Sports Medicine: Just the Facts

152 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE

RUNNER’S RUMP

•A collection of ecchymotic lesions on the superior por-
tion of the gluteal cleft of long-distance runners
(Basler, 1989).

• Results from constant friction between the gluteal
  folds with each running stride.


• The hyperpigmentation will spontaneously resolve
  with rest.

ENVIRONMENTAL INJURY

HEAT

SUNBURN

• Exposure to ultraviolet Bor UVB (290–320 nm) light
  during the hours of 10 a.m. and 2 p.m. for 2–6 h will
  produce mild erythema to intense blistering, edema,
  and pain (Kantor and Bergfeld, 1988).
  •A rise in altitude from sea level to 5,000 feet intensi-
  fies sunlight by 20% (Levine, 1980).


• The ultravioletA (UVA) light range of 320–400 nm is
  1000-fold less burning to the skin than UVB. UVA is
  more penetrating and produces chronic damage to the
  skin (Conklin, 1990).


• Preventive measures include avoiding exercise between
  10 a.m. and 2 p.m., applying sun protective factor(SPF)
  15 or greater sunscreens with para-aminobenzoic acid
  ester (PABA) at least 20 min prior to sun exposure and
  recoating after water exposure (Levine, 1980).

MILIARIA

• Miliaria rubra, or prickly heat, occurs in hot, humid
  summer environments.


• Fine, diffuse erythematous vesiculopapular rash devel-
  ops over the occluded eccrine sweat glands (spares the
  palms and soles) (Habif, 1996).


• Application of hydrophilic ointments (Eucerin) and
  mild topical corticosteroids can open the occluded
  ducts (Bergfeld and Elston, 1994).

SOLARURTICARIA

• Solar urticaria is an uncommon cause of urticaria in
  athletes (Kantor and Bergfeld, 1988).


• The dermatoses manifest by itching and burning of the
  skin within minutes after exposure to UVA, UVB, or both
  wavelengths (Mikhailov, Berova, and Andreev, 1977).


• Erythema and wheal formation will follow and clear
  within 1 h after exposure (Pharis, Teller, and Wolf, Jr,
  1997).


• Normally unexposed skin areas of the trunk will be
  more prone to develop an urticarial reaction than the
  previously exposed face or distal extremities.
  
  
  • Phototesting is recommended to determine the type
    and treatment of solar urticaria.
  
  
  • Desentization and combination of psoralen and
    long-wave ultraviolet light(PUVA) have been suc-
    cessful in minimizing symptoms (Fitzpatrick et al,
    1992).
    •Antimalarials have been found effective (Mikhailov,
    Berova, and Andreev, 1977).
  
  
  
  

CHOLINERGICURTICARIA

• Cholinergic urticaria is an acetylcholine-mediated,
  pruritic dermatosis that occurs commonly on the chest
  and back during exercise or emotional stress (Houston
  and Knox, 1997).


• The condition is characterized by the eruption of pin-
  point papular wheals with a surrounding subcuta-
  neous erythematous flare during and after heat
  exposure or exercise.


• The most reliable and safe test is to have the athlete
  perform exercise for 15 min on a treadmill or bike to
  reproduce the lesions.
  •Treatment with H 1 antihistamines and danazol has
  been found to be effective if taken 1 h prior to exercise
  (Elston, 1999).
  •A hot shower the night prior may deplete histamine
  and provide a refractory period for the athlete to com-
  pete (Habif, 1996).


• The condition can be exacerbated with the use of aspirin.

COLD

CHILBLAIN

• Chilblain or pernio is the mildest form of cold injury
  and develops on the feet, hands, and face.


• Athletes participating in winter sports are initially
  unaware of the injury, but later complain of reddish-
  blue patches that burn, itch, and may later develop
  blisters (Kantor and Bergfeld, 1988).


• The injured area should be rewarmed, massaged
  gently to increase circulation, and protected from fur-
  ther environmental exposure.
  •Topical corticosteroids or a short burst of oral corti-
  costeroids may be utilized to minimize the painful,
  inflammatory skin lesions.


• The use of moisture-wicking socks and gloves, fre-
  quent sock and glove changes, and protective covering
  over the face aid in preventing this injury.

FROSTNIP

• Frostnip or superficial frostbite occurs as temperatures
  drop below 50°F (10°C) (Williams and Batts, 2001).


• The skin and superficial subcutaneous tissue of the
  fingertips, toes, nose, cheeks, and ears will blanche or