Brian B. Adams

Dermatologic disorders of the athlete

AbstractThe most common injuries afflicting the athlete affect the skin. The list of sports-related dermatoses is vast and includes infections, inflammatory conditions, traumatic entities, environmental encounters, and neoplasms. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete.Infections probably cause the most disruption to individual and team activities. Herpes gladiatorum, tinea corporis gladiatorum, impetigo, and furunculosis are sometimes found in epidemic proportions in athletes. Vigilant surveillance and early treatment help teams avoid these epidemics. Fortunately, several recent studies suggest that pharmacotherapeutic prevention may be effective for some of these sports-related infections. Inflammatory cutaneous conditions may be banal or potentially life threatening as in the case of exercise-induced anaphylaxis. Athletes who develop exercise-induced anaphylaxis may prevent outbreaks by avoiding food before exercise and extreme temperatures while they exercise. Almost all sports enthusiasts are at risk of developing traumatic entities such as nail dystrophies, calluses and blisters. Other more unusual traumatic skin conditions, such as talon noire, jogger’s nipples and mogul’s palm, occur in specific sports. Several techniques and special clothing exist to help prevent traumatic skin conditions in athletes. Almost all athletes, to some degree, interact with the environment. Winter sport athletes may develop frostbite and swimmers in both fresh and saltwater may develop swimmer’s itch or sea bather’s eruption, respectively. Swimmers with fair skin and light hair may also present with unusual green hair that results from the deposition of copper within the hair. Finally, athletes are at risk of developing both benign and malignant neoplasms. Hockey players, surfers, boxers and football players can develop athlete’s nodules. Outdoor sports enthusiasts are at greater risk of developing melanoma and non-melanoma skin cancer. Athletes spend a great deal of time outdoors, typically during peak hours of ultraviolet exposure. The frequent use of sunscreens and protective clothing will decrease the athlete’s sun exposure. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete.

Methicillin-resistant Staphylococcus aureus and athletes

Methicillin-resistant Staphylococcus aureus infections have become an increasingly common condition among athletes. Physical contact, shared facilities and equipment, and hygienic practices of athletes all contribute to methicillin-resistant S. aureus transmission among sports participants. This review elucidates the risk factors predisposing to methicillin-resistant S. aureus infection in athletes and provides guidance for treatment and prevention.

Automated bone lead analysis by K-x-ray fluorescence for the clinical environment

The use of K-x-ray fluorescence (K-XRF) for measuring the content of lead in bones began over a decade ago (Ahlgren et al., 1976). In K-XRF, lead atoms are made to emit K-x-rays by exciting them with gamma radiation from a radioisotope. It was realized that extracting the signal (the fluorescence photons) from the large background (Compton scattered photons) was the chief impediment to be overcome. The use of carefully chosen geometries coupled with radioisotopes with gamma emissions of a single or few energies has succeeded in this regard (Ahlgren et al., 1976; Price et al., 1984; Somervaille et al., 1985; Jones et al., 1987). For radiation safety reasons, as well as ease of access to bone material with little overlying tissue, measurement sites are bones in the appendicular skeleton (Ahlgren et al., 1980; Somervaille et al., 1987; Somervaille et al., 1985; Chettle et al., 1989).

A practical guide for serologic evaluation of autoimmune connective tissue diseases

UNLABELLED Serologic testing is important in the evaluation of patients with autoimmune connective tissue diseases (CTD). There are many techniques. Each of the tests has different sensitivity and specificity with varying diagnostic value. These serologic tests detect antibodies to numerous cellular components. The diagnostic significance and specificity of each antibody vary. Choosing the appropriate test and understanding its clinical utility is an important aspect in the diagnostic evaluation of patients with CTD. (J Am Acad Dermatol 2000;42:159-74.) LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be familiar with the various serologic tests for CTD, should understand the associations of specific antibodies with individual CTD, and should identify the factors that influence the predictive value of these serologic tests.

Glipizide-induced pigmented purpuric dermatosis

Pigmented purpuric dermatosis can occasionally be caused by various medications. No reported cases of oral hypoglycemic agents causing pigmented purpuric dermatosis exist. We report a case of glipizide-induced pigmented dermatosis.

Prevalence of tinea pedis in professional and college soccer players versus non-athletes.

Objective:To assess and compare the prevalence of tinea pedis among professional soccer players, college soccer players, and non-athletes. We sought to assess the prevalence of various risk factors and their association with tinea pedis among these different groups. Design:Survey study. Setting:United States. Patients:Members of a United Soccer League (USL) professional team (N = 16), male (N = 16) and female (N = 14) NCAA soccer teams at a local college, and male (N = 15) and female (N = 15) non-athletes from a local medical school. Intervention:All participants anonymously answered questions on their risk factors for tinea pedis and underwent physical and mycological examinations. Main Outcome Measures:Clinical exam, potassium hydroxide solution (KOH), and culture. Results:Tinea pedis infected 69% professional soccer players (11 of 16) compared with 69% of male college soccer players (11 of 16) and 43% of female college soccer players (6 of 14), whereas non-athletes demonstrated significantly less tinea pedis (P < 0.001), including 20% of male non-athletes (3 of 15) and 0% of female non-athletes (0 of 15). Conclusions:These results indicate a need for improved primary prevention of tinea pedis among athletes. A preventive program involving education and coach participation is needed to target these individuals.

Sports-related pads

Knuckle pads, first described by Garrod in 1893, 1 are benign, asymptomatic, well‐ circumscribed, smooth, firm, skin colored papules, nodules, or plaques. They most commonly occur on the dorsal aspect of the proximal interphalangeal joint of the finger, 2 but also may occur on the dorsal aspects of the foot over joints. 3–5 Knuckle pads may be inherited or acquired. 1 While some authors suggest that trauma is not a significant factor, 6 acquired knuckle pads have been associated with repetitive friction and trauma, 2,7 and may resemble athletes nodules (also referred to as collagenomas). 1 Histologically, knuckle pads are characterized by hyperkeratosis, hypergranulosis, proliferation of fibroblasts and capillaries, and thickened and irregular collagen bundles. 1 Few cases of knuckle pads involving the lower extremities have been reported. 7 Knuckle pads of the feet have been described in association with inherited syndromes, such as acrokeratoelastoidosis Costa, 3 a syndrome of knuckle pads, leukonychia and deafness, 4 and a syndrome of knuckle pads, leukonychia, deafness and keratosis palmoplantaris. 5 We report a case that illustrates an unusual presentation of acquired knuckle pads of the feet secondary to repetitive friction from athletic gear.

Tinea pedis in athletes

With the growing number of athletes in the world, the unique health problems specific to this population are increasing. Athletes experience many benefits from exercise, such as a decreased risk for heart disease and stroke, but also experience an increased risk for other medical issues, such as stress fractures, blisters, and even tinea pedis. Prompt diagnosis and treatment of these diseases enable athletes to continue to train and compete. The United States population, at large, has an estimated 10–20% lifetime risk of acquiring some type of dermatophyte infection. 1 Athletes, specifically, experience an increased risk of tinea pedis as a result of increased contact with swimming pools, athletic shoes, and sports equipment, occlusion from equipment, and, to a lesser degree, depressed immune function. 2–4 This article reviews the clinical presentation, epidemiology, diagnosis, treatment, and prevention of tinea pedis in athletes, and also discusses some sport-specific data.

Colocalization of Alopecia Areata and Vitiligo

Abstract: We report an 18‐year‐old woman who had a 4‐month history of colocalization of alopecia areata and vitiligo, principally on the occipital portion of the scalp.

Transmission of cutaneous infections in athletes

Myriad dermatoses can affect athletes. One of the most common cutaneous manifestations of athletic activity are skin infections. Bacteria,1–4 viruses,1,2,4–8 and fungi1,2,4,9–11 cause these infections. Many are contagious and may have serious ramifications for team practices and competitions. Knowledge of these infections facilitates implementation of rapid treatment and preventive measures to ensure the least disruption in daily team activities. Several specific sports related dermatological conditions are caused by bacterial infection. Staphylococcal infection is the most common but streptococcal infection also commonly occurs.1–4 Both organisms may present as varying clinical entities including impetigo, erysipelas, folliculitis,1,2,4 and furunculosis.3 In general, they are probably contagious to some degree. Impetigo, characterised by well defined, erythematous, yellow crusted, scaling plaques, and erysipelas, characterised by well defined, advancing, erythematous plaques, can be treated with topical warm soaks and oral antibiotics.1,4 Folliculitis presents as small follicular pustules that can be treated with topical or oral antibiotics.1 These bacterial infections occur in sports in which close personal contact occurs, including rugby, judo, and wrestling.2,4 Furunculosis outbreaks, however, have been noted also in football and basketball athletes. One study showed that 25% of high school athletes in these sports developed furunculosis.3 …