Skin Conditions in Sports

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1 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 non-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

2 Bacterial Infections Impetigo Honey Colored Crust Erythema May have Bullae Staph >>> Strep Eczema Dry red scaly No weeping Often poorly defined Chronic Itching 2

3 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 crust covering the patches Very common for eczema patients Folliculitis Papules and pustules with minimal erythema Looks like pimples Not contagious 3

4 Staph Aureus Folliculitis Pustles with a bright erythema extending well beyond the lesion Contagious Same guidelines as impetigo Staph Aureus or MRSA Tender, fluctuant nodule usually draining purulent material I&D plus same guidelines as impetigo Furuncles (Boils) Herpetic Infections Varicella (Chicken Pox) Varicella Zoster (Shingles) Herpes Simplex 1 (Cold Sores) Herpes Simplex 2 (Genital Herpes) Not Discussed Molluscum Contagiousum 4

5 85% of US population 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 HSV 1 Non-contagious when all lesions scabbed over in the preceding 48 hours Antiviral treatment if given early will shorten duration to non- contagious HSV with Secondary Impetigo Very common Treat both conditions Athletes with frequent recurrence of HSV may take prophylactic therapy during season especially wrestlers 5

6 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 Non- contagious 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 6

7 Non-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 it is HSV 1 on the body Varicella Zoster - Shingles Varicella Zoster - Shingles Early treatment with antivirals speeds time to non-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 7

8 Molluscum Contagiosum Many treatments Quickest path to non- contagious 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

9 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

10 Eczema Uniform dry scaly patches, with indistinct edges and no central clearing Tinea Corporis May have central pustules if involved in hair bearing areas Oral or OTC Topical treatment for 72 hours If pustules oral tx required Tinea capitis Scaling with hair loss and broken hairs Treatment with oral antifungals for 14 days before not contagious 10

11 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

12 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 12

13 Tinea Pedis OTC Topical (or Rx Oral) treatment for 72 hours to be non- contagious WIAA rules state that 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

14 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

15 Scabies Scabies itchy eroded papules in finger web spaces 15

16 Scabies Linear burrows in the wrist area Non-contagious 24 hours after topical treatment Always treat entire family Head Lice Intense itching especially on occipital scalp Nits within ½ inch of scalp indicate potential active infection Head Lice OTC topical treatment effective Non-contagious 24 hours after first treatment Nits do not need to be removed to be considered non- contagious Treat entire family Nits greater than ½ inch from scalp are old 16

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