KIN 405: Medical Aspects of Sports

1. KIN 405: Medical Aspects of Sports Dermatology: Recognizing Illnesses and Disorders of the Skin

2. Skin Lesions • Often overlooked or trivialized • Can signify serious disease in well patients • Local conditions • Systemic conditions • Difficult for many health professionals to recognize

3. Athletic Trainers’ Goals • Recognize various forms of skin lesions • Reassure patients that every little blemish is NOT skin cancer • Refer for definitive diagnosis and treatment • Restrict competition for athletes with communicable illness

4. Presentation Outline • Anatomy of the skin • Types of lesions • Rashes • Infections • Bacterial • Fungal • Viral

5. Presentation Outline (cont) • Skin cancer • Assessment techniques • Treatment techniques

6. Anatomy of the Skin • Stratum corneum • Epidermis • Dermis • Pilosebaceous unit • Subcutaneous fat

7. Stratum Corneum • Top layer of skin • Flakes off imperceptibly • Barrier to noxious substances • Totally replaced every 27 days

8. Epidermis • Protects against UV damage • Provides cutaneous immunity

9. Dermis • Connective tissue • Provides elasticity & strength • Contains blood vessels, nerves, & sweat glands • Skin splits when dermis is cut

10. Pilosebaceous Unit • Hair shaft • Hair follicle • Erector muscle • Sebaceous gland • Common site of bacterial infections

11. Subcutaneous Fat • Insulates • Protects

12. Macules Papules Plaques Pustules Vesicles Nodules Desquamination Bullae Ulcers Wheals Kinds of Skin Lesions

13. Macules • Flat • Nonpalpable • Discolored • Less than 1cm

14. Causes of Macules • Hypopigmentation • Hyperpigmentation • Permanent vascular abnormalities of the skin • Transient capillary dilatation (erythema)

15. Hypopigmentation Macules Vitiligo Depigmentation

16. Hyperpigmentation Macules Café-au-lait spots

17. Permanent Vascular Abnormalities of the Skin CAPILLARY HEMANGIOMA OF INFANCY PORT-WINE STAIN

18. Transient Capillary Dilatation (Erythema) Erythema Infectiosum (systemic viral)

19. Papules • Latin for “Pimple” • Raised lesion • Less than .5 cm • Solid

20. Example of Papules Rosacea

21. Plaques • Large, raised lesion • Well-defined • Confluence of multiple papules • Chronic rubbing leads to “lichenification” (thickened skin)

22. Example of Plaques PSORIASIS VULGARIS OF THE ELBOW

23. Pustules • Circumscribed • Superficial • Contains purulent exudate that may be • white • yellow • greenish yellow • hemorrhagic.

24. Example of Pustules Acne Vulgaris

25. Vesicles • Latin for “little bladder” • Fluid filled cavity • Less than .5 cm • Walls can be translucent • Contains serum, lymph, blood, or extracellular fluid

26. Example of Vesicles Nongenital herpes simplex virus (HSV) infection

27. Bullae • Latin for “bubble” • Fluid filled cavity • Greater than .5 cm • Walls can be translucent • Contains serum, lymph, blood, or extracellular fluid Diabetic bullae

28. Nodules • Latin for “small knot” • Palpable, solid • Round or ellipsoid • Epidermal, dermal, or subcutaneous • Generally deeper and larger than papules

29. Example of Nodules Adult T-Cell Leukemia/Lymphoma

30. Desquamination • Proliferation of epidermis resulting in abnormally formed stratum corneum • “Scaly” • Large (membranous) or small (dust)

31. Example of Desquamination Solar Keratosis

32. Ulcers • Pathologically altered tissue (different from a wound) • Epidermal - heals w/out scar • Dermal - heals w/ scar

33. Example of Ulcers Stage IV Pressure Ulcer on Sacrum

34. Wheals • Hives • Rounded or flat topped • Pale red • Transient • Can change rapidly in size, shape, and location due to shifting edema in the dermis

35. Example of Wheals Cutaneous Vasculitis

36. Rashes • Acne • Dermatitis • Intertrigo • Urticaria • Psoriasis • Seborrheic dermatitis • Pityriasis rosea

37. Acne • Affects 75% of the population • Can involve inflammation of the pilosebaceous unit • Food choices NOT causative • Endocrine and emotional links • Not contagious • Four stages

38. Grade I Acne • Comedones (blackheads) • Some whiteheads • Topical antibiotics (clindamycin, erythromycin • Benzoyl peroxide gels (2%,5%,10%) • Tretinoin (Retin-A) creams

39. Grade II Acne • Erythematous papules • Oral tetracycline antibiotics added to previous tx regimen • For females, oral estrogens combined with progesterone or antiandrogens

40. Grade III Acne • Pustules • Isotretinoin (Accutane) • Contraception (2 forms) is absolutely necessary • Do not combine tetracycline and isotretinoin • Risk of psychiatric side effects

41. Grade IV Acne • Cysts • Nodules • Scars

42. Dermatitis • Inflammation of the skin • Sometimes called eczema • Many causes and forms (allergic vs non-allergic) • Not contagious • Contact dermatitis caused by contact with noxious substances (formaldehyde, plant oils, rubber, etc)

43. Dermatitis-Signs and Symptoms • Pruritis (itching) • Erythematous papules • Vesicles (or bullae) • Crusting • Edema Poison Ivy, 5 days post exposure

44. Dermatitis-Treatment • Identify and remove the etiologic agent • Bullae may be drained, but tops should not be removed • Cool compresses • Topical corticosteroids Contact dermatitis from paraben-containing foot cream

45. Dermatitis-Treatment (cont) • In severe cases, systemic corticosteroids may be indicated • Prednisone: two-week course, 70 mg initially, tapering by 5 mg daily Chronic contact dermatitis on the hands of a concrete worker

46. Intertrigo • Caused by friction in skin folds • Axilla, inframammary area, groin • Gradual and progressive skin abrasion irritated by sweat and heat

47. Intertrigo-Treatment • Mild topical hydrocortisone • Zinc oxide ointment • Reduce friction • Corn starch/baby powder • Expose to air

48. Urticaria • Transient hives characterized by wheals • Pruritis • Caused by sunlight, medication or food allergy, cold, and exercise

49. Urticaria Wheals with white-to-light-pink color centrally and peripheral erythema in a close-up view.

50. Cholinergic Urticaria • Exercise-induced wheals & pruritis • Hot shower may also reproduce symptoms Urticarial papules on neck w/in 30 minutes of vigorous exercise