Skin Conditions

Question 1

Organizations Managing Athlete Participation

Answer 1

NCAA and NFHS

Question 2

What are the layers of the skin?

Answer 2

1. Epidermis:
   - Stratum corneal (top layer)
   - Squamous cells (middle layer)
   - Basal cells (deep layer)
2. Dermis
3. Hypodermis (Has adipose tissue)
4. Muscle

Question 3

What are roles of skin?

Answer 3

1. Thermoregulation
2. Protection

Question 4

How often should these things be cleaned:
1. Shower room in public locker room?
2. Locker room surfaces (benches, walls, mirrors, floors)?
3. Wrestling room?
4. Wrestling weight room
5. Wrestling treatment/taping tables
6. Wrestling support areas
7. Steam room/sauna
8. Carpeting

Answer 4

1. 1x/day
2. 1x/day
3. Walls and mats on walls = 1x/day; Mats (3x/day)
4. 1x/day where bodies touch equipment
5. 1x/day
6. Stairs and public areas = 1x/day
7. 1x/day
8. Extracting: monthly; vacuuming = 1x/day

Question 5

Categories of infectious skin conditions

Answer 5

1. Bacterial
2. Fungal
3. Viral

Question 6

Infections bacterial infections?

Answer 6

1. MRSA
2. Impetigo
3. Furuncles and carbuncles
4. Folliculitis

Question 7

How to identify MRSA? Treatment?

Answer 7

1. Often mistaken as spider bite
2. Swollen, red painful bump that looks like boil or insect bite
3. Can turn into a cluster of pimples

Treat with antimicrobial agents

Question 8

Impetigo:
1. What is it?
2. How to identify?
3. Management?

Answer 8

1. Superficial strep infection
2. Raised blisters around nose/mouth with honey-colored crust
3. Antibacterial soap, topical/oral antibiotics, avoid contact with lesion

Question 9

Carbuncles/Furnuncles

Answer 9

1. Occur in areas with a lot of friction or perspiration (under shoulder pads, armpits)
2. Look like boils with pus in them, almost like a pimple
3. Another form of staph
4. Furnuncle is one boil but if multiple come together they form a common purulent mass and that is a carbuncle
5. Warm compress to bring to surface and professional can lance it (don’t have athlete pop it)

Question 10

Folliculitis

Answer 10

1. Whole bunch of bumps around areas of hair growth
2. May be in areas that are shaved or taped often
3. Less contagious but is form of staph

Question 11

Guidelines to play for bacterial infections?

Answer 11

1. Must complete 72 hour course of antibiotic therapy
2. No drainage or exudate from wounds
3. No new lesion for 48 hours
4. Active lesions can’t be covered to allow participation

Question 12

Categories of viral infections

Answer 12

1. Herpes simplex
2. Molluscum contagiosum

Question 13

HSV

Answer 13

1. HSV-1 (information below contains to this) and HSV-2 (genital)
2. Incubation period for 3-10 days; prodromal symptoms = flu-like or burning
3. Single vesicle or cluster (almost looks like a pimple size blister)
4. Use antivirals (oral or cream)
5. If on lip = herpes labialis; on body = herpes glatiatorum

Question 14

Return to play for HSV

Answer 14

1. Free of systemic symptoms
2. No new lesions for 72 hours
3. No moist lesions
4. Minimum 5 days on systemic antiviral therapy

Question 15

Molluscum Contagiousum

Answer 15

1. Single vesicle or cluster
2. Look similar to HSV but more fleshy colored/pink
3. Can happen wherever
4. May have flu-symptoms or burning
5. You have to physically destroy the lesion (laser, cut it out, freeze)

Question 16

Molluscum Contagiosum return to play

Answer 16

1. Has to be curetted or removed
2. Localized lesions can be covered with gas-permeable dressing followed by underwrap and stretch tape

Question 17

Types of fungal infections

Answer 17

1. Tinea capitus (head)
2. Tinea corporus (body)
3. Tinea cruris (groin)
4. Tinea pedis (feet)

Question 18

Tinea capitus

Answer 18

1. Occurs on scalp
2. Scaly patches and mild hair loss
3. Topical antifungals

Question 19

Tinea Corporus

Answer 19

1. Ringworm
2. Red, round, scaly patches on the skin
3. Keep skin clean/dry
4. Topical antifungal
5. Wash anything that comes in contact with it

Question 20

Tinea Pedis

Answer 20

1. Usually in toe webs
2. Topical antifungals (powders or creams)

Question 21

How to manage open skin lesion?

Answer 21

1. Clean
   - Saline or portable tap water
   - No scrubbing
2. Debridement
   - Dependent on the wound
   - If abrasion and turf on there, you need to irrigate/debride it
   - If clean laceration you’re welcome to rinse it but don’t have to
3. Dressing
   - Nonocclusive vs occlusive
4. Monitor/Treat

Question 22

Nonocclusive vs occlusive dressing

Answer 22

1. Nonocclusive
   - Some sort of woven or non-woven gauze
   - Non- adherent pad
   - Used when we want air to get to this wound
   - Puncture wound, wounds with cavities, some level of infection
2. Occlusive dressing
   - Don’t want any air/moisture to come in

Question 23

Contact Dermatitis

Answer 23

1. Local inflammatory reaction to some offending agent
2. Red, itchy, swollen, clearly demarcated
3. Not contagious
4. Avoid offending material
5. If severe enough can use topical steroid or antihistamine

Question 24

Acne Mechanica

Answer 24

1. Looks like acne
2. Friction/heat between skin and equipment
3. Personal hygiene and moisture wicking clothes

Question 25

Talon Noir

Answer 25

1. Also called black heel 2. Trauma induced/friction in footwear 3. Dark lesion on fat pad 4. Make sure things fit appropriately and see if they’re doing too much

Question 26

Psoriasis

Answer 26

1. Systemic inflammation, autoimmune 2. Thick red skin with white patches anywhere on body (often in elbows and knees but can happen anywhere and often happens in flares) 3. Not contagious 4. Topical medications

Question 27

Eczema

Answer 27

1. Also, called atopic dermatitis 2. Almost looks like a mix between abrasion and psoriasis (itchy and scaley) 3. Usually environmental irritant but could be genetic 4. Can be managed with topical steroid or moisturizer

Question 28

Cholinergic Urticaria

Answer 28

1. Sweat and heat 2. Hives surrounded by redness caused by heat 3. Cool the area and antihistamines

Question 29

Types of scarring? Management?

Answer 29

Keloid = abdormal scarring beyond wound Barrie’s Hypertrophic scarring = stays within the border but enlarged Steroid injection, surgical removal, pressure dressing as developing (usually after surgical removal)

Question 30

Pediculosis? Return to Play?

Answer 30

1. Ectoparasite 2. See burrows or tracks 3. Louse (bug) or nit (eggs) 4. Can easily be transmitted 5. Medicated shampoos and lotions, thoroughly clean clothes/bed You can return if you don’t have louse but if you have nits you can return (can be dead and located on body after treatment = medicated cream or shampoos).

Question 31

Return to play requirements for the following: 1. Tinea capitis 2. Tinea corporis 3. HSV 4. Molluscum contagiosum 5. Impetigo 6. Folliculitis/furuncles/carbuncles 7. MRSA

Answer 31

1. Minimum of 2 weeks of systemic antifungal therapy 2. Topical fungicide for 72 hours and lesions covered with gas-permeable membrane 3. HSV - Free of systemic fever, malaise, etc - No new blisters for 72 hours - All lesions firm, adherent crust - Completion of 5 days of systemic antiviral therapy - Active lesions can’t just be covered to participate 4. Lesions curetted and covered with gas-permeable membrane 5. All Bacterial Infections (5-7) - No new lesion for 48 hours - Completion of 72 hour antibiotic therapy - No further drainage/exudate from wound - Active infections can’t just be covered

Question 32

What type of disinfectant should be used for routine cleaning?

Answer 32

Relatively unimportant, as long as it’s registered by EPA and manufacturer’s recommendations followed. Can use 1:10 ratio of household bleach to tap water for routine environmental disinfection.

Question 33

How to clean sleeves, braces, and pads?

Answer 33

1:10 bleach/tap water solution every day.

Question 34

Difference between psoriasis and eczema?

Answer 34

Psoriasis usually has white scaly portions, is less itchy, and is usually on the external surfaces of the body (not where the body folds). Eczema is more itchy, can be oozing and crusting, and is more often on the folds of the body. Psoriasis looks like more while scaly portions like outside of bread (thing sourdough sounds like psoriasis).