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Skin Manifestations of Athletes Competing in the Summer Olympics

What a Sports Medicine Physician Should Know

  • Review Article
  • Skin Manifestations of Athletes Competing in the Summer Olympics
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Abstract

Olympic athletes are vulnerable to traumatic, environmental and infectious skin manifestations. Although dermatological complaints are frequent among Olympians, there is a scarcity of literature that reviews sports-related dermatoses among Olympic athletes. A comprehensive review of PREMEDLINE and MEDLINE searches of all available literature through to January 2011 was conducted, focusing on sports-related dermatological presentations as well as the key words ‘Olympic athletes’ and ‘skin diseases’. Common skin conditions can be harmful and even prohibitive for competition.

Common aetiologies of dermatological conditions related to sports include: skin infections with dermatophytes such as tinea pedis and tinea corporis, bacteria such as pitted keratolysis, and folliculitis and viruses such as herpes gladiatorum. Frictional dermatoses occur commonly and include athlete’s nodules, jogger’s itch, frictional blisters, callosities and talon noir. Trauma can cause haematomas such as auricular haematomas. Due to long training hours in the sun, many endurance athletes experience high levels of UV radiation and a higher risk for both melanoma and non-melanoma skin cancer. Pre-existing dermatoses can also be aggravated with practice and competition; in particular, atopic eczema and physical urticarias.

Infrequent dermatoses are susceptible to misdiagnosis, delay in treatment and needless biopsies. This review highlights the diagnosis and management of sports-related dermatoses by the following general categories of Olympic sport: endurance, resistance, team sport, and performing arts.

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References

  1. Ljungqvist A, Jenoure PJ, Engebretsen L, et al. The International Olympic Committee (IOC) consensus statement on periodic health evaluation of elite athletes. Clin J Sport Med 2009; 19: 347–65

    Article  PubMed  Google Scholar 

  2. Carlsen KH, Kowalski ML. Asthma, allergy, the athlete and the Olympics. Allergy 2008; 63: 383–6

    Article  PubMed  Google Scholar 

  3. Derman WE. Profile of medical and injury consultations of Team South Africa during the XXVIIIth Olympiad, Athens 2004. South African J Sports Med 2008; 20: 72–6

    Google Scholar 

  4. Dickens R, Adams BB, Mutasim DF. Sports-related pads. Int J Dermatol 2002; 4: 291–3

    Article  Google Scholar 

  5. Uchiyama M, Tsuboi R, Mitsuhashi Y. Athlete’s nodule. J Dermatol 2009; 36: 608–11

    Article  PubMed  Google Scholar 

  6. Mailler EA, Adams BB. The wear and tear of 26.2: dermatological injuries reported on marathon day. Br J Sports Med 2004; 38: 498–501

    Article  PubMed  CAS  Google Scholar 

  7. Redbord KP, Adams BB. Piezogenic pedal papules in a marathon runner. Clin J Sport Med 2006; 16: 81–3

    Article  PubMed  Google Scholar 

  8. Adams BB. Dermatologic disorders of the athlete. Sports Med 2002; 32: 309–21

    Article  PubMed  Google Scholar 

  9. Kantor GR, Bergfeld WF. Common and uncommon dermatologic diseases related to sports activities. Exerc Sport Sci Rev 1988; 16: 215–53

    Article  PubMed  CAS  Google Scholar 

  10. Auger P, Marquis G, Joly J, et al. Epidemiology of tinea pedis in marathon runners: prevalence of occult athlete’s foot. Mycoses 1993; 36: 35–41

    Article  PubMed  CAS  Google Scholar 

  11. Tomecki KJ, Mikesell JF. Rower’s rump. J Am Acad Dermatol 1987; 16: 890–1

    Article  PubMed  CAS  Google Scholar 

  12. Basler RS, Basler GC, Palmer AH, et al. Special skin symptoms seen in swimmers. J Am Acad Dermatol 2000; 43: 299–305

    Article  PubMed  CAS  Google Scholar 

  13. Kamihama T, Kimura T, Hosokawa JI, et al. Tinea pedis outbreak in swimming pools in Japan. Public Health 1997; 111: 249–53

    PubMed  CAS  Google Scholar 

  14. Giffin CS. Wrestler’s ear: pathophysiology and treatment. Ann Plast Surg 1992; 28: 131–9

    Article  PubMed  CAS  Google Scholar 

  15. Kirkland EB, Adams BB. Methicillin-resistant Staphylococcus aureus and athletes. J Am Acad Dermatol 2008 Sep; 59 (3): 494–502

    Article  PubMed  Google Scholar 

  16. Brzeziński P. Piezogenic pedal papules: a chronic disease of athletes. Polish J Sports Med 2009; 25: 183–8

    Google Scholar 

  17. Basler RS, Garcia MA. Acing common skin problems in tennis players. Phys Sportsmed 1998; 26: 37–44

    Article  PubMed  CAS  Google Scholar 

  18. Wright JM, Webner D. Playing field issues in sports medicine. Curr Sports Med Rep 2010; 9 (3): 129–33

    PubMed  Google Scholar 

  19. Pickup TL, Adams BB. Prevalence of tinea pedis in professional and college soccer players versus non-athletes. Clin J Sport Med 2007; 17: 52–4

    Article  PubMed  Google Scholar 

  20. Biolcati G, Berlutti G, Bagarone A, et al. Dermatological marks in athletes of artistic and rhythmicgymnastics. Int J Sports Med 2004; 25: 638–40

    Article  PubMed  CAS  Google Scholar 

  21. Tomi NS, Altmeyer P, Kreuter A. Tacrolimus ointment for ‘jogger’s nipples’. Clin Exp Dermatol 2007; 32: 106–7

    PubMed  CAS  Google Scholar 

  22. Kohl TD, Lisney M. Tinea gladiatorum: wrestling’s emerging foe. Sports Med 2000; 29: 439–47

    Article  PubMed  CAS  Google Scholar 

  23. Doukas DJ, Holmes J, Leonard JA. A nonsurgical approach to painful piezogenic pedal papules. Cutis 2004; 73: 339–40,346

    PubMed  Google Scholar 

  24. Tamura BM, Cucé LC, Souza RL, et al. Plantar hyperhidrosis and pitted keratolysis treated with botulinum toxin injection. Dermatol Surg 2004; 30: 1510–4

    Article  PubMed  Google Scholar 

  25. Vlahovic TC, Dunn SP, Kemp K. The use of a clindamycin 1%-benzoyl peroxide 5% topical gel in the treatment of pitted keratolysis: a novel therapy. Adv Skin Wound Care 2009; 22: 564–6

    Article  PubMed  Google Scholar 

  26. Vazquez-Lopez F, Perez-Oliva N. Mupirocine ointment for symptomatic pitted keratolysis. Infection 1996; 24: 55

    Article  PubMed  CAS  Google Scholar 

  27. Ramsey ML. Pitted keratolysis: a common infection of active feet. Phys Sportsmed 1996; 24: 51–6

    Article  PubMed  CAS  Google Scholar 

  28. Whiting D. The successful treatment of creeping eruption with topical thiabendazole. S Afr Med J 1976; 50: 253–4

    PubMed  CAS  Google Scholar 

  29. Person JR. Green hair: treatment with a penicillamine shampoo. Arch Dermatol 1985; 121: 717–8

    Article  PubMed  CAS  Google Scholar 

  30. World Anti-Doping Agency. The World Anti-Doping Code. The 2010 Prohibited List International Standard [online]. Available from URL: http://www.wada-ama.org/rtecontent/document/2010_Prohibited_List_FINAL_EN_Web.pdf [Accessed 2010 Nov 22]

  31. Zuberbier T, Münzberger C, Haustein U, et al. Doubleblind crossover study of high-dose cetirizine in cholinergic urticaria. Dermatology 1996; 193: 324–7

    Article  PubMed  CAS  Google Scholar 

  32. Global DRO United States [online]. Available from URL: http://www.globaldro.com/us-en/default.aspx [Accessed 2011 Nov 14]

  33. Feinberg JH, Toner CB. Successful treatment of disabling cholinergic urticaria. Mil Med 2008 Feb; 173: 217–20

    PubMed  Google Scholar 

  34. Hazen PG, Weil ML. Itraconazole in the prevention and management of dermatophytosis in competitive wrestlers. J Am Acad Dermatol 1997 Mar; 36 (3Pt1): 481–2

    Article  PubMed  CAS  Google Scholar 

  35. Kohl TD, Martin DC, Nemeth R, et al. Fluconazole for the prevention and treatment of tinea gladiatorum. Pediatr Infect Dis J 2000; 19: 717–22

    Article  PubMed  CAS  Google Scholar 

  36. Anderson BJ. Managing herpes gladiatorum outbreaks in competitive wrestling: the 2007 Minnesota experience. Curr Sports Med Rep 2008 Nov-Dec; 7 (6): 323–7

    PubMed  CAS  Google Scholar 

  37. Ghosh SK, Bandyopadhyay D. Dermacase. Can you identify this condition? Cutaneous larva migrans. Can Fam Physician 2009 May; 55 (5): 489–491

    PubMed  Google Scholar 

  38. Knapik JJ, Reynolds KL, Duplantis KL, et al. Friction blisters. Pathophysiology, prevention and treatment. Sports Med 1995; 20: 136–47

    Article  PubMed  CAS  Google Scholar 

  39. Gerhardt LC, Strässle V, Lenz A, et al. Influence of epidermal hydration on the friction of human skin against textiles. J R Soc Interface 2008; 5: 1317–28

    Article  PubMed  Google Scholar 

  40. Cohen PR, Eliezri YD, Silvers DN. Athlete’s nodules: treatment by surgical excision. Sports Med 1990; 10: 198–203

    Article  PubMed  CAS  Google Scholar 

  41. Mikhailov P, Berova N, Andreev VC. Physical urticaria and sport. Cutis 1977; 20: 381–4, 389-90

    PubMed  CAS  Google Scholar 

  42. Dice JP. Physical urticaria. Immunol Allergy Clin North Am 2004; 24: 225–46,vi

    Article  PubMed  Google Scholar 

  43. Nichols AW. Exercise-induced anaphylaxis and urticaria. Clin Sports Med 1992; 11: 303–12

    PubMed  CAS  Google Scholar 

  44. MacKnight JM, Mistry DJ. Allergic disorders in the athlete. Clin Sports Med 2005; 24: 507–23,vii-viii

    Article  PubMed  Google Scholar 

  45. Schwartz LB, Delgado L, Craig T, et al. Exercise-induced hypersensitivity syndromes in recreational and competitive athletes: a PRACTALL consensus report (what the general practitioner should know about sports and allergy). Allergy 2008; 63: 953–61

    Article  PubMed  CAS  Google Scholar 

  46. Wong E, Eftekhari N, Greaves MW, et al. Beneficial effects of danazol on symptoms and laboratory changes in cholinergic urticaria. Br J Dermatol 1987; 116: 553–6

    Article  PubMed  CAS  Google Scholar 

  47. Del Giacco SR, Manconi PE, Del Giacco GS. Allergy and sports. Allergy 2001; 56: 215–23

    Article  PubMed  Google Scholar 

  48. Gerth van Wijk R, Roovers MH, Dieges PH. Exercisedependent anaphylaxis. Ned Tijdschr Geneeskd 1991; 135: 2293–5

    Google Scholar 

  49. Shadick NA, Liang MH, Partridge AJ, et al. The natural history of exercise-induced anaphylaxis: survey results from a 10-year follow-up study. J Allergy Clin Immunol 1999; 104: 123–7

    Article  PubMed  CAS  Google Scholar 

  50. Wade JP, Liang MH, Sheffer AL. Exercise-induced anaphylaxis: epidemiologic observations. Prog Clin Biol Res 1989; 297: 175–82

    PubMed  CAS  Google Scholar 

  51. Volcheck GW, Li JT. Exercise-induced urticaria and anaphylaxis. Mayo Clin Proc 1997; 72 (2): 140–7

    Article  PubMed  CAS  Google Scholar 

  52. Lee HB, Ahn IS, Choi JH, et al. A case of wheat-dependent exercise-induced anaphylaxis. Ann Dermatol 2009; 21: 447–9

    Article  PubMed  Google Scholar 

  53. Romano A, Di Fonso M, Giuffreda F, et al. Diagnostic work-up for food-dependent, exercise-induced anaphylaxis. Allergy 1995; 50: 817–24

    Article  PubMed  CAS  Google Scholar 

  54. Attye A, Auger P, Joly J. Incidence of occult athlete’s foot in swimmers. Eur J Epidemiol 1990; 6: 244–7

    Article  PubMed  CAS  Google Scholar 

  55. Bolaños B. Dermatophyte feet infection among students enrolled in swimming courses at a university pool. Bol Asoc Med P R 1991; 83: 181–4

    PubMed  Google Scholar 

  56. Field LA, Adams BB. Tinea pedis in athletes. Int J Dermatol 2008; 47: 485–92

    Article  PubMed  Google Scholar 

  57. Little M, Pereira P, Carrette T, et al. Jellyfish responsible for Irukandji syndrome. QJM 2006; 99 (6): 425–7

    Article  PubMed  CAS  Google Scholar 

  58. Gloster Jr HM, Brodland DG. The epidemiology of skin cancer. Dermatol Surg 1996; 22: 217–26

    Article  PubMed  Google Scholar 

  59. Moehrle M. Ultraviolet exposure in the Ironman triathlon. Med Sci Sports Exerc 2001; 33: 1385–6

    Article  PubMed  CAS  Google Scholar 

  60. Moehrle M, Heinrich L, Schmid A, et al. Extreme UV exposure of professional cyclists. Dermatology 2000; 201: 44–5

    Article  PubMed  CAS  Google Scholar 

  61. Moehrle M, Koehle W, Dietz K, et al. Reduction of minimal erythema dose by sweating. Photodermatol Photoimmunol Photomed 2000; 16: 260–2

    Article  PubMed  CAS  Google Scholar 

  62. Blazek V, Wienert V. The influence of corneal stratum hydratation on the chronological development of acute ultraviolet injury (author’s transl). Strahlentherapie 1981; 157: 280–6

    PubMed  CAS  Google Scholar 

  63. Ohlsén L, Skoog T, Sohn SA. The pathogenesis of cauliflower ear: an experimental study in rabbits. Scand J Plast Reconstr Surg 1975; 9: 34–9

    Article  PubMed  Google Scholar 

  64. Lee EC, Soliman AM, Kim J. Traumatic auricular hematoma: a case report. J Craniomaxillofac Trauma 1997; 3: 32–5

    PubMed  CAS  Google Scholar 

  65. Masterson DW. The ancient Greek origins of sports medicine. Br J Sports Med 1976; 10: 196–202

    Article  PubMed  CAS  Google Scholar 

  66. Kordi R, Mansournia A, Nourian RA, et al. Cauliflower ear and skin infections among wrestlers in Tehran. J Sports Sci Med 2007; 6: 39–44

    Google Scholar 

  67. Jones SE, Mahendran S. Interventions for acute auricular haematoma. Cochrane Database Syst Rev 2004; (vn2): CD004166

    Google Scholar 

  68. Ghanem T, Rasamny JK, Park SS. Rethinking auricular trauma. Laryngoscope 2005; 115: 1251–5

    Article  PubMed  Google Scholar 

  69. Yotsuyanagi T, Yamashita K, Urushidate S, et al. Surgical correction of cauliflower ear. Br J Plast Surg 2002; 55: 380–6

    Article  PubMed  CAS  Google Scholar 

  70. USA Wrestling. International rule book & guide to wrestling: freestyle, Greco-Roman, women’s wrestling, and beach wrestling. 2010 ed [online]. Available from URL: http://www.themat.com/forms/Rulebook.pdf [Accessed 2010 Oct 25]

  71. Kim SH, Kim S, Choi HI, et al. Callus formation is associated with hyperproliferation and incomplete differentiation of keratinocytes, and increased expression of adhesion molecules. Br J Dermatol 2010; 163: 495–501

    Article  PubMed  CAS  Google Scholar 

  72. Helm TN, Bergfeld WF. Sports dermatology. Clin Dermatol 1998; 16: 159–65

    Article  PubMed  CAS  Google Scholar 

  73. Scott Jr MJ, Scott NI, Scott LM. Dermatologic stigmata in sports: weightlifting. Cutis 1992; 50: 141–5

    PubMed  Google Scholar 

  74. Adams BB. Tinea corporis gladiatorum. J Am Acad Dermatol 2002; 47: 286–90

    Article  PubMed  Google Scholar 

  75. Bassiri-Jahromi S, Khaksar AA. Outbreak of tinea gladiatorum in wrestlers in Tehran (Iran). Indian J Dermatol 2008; 53: 132–6

    Article  PubMed  Google Scholar 

  76. Foster KW, Ghannoum MA, Elewski BE. Epidemiologic surveillance of cutaneous fungal infection in the United States from 1999 to 2002. J Am Acad Dermatol 2004; 50: 748–52

    Article  PubMed  Google Scholar 

  77. Hand JW, Wroble RR. Prevention of tinea corporis in collegiate wrestlers. J Athl Train 1999; 34: 350–2

    PubMed  CAS  Google Scholar 

  78. Hazen PG, Weil ML. Itraconazole in the prevention and management of dermatophytosis in competitive wrestlers. J Am Acad Dermatol 1997; 36: 481–2

    Article  PubMed  CAS  Google Scholar 

  79. Holland EJ, Mahanti RL, Belongia EA, et al. Ocular involvement in an outbreak of herpes gladiatorum. Am J Ophthalmol 1992; 114: 680–4

    PubMed  CAS  Google Scholar 

  80. Wilhelmus KR. The treatment of herpes simplex virus epithelial keratitis. Trans Am Ophthalmol Soc 2000; 98: 505–32

    PubMed  CAS  Google Scholar 

  81. Becker TM, Kodsi R, Bailey P, et al. Grappling with herpes: herpes gladiatorum. Am J Sports Med 1988; 16: 665–9

    Article  PubMed  CAS  Google Scholar 

  82. Strauss RH, Leizman DJ, Lanese RR, et al. Abrasive shirts may contribute to herpes gladiatorum among wrestlers. N Engl J Med 1989; 320: 598–9

    PubMed  CAS  Google Scholar 

  83. Anderson BJ. The epidemiology and clinical analysis of several outbreaks of herpes gladiatorum. Med Sci Sports Exerc 2003; 35: 1809–14

    Article  PubMed  Google Scholar 

  84. Adams BB. New strategies for the diagnosis, treatment, and prevention of herpes simplex in contact sports. Curr Sports Med Rep 2004; 3: 277–83

    PubMed  Google Scholar 

  85. Wald A, Zeh J, Selke S, et al. Virology characteristics of subclinical and symptomatic genital herpes infections. N Engl J Med 1995; 333: 770–5

    Article  PubMed  CAS  Google Scholar 

  86. Koelle DM, Wald A. Herpes simplex virus: the importance of asymptomatic shedding. J Antimicrob Chemother 2000; 45 Suppl.T3: 1–8

    Article  PubMed  CAS  Google Scholar 

  87. Anderson BJ. The effectiveness of valacyclovir in preventing reactivation of herpes gladiatorum in wrestlers. Clin J Sport Med 1999; 9: 86–90

    Article  PubMed  CAS  Google Scholar 

  88. Bacon TH, Levin MJ, Leary JJ, et al. Herpes simplex virus resistance to acyclovir and penciclovir after two decades of antiviral therapy. Clin Microbiol Rev 2003; 16: 114–28

    Article  PubMed  CAS  Google Scholar 

  89. Urbina F, León L, Sudy E. Black heel, talon noir or calcaneal petechiae? Australas J Dermatol 2008 Aug; 49: 148–51

    Article  PubMed  Google Scholar 

  90. Zalaudek I, Argenziano G, Soyer HP, et al. Dermoscopy of subcorneal hematoma. Dermatol Surg 2004; 30: 1229–32

    Article  PubMed  Google Scholar 

  91. Wolf IH. Dermoscopic diagnosis of vascular lesions. Clin Dermatol 2002; 20: 273–5

    Article  PubMed  Google Scholar 

  92. Böni R, Dummer R. Compression therapy in painful piezogenic pedal papules. Arch Dermatol 1996; 132: 127–8

    Article  PubMed  Google Scholar 

  93. Woodrow SL, Brereton-Smith G, Handfield-Jones S. Painful piezogenic pedal papules: response to local electroacupuncture. Br J Dermatol 1997; 136: 628–30

    Article  PubMed  CAS  Google Scholar 

  94. Lebovits PE, Kouskoukis CE, Weidman AI. Piezogenic pedal papules. Cutis 1982; 29: 276–7,280

    PubMed  CAS  Google Scholar 

  95. Takama H, Tamada Y, Yano K, et al. Pitted keratolysis: clinical manifestations in 53 cases. Br J Dermatol 1997; 137: 282–5

    Article  PubMed  CAS  Google Scholar 

  96. Singh G, Naik CL. Pitted keratolysis. Indian J Dermatol Venereol Leprol 2005; 71: 213–5

    Article  PubMed  Google Scholar 

  97. Nordstrom KM, McGinley KJ, Cappiello L, et al. Pitted keratolysis: the role of Micrococcus sedentarius. Arch Dermatol 1987; 123: 1320–5

    Article  PubMed  CAS  Google Scholar 

  98. Woodgyer AJ, Baxter M, Rush-Munro FM, et al. Isolation of Dermatophilus congolensis from two New Zealand cases of pitted keratolysis. Australas J Dermatol 1985; 26: 29–35

    Article  PubMed  CAS  Google Scholar 

  99. Longshaw CM, Wright JD, Farrell AM, et al. Kytococcus sedentarius, the organism associated with pitted keratolysis, produces two keratin-degrading enzymes. J Appl Microbiol 2002; 93: 810–6

    Article  PubMed  CAS  Google Scholar 

  100. Shah AS, Kamino H, Prose NS. Painful, plaque-like, pitted keratolysis occurring in childhood. Pediatr Dermatol 1992; 9: 251–4

    Article  PubMed  CAS  Google Scholar 

  101. Biolcati G, Alabiso A. Creeping eruption of larva migrans: a case report in a beach volley athlete. Int J Sports Med 1997; 18: 612–3

    Article  PubMed  CAS  Google Scholar 

  102. Davies HD, Sakuls P, Keystone JS. Creeping eruption: a review of clinical presentation and management of 60 cases presenting to a tropical disease unit. Arch Dermatol 1993; 129: 588–91

    Article  PubMed  CAS  Google Scholar 

  103. Jackson A, Heukelbach J, Calheiros CM, et al. A study in a community in Brazil in which cutaneous larva migrans is endemic. Clin Infect Dis 2006; 43: e13–8

    Article  PubMed  Google Scholar 

  104. Edelglass JW, Douglass MC, Stiefler R, et al. Cutaneous larva migrans in northern climates: a souvenir of your dream vacation. J Am Acad Dermatol 1982; 7: 353–8

    Article  PubMed  CAS  Google Scholar 

  105. Van den Enden E, Stevens A, Van Gompel A. Treatment of cutaneous larva migrans. N Engl J Med 1998; 339: 1246–7

    Article  PubMed  Google Scholar 

  106. Ang CC. Images in clinical medicine: cutaneous larva migrans. N Engl J Med 2010; 362: e10

    Article  PubMed  Google Scholar 

  107. Tlougan BE, Podjasek JO, Adams BB. Aquatic sports dermatoses: part 1. In the water: freshwater dermatoses. Int J Dermatol 2010; 49 (8): 874–85

    Article  PubMed  Google Scholar 

  108. Blanc D, Zultak M, Rochefort A, et al. Green hair: clinical, chemical and epidemiologic study. Apropos of a case. Ann Dermatol Venereol 1988; 115: 807–12

    PubMed  CAS  Google Scholar 

  109. Mascaró Jr JM, Ferrando J, Fontarnau R, et al. Green hair. Cutis 1995; 56: 37–40

    PubMed  Google Scholar 

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No funding was received to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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De Luca, J.F., Adams, B.B. & Yosipovitch, G. Skin Manifestations of Athletes Competing in the Summer Olympics. Sports Med 42, 399–413 (2012). https://doi.org/10.2165/11599050-000000000-00000

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