Download Skin Conditions in Sports

Skin Conditions in Sports
Identification
WIAA definition for not contagious
Kenneth H. Katz, M.D.
President, Dermatology Associates of Wisconsin
Assistant Clinical Professor, UW Fox Valley Family
Medicine Residency Program
• Many skin conditions are contagious and may
•
•
•
look similar to other nonnon-contagious skin
conditions
Contagious skin diseases can be transmitted
through sporting contact, especially wrestling
Contagious skin diseases can disqualify wrestlers
If a contagious skin disease is identified by a
trainer, therapist, or physician it can be promptly
treated to prevent spread to other athletes
• Bacterial Infections
• Viral Infections
• Fungal Infections
• Parasitic Infestations
• Inflammatory Mimickers
1
Bacterial Infections
Impetigo
• Honey Colored
Crust
• Erythema
• May have
Bullae
• Staph >>>
Strep
Eczema
• Dry red scaly
• No weeping
• Often poorly
defined
• Chronic
• Itching
2
Impetigo
• Dicloxacillin
• Oral
•
Antibiotic for
minimum 3
days and no
new lesions
in 24 hours
If MRSA then
oral antibiotic
for minimum
of 10 days
• Eczema with secondary impetigo – note the
“honey colored”
colored” crust covering the patches
• Very common for eczema patients
Folliculitis
• Papules and
pustules with
minimal erythema
• Looks like pimples
• Not contagious
3
Staph Aureus Folliculitis
• Pustles with a
•
•
bright erythema
extending well
beyond the lesion
Contagious
Same guidelines
as impetigo
Furuncles (Boils)
• Staph Aureus or
MRSA
• Tender, fluctuant
nodule usually
draining purulent
material
• I&D plus same
guidelines as
impetigo
• Herpetic Infections
– Varicella (Chicken Pox)
– Varicella Zoster (Shingles)
– Herpes Simplex 1 (Cold Sores)
– Herpes Simplex 2 (Genital Herpes)
• Not Discussed
• Molluscum Contagiousum
4
• 85% of US population
•
•
•
HSV 1
infected – lives in
nerve cell bodies in the
cranial or paraspinal
ganglions
10% have recurrent
outbreaks
Numb or tingling
prodrome
Painful or tender
grouped vesicles on a
red base
HSV 1
• NonNon-contagious
•
when all lesions
scabbed over in
the preceding 48
hours
Antiviral
treatment if
given early will
shorten duration
to nonnoncontagious
HSV with Secondary Impetigo
• Very common
• Treat both conditions
• Athletes with
frequent recurrence
of HSV may take
prophylactic therapy
during season –
especially wrestlers
5
Varicella - Chicken Pox
• Less common since
•
•
•
vaccination at age
one
Milder outbreak
can occur in
vaccinated
individuals
Prodrome is a URI
typically with fever
Very itchy >>
painful
Varicella - Chicken Pox
• Dew drop on a
rose petal
• NonNoncontagious
when all
lesions
scabbed over
and no new
lesions for 48
hours
Varicella Zoster - Shingles
• Reactivation of
•
•
Varicella Virus
along a
dermatome from
the neuron cell
bodies in the
ganglion
More common in
kids since
vaccination
Painful >> itchy
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• NonNon-contagious
•
•
when all lesions
scabbed over and
no new lesions in
24 hours
Looks very similar
to HSV 1 – grouped
pustules and
vesicles on a red
base
If athlete has
“recurrent shingles”
shingles”
it is HSV 1 on the
body
Varicella Zoster
- Shingles
Varicella Zoster
- Shingles
• Early treatment
with antivirals
speeds time to
nonnon-contagious
and can
decrease risk of
post herpetic
neuralgia
Molluscum
Contagiosum
• Umbilicated
papule
occasionally
some erythema
• Typically on
body
• Most adults
have been
infected as a
child
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Molluscum
Contagiosum
• Many
treatments
• Quickest path
to nonnoncontagious is
currettage
(may scar)
• No new lesions
and all lesions
crusted and
scabbed for 24
hours
Molluscum
Contagiosum
• Sometimes can
be subtle
• In the genital
area it can be
a sexually
transmitted
disease
Tinea - Ringworm
• Ringworm is actually a fungal infection
with a dermatophyte, usually Tinea
Rubrum
• It can come from other people, animals,
or the soil
• It has many manifestations from hair loss
to athletes foot to itchy scaly hands to red
patches on the body
8
Tinea Corporis
• Raised
periperhal
scaly border
with central
clearing
• Itchy
Psoriasis – thick white scale throughout
no central clearing
Tinea Corporis
• Raised
peripheral
scaly border
• Some
central
clearing
9
Eczema
• Uniform dry scaly
patches, with
indistinct edges
and no central
clearing
Tinea Corporis
• May have
•
•
Tinea capitis
central pustules
if involved in
hair bearing
areas
Oral or OTC
Topical
treatment for 72
hours
If pustules oral
tx required
• Scaling with
hair loss and
broken hairs
• Treatment
with oral
antifungals
for 14 days
before not
contagious
10
• Alopecia Areata
• No erythema
• No scaling
• No symptoms
• No broken hairs
Tinea Capitis
• Clearly see
areas of scale
and rings with
hair loss –
broken hairs on
close
inspection
Psoriasis of the Scalp
•No hair loss
•No raised
peripheral
border
•No central
clearing
11
Tinea with secondary impetigo
•Hair loss present
tells you that it is
tinea and not just
impetigo
•Central clearing
still evident
•Honey colored
crusting present
especially at
periphery
•Treat both
disorders to be
non-contagious
Tinea Pedis
• Peripheral scale
• Extends
between toes
• In this example
involves the
great toe nail
• Areas of central
clearing
Eczema
• No raised
border of
peripheral
scale
• Dry scale and
erythema
confluent
• May or may
not extend
between the
toes – usually
does not
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Tinea Pedis
• OTC Topical (or Rx
•
•
•
•
Oral) treatment for
72 hours to be nonnoncontagious
WIAA rules state that
“covering”
covering” a
contagious disease is
not adequate
WIAA release only
lists ringworm of the
scalp and skin as
disqualifiers
I interpret as tinea
pedis is not a
disqualifier but have
athletes treat anyway
Same with tinea
cruris (jock itch)
unless extending
widely to be
classified as tinea
corporis
Atopic Dermatitis
• No central
clearing
• Lichenification
• Does not
involve
interdigital toe
space
Tinea Pedis
• Moccassin tinea
pedis
• Peripheral scale
more intense
than central
• Often tiny
vesicles
• Usually very
itchy
• OTC topical
treatment
13
Pustular Psoriasis of the foot
• Confluent
•
•
pustules but no
vesicles, no
peripheral
scale on palms
or soles (no
hair follicles)
Often painful
+/+/- other
psoriasis
Parasitic Infestations
• Scabies
• Head Lice
Scabies
• Itching wrists,
between
fingers, and
frequently
genitals
• Very, very
itchy much out
of proportion
to the degree
of skin
findings
14
Scabies
Scabies – itchy eroded papules in
finger web spaces
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Scabies
• Linear burrows
in the wrist
area
• NonNon-contagious
24 hours after
topical
treatment
• Always treat
entire family
Head Lice
• Intense itching
•
Head Lice
especially on
occipital scalp
Nits within ½
inch of scalp
indicate
potential active
infection
• OTC topical
treatment effective
• NonNon-contagious 24
•
•
•
hours after first
treatment
Nits do not need to
be removed to be
considered nonnoncontagious
Treat entire family
Nits greater than ½
inch from scalp are
“old”
old”
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