Fitzpatrick's Dermatology in General Medicine, 8e

Chapter 99. Sports Dermatology

Dirk M. Elston

Sports Dermatology at a Glance

Forty percent of all athletes develop skin problems.
Infections are highly prevalent.
Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) has emerged as the most important pathogen among athletes.
MRSA typically presents as an abscess or folliculitis.
The most important intervention for a CAMRSA abscess is drainage.
Control of MRSA outbreaks requires treatment of fomites and skin colonization.
Infections with Pseudomonas, Vibrio, and atypical mycobacteria are frequently associated with water sports.
Heat and cold injury remain important problems in athletes.

Skin problems are common among athletes.1,2 During an 8-week survey of university athletes, 40% reported skin problems.3 In a study of mountain biking injuries, skin lesions accounted for 75% of all injuries.4 Skin lesions account for 35% of all in-line skating injuries.5 Skin infections are more prevalent in athletes than in the general population.6 Skin-related complaints are especially common in warm, humid climates. During the 1993 Central American and Caribbean Games, held in Puerto Rico, one out of every hundred athletes had a skin-related complaint severe enough to require medical care.7 Similarly, sports that involve repeated immersion in water are associated with an increased incidence of skin injury and infection.8 Winter sports often involve short periods of repetitive injury resulting in a high frequency of injuries.9

Table 99-1 lists some unique sports-associated skin conditions that are worthy of mention but are not discussed further in this chapter (Figs. 99-1 and 99-2).

Table 99-1 Sports-Associated Skin Conditions

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Table 99-1 Sports-Associated Skin Conditions

Bikini bottom: bacterial folliculitis on the buttocks of swimmers

Jazz ballet bottom: buttock cleft abscess

Jogger's nipples: painful, swollen, eroded or hyperkeratotic nipples

Karate cicatrices: linear scars on the dorsal aspects of the hands

Mogul skier's palm: traumatic hypothenar ecchymosis

Painful piezogenic pedal papules: transdermal fat herniations

Ping-pong patches: traumatic ecchymotic patches

Pool palms: smooth, shiny, tender palms secondary to rough pool surfaces

Pulling-boat hands: pernio-like condition produced by friction and damp cold

Rower's rump: lichenification

Runner's nail: multiple Beau's lines or periodic shedding of the nail plate (see Fig. 99-1)

Runner's rump: ecchymoses of the superior gluteal cleft

Stingray hickey: bite ecchymosis

Stretcher's scrotum: scrotal hematoma

Swimmer's shine: facial oiliness seen in swimmers

Swimmer's shoulder: abrasion of the shoulder by the beard during crawl stroke

Talon noir (black heel): intradermal hemorrhage

Tennis toe: subungual hematoma with or without subungual hyperkeratosis or nail dystrophy (jogger's toe, hiker's toe, skier's toe are similar) (see Fig. 99-2)

Turf toe: metatarsophalangeal joint sprain