Sports Medicine: Just the Facts

CHAPTER 26 • DERMATOLOGY 155

TINEACORPORIS

• Annular lesion having a sharply demarcated, red-
  dened border with central clearing.


• The dermatophyte infection produces concentric rings
  along its annular margins.
  •Tinea corporis gladiatorum has been more frequently
  isolated and reported in wrestlers on their head, neck,
  and upper arms (Adams, 2002b).


• In the majority of cases, Trichophyton tonsuransis the
  causative fungus (Adams, 2002b).


• Recent studies reveal oral fluconazole, 200 mg, taken
  once weekly for 4 weeks had negative cultures after
  7 days in 60% of the wrestlers (Adams, 2002b).


• The NCAA requires a minimum of 72 h of topical
  terbinafine or naftifine to skin lesions, a minimum of
  2 weeks of oral therapy for scalp lesions, and all
  lesions to be adequately covered with an antifungal
  cream, gas-permeable dressing, and ProWrap with
  stretch tape prior to wrestling (Bubb, 2002).

TINEACRURIS

• An erythematous, pruritic plaque with well-demar-
  cated, scaly borders that extends to the groin, upper
  thighs, abdomen, and perineum, but spares the scro-
  tum (Freeman and Bergfeld, 1977).


• The scrotum is spared because of the fungistatic
  sebum produced by the scrotal skin (Basler, 1983).


• The appearance of an inflammatory, red rash with
  satellite lesions involving the scrotum is candidiasis
  and requires treatment with imadazole creams.


• Diagnosis can be confirmed by the presence of fungal
  hyphae on a KOH slide.


• Oral antifungal agents may be required in recalcitrant
  cases, if the hair roots are involved.
  •Tinea cruris must also be differentiated from candidia
  intertrigo (scrotal involvement and satellite lesions),
  erythrasma (brown and scaly, fluoresces coral red),
  psoriasis (silvery scale, pitted nails, and scalp
  lesions), folliculitis (punctate pustules), or a chronic
  irritant dermatitis from elasticized undergarments
  (Hainer, 2003).

TINEAVERSICOLOR
•A chronic, asymptomatic pigmented scaling macular
dermatosis associated with the overgrowth of the
active fungal form of Pityrosporum orbiculareknown
as Malasseziafurfur(Kantor and Bergfeld, 1988).
•Wood’s lamp reveals a yellow-green flourescence of
the skin scales (Conklin, 1990).
•Tinea versicolor is treated with topical 2.5% selenium
sulfide shampoo (Selsun) for 15 to 30 min over 5 to
10 days or by applying the lotion from the neck down
to the thighs overnight (6 to 12 h) and rinsed off the
next morning (Bergfeld and Helm, 1991).

• In extensive disease, oral ketoconazole 200 mg daily
  for 5 days or 400 mg once a month has been shown
  to be an effective alternative therapy (Conklin, 1990).


• The athlete needs to continue to exercise and perspire
  for at least 1 h after taking ketoconazole to promote
  absorption into the hair root (Bergfeld and Elston,
  1994).


• Griseofulvin is not an effective treatment.

ONYCHOMYCOSIS

•Onychomycosis is a common toenail fungal infection

known as tinea unguium and can be attributed to either

of two dermataphytes, trichophyton rubrum or tryto-

phytum mentagrophytes, in 80% of cases (Scher, 1999).

• Itraconazole (Sporanox) and terbinafine (Lamisil) are
  the therapeutic agents of choice for both toenail and
  fingernail therapy in adults (Rodgers and Basler,
  2001).


• Itraconazole can be given in either a continuous dose
  of 200 mg daily for 12 weeks for toenails and 6 weeks
  for fingernails or a pulsed dose of 400 mg daily for the
  first full week of 3–4 successive months (toenails) and
  two successive months (fingernails) (Scher, 1999;
  Rodgers and Basler, 2001).
  •Terbinafine 250 mg, is taken daily for 12 weeks for
  toenails and 6 weeks for fingernails (Scher, 1999;
  Rodgers and Basler, 2001).


• Laboratory analysis for hepatotoxicity and pancytope-
  nia must be performed during therapy.

MISCELLANEOUS

CONTACT DERMATITIS

• Primary irritant dermatitis is a nonallergic reaction that
  leads to symptoms within minutes of the exposure
  (Bergfeld, 1984). The dermatitis is localized to the con-
  tact site and exhibits erythema and a burning sensation.
  Common irritants are detergents and soaps, adhesive pre-
  tape sprays, sunscreens, and fiberglass (Adams, 2002a).


• Allergic contact dermatitis is an acquired immune
  response that develops hours to days after recurrent
  exposure to an allergen. The dermatitis exhibits
  patches of erythema, edema, vesicle formation, and
  extreme pruritus. Equipment with protective rubber
  coverings (golf clubs) and black rubber seals (swim
  gear), tanned leather straps, latex products, iodine
  preparations, topical antibiotic ointments, adhesive
  tape, shoe dyes, and poison ivy or oak have all pro-
  duced allergic reactions (Bergfeld and Helm, 1991).


• Initial treatment includes avoidance, washing with
  water in an attempt to physically remove the irritant
  and prevent further systemic progression.