Q

How is Tinea Pedis (Athletes Foot) Diagnosed?

A
  • Clinical Manifestation

- KOH Preparation

88
Q

How is Tinea Pedis (Athletes Foot) Treated?

A
  • Hygiene

- Topical antifungal cream like Terbinafine, Naftifine, Butenafine, Miconazole or Clotrimazole

89
Q

What is the proper way to remove a tick?

A
  • Use fine tweezers and get as close to the skin as possible, then pull the tick firmly and gently
90
Q

When should an individual be referred to physician after Tick Bite?

A
  • If they display signs of infection, systemic illness, neurological symptoms, paresthethia, or paralysis
91
Q

What are some common treatments for Mosquito Bites?

A
  • Benadryl and other topical antihistamines for relief

- In more serious cases, corticosteroids

92
Q

What is treatment for bee sting?

A
  • Stinger, or barb, should be removed and a cold compress can be applied to reduce pain and inflammation
  • Topical Anesthetic
93
Q
  • If individual is allergic to bee sting, what symptoms would they present with? Treatment?
A
  • 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
94
Q

What are the two types of Contact Dermatitis?

A
  • Allergic and Irritant
95
Q

When does Allergic Contact Dermatitis occur?

A
  • Skin comes in contact with allergen and triggers delayed hypersensitivity response
  • Example is Poison Ivy
96
Q

When does Irritant Contact Dermatitis occur?

A
  • Skin is exposed to a chemical or substance that disrupts skin barrier, causing skin inflammation
97
Q

What is the clinical manifestation of Allergic Contact Dermatitis?

A
  • 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
98
Q

What is the clinical manifestation of Irritant Contact Dermatitis?

A
  • 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
99
Q

How do you diagnose Contact Dermatitis?

A
  • History, Physical Examination

- Sometimes patch testing if Allergic Dermatitis

100
Q

What is treatment for Allergic Contact Dermatitis?

A
  • 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
101
Q

What is treatment for Irritant Contact Dermatitis?

A
  • application of moisturizers to the affected area

- Use of topical corticosteroids if needed

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