CHAPTER 26 • DERMATOLOGY 151- Bullous blisters should be drained at the edge with a
small needle leaving the roof of the blister as a pro-
tective layer. - Ruptured and deroofed blisters may require the appli-
cation of a hydrocolloidal dressing (Duoderm) or an
adhesive polyurethane dressing (Op-Site) as a second-
skin layer to reduce discomfort and enhance healing
(Bergfeld and Elston, 1994). - Primary prevention includes wearing properly fitted
and broken-in footwear, use of absorbent socks, and
applying petrolatum jelly over bony prominences.
CORN AND CALLUSES
- Corns are small, soft or hard, deep painful conical
lesions with a translucent central core in the web spaces
of the toes and the plantar surface of a malaligned
distal metatarsal head. - Calluses tend to be larger, hyperkeratotic nonpainful
lesions that serve as a protective skin layer and are
considered an advantage in gymnastics, racquet sports,
and rowing. - The development of small black dots representing
thrombosed capillaries implies the presence of plantar
warts, compared to calluses that display a thickened
epidermis with intact dermatoglyphics. - The most important factor for successful recovery and
prevention of the condition is redistributing the source
of pressure (Conklin, 1990). - The shaping of a metatarsal pad to the plantar surface,
creating a wider shoe toebox, adding cotton or foam
padding between the toes, and applying moleskin will
all aid in decreasing the pressure over the existing
lesion and prevent further injury.
•Keratolytic agents such as 5–10% salicylic acid in col-
lodian, 40% salicylic acid plaster, and 12% lactic acid
will eliminate the lesions (Kantor and Bergfeld, 1988).
FOLLICULAR KELOIDITIS
- An inflammatory proliferation of fibrous tissue—
usually painless and more prevalent in dark-skinned
African athletes. - Multiple, small keloids commonly develop where
the headgear comes in contact with the forehead,
cheeks, and posterior neck or where the undergar-
ment pads cover the thighs, knees, and shoulders
(Basler, 1983).
•Treatment involves gradual reduction of the lesion
with intralesional injections of steroids or topical
application of a steroid-impregnated adhesive tape
(Dover, 1993).
INGROWN TOENAIL- The condition is caused by nailbed pressure forcing
the lateral edge of the nailplate into the lateral nail
fold. - The distal nail should be trimmed straight across and
at least one thumbnail in distance should exist from
the longest distal toenail to the end of the shoe to pre-
vent reoccurrence. - Acute treatment options include Epsom salt water
bath, gentle manual nail elevation, placing a small
piece of cotton under the corner of the nail to elevate
the lateral margin to alleviate inflammation, use of
antibiotics, and excision of the lateral one-third of the
nail (Williams and Batts, 2001).
JOGGER’S NIPPLES- Irritation and friction between coarse, cotton fabrics
and the unprotected nipple and areola lead to painful,
bleeding nipples (Levit, 1977). - The majority of jogger’s nipples occur in male ath-
letes, especially long-distance runners and triathletes
(Basler, 1989). - Preventive measures include wearing of soft, natural,
silk fiber shirts, and the application of breast padding,
electrocardiographic lead pads, band-aids, or a
double coat of fingernail polish over the nipples prior
to running.
PIEZOGENIC PAPULES•Painful hernitations of subdermal fat into the dermis
on the lateral or medial heel surface (Shelly and
Raunsley, 1968).- Flesh-colored papules noticeable only on weight-
bearing are found in up to 20% of the general popula-
tion (Dover, 1993). - More common in endurance athletes.
•Padding, taping for support and/or heel cups may help
reduce the pain.
ROWER’S RUMP•Rower’s rump develops in the gluteal cleft of rowers
training on small, unpadded scull seats, and metal
rowing machines (Tomecki and Mikesell, 1987).- Repeated friction produces a lichen simplex chronicus
of the buttocks.
•Treatment consists of padding the rowing seat and the
use of potent, fluorinated topical steroids.