150 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE
•Treatment consists of cleaning and debriding the
tissue with warm, soapy water and applying a topical
antibacterial ointment.
- Thin covering of antibacterial ointment (mupirocin) or
an adhesive dressing (DuoDerm, Op-Site) promotes
healing. - Because of the risk of blood-borne pathogens and sub-
sequent disease transmission, all wounds should be cov-
ered with an occlusive dressing during participation. - National Collegiate Athletic Association (NCAA)
mandates athletes be removed from competition if
active bleeding exists, the bleeding stopped and a
dressing applied to withstand the rigors of competi-
tion (Bubb, 2002).
ACNE MECHANICA
- An occlusive obstruction of the follicular piloseba-
ceous units - The papulopustular eruption commonly affects areas
include the forehead, cheek, chin, shoulders, back,
and hips. - Preventive measures include wearing a clean, cotton
T-shirt against the skin to absorb the perspiration,
reduce friction, and prevent follicular occlusion
(Basler, 1989). - The equipment should be routinely cleaned with soap
and water or an alcohol solution to prevent bacterial
formation. - Acne mechanica in dark-skinned athletes may evolve
into acne keloidalis on the nape of the neck (Pharis,
Teller, and Wolf, Jr, 1997). - The athlete can treat the condition with various topical
acne keratolytics with astringents (3% salicylic acid,
70% resorcinol) and antibiotics (tetracycline, clin-
damycin) (Basler, 1989). Athletes should be well
informed and educated prior to the use isotretinoin for
severe pustular acne because of the side effects of
muscle soreness, joint pain, and lethargy (Basler,
1989).
ATHLETIC NODULES
- Fibrotic connective tissue (collagenomas) because of
repetitive pressure, friction, or trauma over bony
prominences (Cohen, Eliezri, and Silvers, 1992). - Commonly located on knuckles (boxers, football play-
ers), tibial tuberosity (surfers), dorsal feet (hockey,
skate bites. runners. hikers) (Pharis, Teller, and Wolf, Jr,
1997; Erickson, 1967).
•Treatment includes intralesional steroids and protective
taping and padding (Cohen, Eliezri, and Silvers, 1992).
BLACK HEEL- Black heel, or talon noir,refers to a bluish-black plaque
formation of horizontally arranged dots or calcaneal
petechiae within the stratum corneum on the posterior
or posterolateral aspect of the heel (Wilkinson, 1977). - The condition occurs more frequently in adolescent and
younger adults playing basketball, tennis, track, and field
events where athletes are changing direction suddenly.
•A similar condition, mogul’s palm, has been described
on the hypothenar eminence of mogul skiers’ palms
that are constantly planting their poles and shifting
direction (Swinehart, 1992). - Self-limiting and will resolve spontaneously once the
season ends. - The use of heel cups, felt pads, cushioned athletic socks,
and properly fitted footwear may help to prevent black
heel formation.
BLACK TOENAIL- Rapid deceleration of the forefoot against the shoe toe
box may produce subungual hemorrhages of the first
and second toenail beds. - The condition occurs with greater frequency in sports
requiring quick stops, such as tennis, skiing, hiking,
and rock climbing (Pharis, Teller, and Wolf, Jr, 1997). - The hematoma can be drained by carefully boring a
hole through the nail with an 18-gauge needle or elec-
trocautery unit. - Appropriate running shoes (2 cm from the longest toe to
the end of the shoe) and properly trimming the distal nail
to its shortest length in a straight-cut line will reduce the
likelihood of developing this condition (Adams, 2002a). - Notable exceptions are the persistence of a linear
black band or streak running the entire length of the
nail representing a melanocytic nevus or the more
serious involvement of the proximal nail fold in
malignant melanoma (Crowe and Sorensen, 1999).
BLISTERS•Vesicles or bulla filled with either serosanguinous
fluid or blood.- Repeated pressure or friction over boney prominences
associated with excessive perspiration and improperly
fitted equipment leads to the formation of blisters.
•Treat early with moleskin donuts and nylon foot stock-
ings to decrease friction, talcum powder to absorb per-
spiration, and benzoin to harden the epidermis
(Levine, 1980).