Sports Medicine: Just the Facts

CHAPTER 26 • DERMATOLOGY 153

turn grayish-white, develop paresthesias, and finally

lose sensation.

• Penile frostnip has been reported in joggers wearing
  polyester trousers and cotton undershorts (Hershkowitz,
  1977).


• Frostnip can be reversed with immediate self-rewarm-
  ing of the exposed area.
  •Paresthesias and a burning sensation may persist for
  several months after the injury.


• Prevention includes insulation and skin protection
  from both wind and cold, not shaving prior to partici-
  pation to preserve the natural skin oils and application
  of a sunscreen. (D’Ambrosia, 1977)

FROSTBITE

• Frostbite occurs as living tissue ceases cellular metab-
  olism from exposure to temperatures below 28°F
  (–2°C)(D’Ambrosia, 1977).


• Muscles, nerves and blood vessels are damaged ear-
  lier than tendons and bone (D’Ambrosia, 1977).


• The tissue appears cold, white, and hard and will not
  exhibit pain or sensation to tactile stimulation until
  thawing occurs.
  •Rewarming of the tissue should be attempted only
  when the environment can be controlled and risk of
  refreezing of the affected part is eliminated.


• Frozen areas should be rewarmed as rapidly as possible
  in a warm-water, circulating bath of 110–112°F (38–
  44 °C) to prevent mechanical trauma (D’Ambrosia,
  1977).
  •Tissue necrosis may occur for weeks to months as
  reepithelialization replaces the denuded areas (Levine,
  1980).

COLDURTICARIA

• Cold urticaria is rare but the most common form of
  acquired physical urticaria in winter athletics and cold
  water swimming (Mikhailov, Berova, and Andreev,
  1977).


• Wheals or hives are usually confined to the exposed
  area.


• Athletes with cold urticaria are likely to have recurrent,
  severe episodes during similar circumstances because
  of the antigen–antibody reaction resulting in the
  release of histamine (D’Ambrosia, 1977).
  •To confirm the diagnosis, provocative testing of the
  forearm with ice cubes for 5 min or submerging the
  forearm in cold water for 5–15 min will produce
  wheals (Pharis, Teller, and Wolf, Jr, 1997).


• The prophylactic use of cyproheptadine (Periactin), 2 mg
  once or twice a day, or doxepin (Sinequan), 10 mg two
  or three times daily have been useful in preventing
  reoccurrence (Williams and Batts, 2001).

INFECTIOUS INJURY

BACTERIAL

FURUNCULOSIS

• Erythematous, nodular abscesses found in the hairy
  areas of the axilla, buttocks, and groin.
  •Highly contagious and known outbreaks have occur-
  red in team sports, implicating close contact and poor
  hygiene practices (Sosin et al, 1989).


• Staphyloccocci are the most common bacteria and the
  nares should be cultured because of the predisposition
  of the nares to harbor the staphylococcus species
  (Adams, 2002a).


• Acute treatment consists of warm compresses and a
  10-day course of a cephalosporin, erythromycin, or
  penicillinase-resistant penicillin derivative (Bergfeld
  and Helm, 1991).
  •A prophylactic dose of rifampin, 600 mg for 10 days,
  has been utilized in resistant cases (Williams and
  Batts, 2001).


• Incision and drainage is necessary because of the poor
  hematogenous antibiotic penetration.


• The NCAA requires all wrestlers to be without new
  lesions for 48 h before a meet, have completed 72 h of
  antibiotic therapy, and have no moist or draining
  lesions prior to competition (Bubb, 2002).

PITTEDKERATOLYSIS

•A scalloped-bordered plaque with sculpted pits of vari-

able depth forms on the weight-bearing plantar surfaces

(heel and toes) and is often misdiagnosed as tinea pedis.

• Hyperhidrosis and gram-positive bacteria, most com-
  monly Corynebacterium and Micrococcus species,
  found in the stratum corneum have been implicated in
  producing the pungent foot odor (Schissel, Aydelotte,
  and Keller, 1999).


• Application of topical antibiotics for 2–4 weeks (5%
  erythromycin in 10% benzoyl peroxide) will reduce
  the bacterial inflammatory component and result in
  clearing (Kantor and Bergfeld, 1988).


• Prophylactic therapy includes washing with benzoyl
  peroxide soap and adding topical foot powders with
  20% aluminum chloride (Drysol) to control hyper-
  hidrosis (Schissel, Aydelotte, and Keller, 1999).

IMPETIGO

• Serosanguinous, honey-crusted pustules on an erythe-
  matous base.


• Beta-hemolytic streptococci more commonly produce
  impetigo, but staphylococcal species have been iso-
  lated from cultured wounds.


• Athletes participating in contact sports or swimming
  are highly contagious and should not participate in