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Sports Medicine

, Volume 41, Issue 11, pp 967–984 | Cite as

Skin Conditions in Figure Skaters, Ice-Hockey Players and Speed Skaters

Part II — Cold-Induced, Infectious and Inflammatory Dermatoses
  • Brook E. TlouganEmail author
  • Anthony J. Mancini
  • Jenny A. Mandell
  • David E. Cohen
  • Miguel R. Sanchez
Review Article

Abstract

Participation in ice-skating sports, particularly figure skating, ice hockey and speed skating, has increased in recent years. Competitive athletes in these sports experience a range of dermatological injuries related to mechanical factors: exposure to cold temperatures, infectious agents and inflammation. Part I of this two part review discussed the mechanical dermatoses affecting ice-skating athletes that result from friction, pressure, and chronic irritation related to athletic equipment and contact with surfaces. Here, in Part II, we review the cold-induced, infectious and inflammatory skin conditions observed in ice-skating athletes. Cold-induced dermatoses experienced by ice-skating athletes result from specific physiological effects of cold exposure on the skin. These conditions include physiological livedo reticularis, chilblains (pernio), Raynaud phenomenon, cold panniculitis, frostnip and frostbite. Frostbite, that is the literal freezing of tissue, occurs with specific symptoms that progress in a stepwise fashion, starting with frostnip. Treatment involves gradual forms of rewarming and the use of friction massages and pain medications as needed. Calcium channel blockers, including nifedipine, are the mainstay of pharmacological therapy for the major nonfreezing cold-induced dermatoses including chilblains and Raynaud phenomenon. Raynaud phenomenon, a vasculopathy involving recurrent vasospasm of the fingers and toes in response to cold, is especially common in figure skaters. Protective clothing and insulation, avoidance of smoking and vasoconstrictive medications, maintaining a dry environment around the skin, cold avoidance when possible as well as certain physical manoeuvres that promote vasodilation are useful preventative measures. Infectious conditions most often seen in ice-skating athletes include tinea pedis, onychomycosis, pitted keratolysis, warts and folliculitis. Awareness, prompt treatment and the use of preventative measures are particularly important in managing such dermatoses that are easily spread from person to person in training facilities. The use of well ventilated footgear and synthetic substances to keep feet dry, as well as wearing sandals in shared facilities and maintaining good personal hygiene are very helpful in preventing transmission. Inflammatory conditions that may be seen in ice-skating athletes include allergic contact dermatitis, palmoplantar eccrine hidradenitis, exercise-induced purpuric eruptions and urticaria. Several materials commonly used in ice hockey and figure skating cause contact dermatitis. Identification of the allergen is essential and patch testing may be required. Exercise-induced purpuric eruptions often occur after exercise, are rarely indicative of a chronic venous disorder or other haematological abnormality and the lesions typically resolve spontaneously. The subtypes of urticaria most commonly seen in athletes are acute forms induced by physical stimuli, such as exercise, temperature, sunlight, water or particular levels of external pressure. Cholinergic urticaria is the most common type of physical urticaria seen in athletes aged 30 years and under. Occasionally, skaters may develop eating disorders and other related behaviours some of which have skin manifestations that are discussed herein. We hope that this comprehensive review will aid sports medicine practitioners, dermatologists and other physicians in the diagnosis and treatment of these dermatoses.

Keywords

Anorexia Nervosa Eating Disorder Cold Exposure Terbinafine Tinea Pedis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

The authors have received no funding and have no conflicts of interest that are directly relevant to the content of this review.

References

  1. 1.
    Tlougan BE, Mancini AJ, Mandell JA, et al. Skin conditions in figure skaters, ice-hockey players and speed skaters. Part I: mechanical dermatoses Sports Med 2011; 41 (9): 709–19PubMedCrossRefGoogle Scholar
  2. 2.
    Cappaert TA, Stone JA, Castellani JW, et al. National Athletic Trainers’ Association position statement: environmental cold injuries. J Athl Train, 2008; 43 (6): 640–58PubMedCrossRefGoogle Scholar
  3. 3.
    D. Klossner, editor. 2008-09 NCAA® sports medicine handbook. Indianapolis (IN): The National Collegiate Athletic Association, 2008Google Scholar
  4. 4.
    Gibbs MB, English 3rd JC, Zirwas MJ. Livedo reticularis: an update. J Am Acad Dermatol 2005; 52 (6): 1009–19PubMedCrossRefGoogle Scholar
  5. 5.
    Simon TD, Soep JB, Hollister JR. Pernio in pediatrics. Pediatrics 2005; 116 (3): e472–5CrossRefGoogle Scholar
  6. 6.
    Englund SL, Adams BB. Winter sports dermatology: a review. Cutis 2009; 83 (1): 42–8PubMedGoogle Scholar
  7. 7.
    Castellani JW, Young AJ, Ducharme MB, et al. American College of Sports Medicine position stand: prevention of cold injuries during exercise. Med Sci Sports Exerc 2006; 38 (11): 2012–29PubMedGoogle Scholar
  8. 8.
    Bakst R, Merola JF, Franks Jr AG, et al., Raynaud’s phenomenon: pathogenesis and management. J Am Acad Dermatol 2008; 59 (4): 633–53PubMedCrossRefGoogle Scholar
  9. 9.
    Quesada-Cortes A, Campos-Munoz L, Diaz-Diaz RM, et al. Cold panniculitis. Dermatol Clin 2008; 26 (4): 485–49, viiPubMedCrossRefGoogle Scholar
  10. 10.
    Field LA, Adams BB. Tinea pedis in athletes. Int J Dermatol 2008; 47 (5): 485–92PubMedCrossRefGoogle Scholar
  11. 11.
    Scher RK, Tavakkol A, Sigurgeirsson B, et al. Onychomycosis: diagnosis and definition of cure. J Am Acad Dermatol 2007; 56 (6): 939–44PubMedCrossRefGoogle Scholar
  12. 12.
    Mohrenschlager M, Seidl HP, Schnopp C, et al. Professional ice hockey players: a high-risk group for fungal infection of the foot [letter]? Dermatology 2001; 203 (3): 271PubMedCrossRefGoogle Scholar
  13. 13.
    Finch JJ, Warshaw EM. Toenail onychomycosis: current and future treatment options. Dermatol Ther 2007; 20 (1): 31–46PubMedCrossRefGoogle Scholar
  14. 14.
    Brautigam M, Nolting S, Schopf RE, et al. Randomised double blind comparison of terbinafine and itraconazole for treatment of toenail tinea infection. Seventh Lamisil German Onychomycosis Study Group. BMJ 1995; 311 (7010): 919–22PubMedCrossRefGoogle Scholar
  15. 15.
    Piraccini BM, Sisti A, Tosti A. Long-term follow-up of toenail onychomycosis caused by dermatophytes after successful treatment with systemic antifungal agents. J Am Acad Dermatol 2010; 62 (3): 411–4PubMedCrossRefGoogle Scholar
  16. 16.
    Pharis DB, Teller C, Wolf Jr JE. Cutaneous manifestations of sports participation. J Am Acad Dermatol 1997; 36 (3Pt1): 448–59PubMedCrossRefGoogle Scholar
  17. 17.
    Karsai S, Roos S, Hammes S, et al. Pulsed dye laser: what’s new in non-vascular lesions? J Eur Acad Dermatol Venereol 2007; 21 (7): 877–90PubMedCrossRefGoogle Scholar
  18. 18.
    Micali G, Dall’Oglio F, Nasca MR, et al. Management of cutaneous warts: an evidence-based approach. Am J Clin Dermatol 2004; 5 (5): 311–7PubMedCrossRefGoogle Scholar
  19. 19.
    Adams BB. Sports dermatology. Adolesc Med 2001; 12 (2): vii, 305–22Google Scholar
  20. 20.
    Cordoro KM, Ganz JE. Training room management of medical conditions: sports dermatology. Clin Sports Med 2005; 24 (3): 565–98, viii-ixPubMedCrossRefGoogle Scholar
  21. 21.
    Cohen PR. Community-acquired methicillin-resistant Staphylcoccus aureus skin infections: implications for patients and practitioners. Am J Clin Dermatol 2007; 8 (5): 259–70PubMedCrossRefGoogle Scholar
  22. 22.
    Adams BB. Skin infections in athletes. Dermatol Nurs 2008; 20 (1): 39–44PubMedGoogle Scholar
  23. 23.
    Huang JT, Abrams M, Tlougan B, et al. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics 2009; 123 (5): e808–14CrossRefGoogle Scholar
  24. 24.
    Kockentiet B, Adams BB. Contact dermatitis in athletes. J Am Acad Dermatol 2007; 56 (6): 1048–55PubMedCrossRefGoogle Scholar
  25. 25.
    Fisher AA. Allergic contact dermatitis: practical solutions for sports-related rashes. Phys Sportsmed 1993; 21: 65–72Google Scholar
  26. 26.
    Klein AW, Rish DC. Sports related skin problems. Compr Ther 1992; 18 (9): 2–4PubMedGoogle Scholar
  27. 27.
    Levine N. Dermatologic aspects of sports medicine. J Am Acad Dermatol 1980; 3 (4): 415–24PubMedCrossRefGoogle Scholar
  28. 28.
    Mandell JA, Tlougan BE, Cohen DE. Bunga Pad-induced ankle dermatitis in a figure skater. Dermatitis 2011 Feb; 22 (1): 58–9PubMedGoogle Scholar
  29. 29.
    Warshaw EM, Schram SE, Belsito DV, et al. Shoe allergens: retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004. Dermatitis 2007; 18 (4): 191–202PubMedCrossRefGoogle Scholar
  30. 30.
    Rubinson R, Larralde M, Santos-Munoz A, et al. Palmoplantar eccrine hidradenitis: seven new cases. Pediatr Dermatol 2004; 21 (4): 466–8PubMedCrossRefGoogle Scholar
  31. 31.
    Tlougan BE, Podjasek JO, Dickman PS, et al. Painful plantar papules and nodules in a child: palmoplantar eccrine hidradenitis (PEH). Pediatr Ann 2008; 37 (2): 83–4, 87PubMedCrossRefGoogle Scholar
  32. 32.
    Allan SJ, Humphreys F, Buxton PK. Annular purpura and step aerobics [letter]. Clin Exp Dermatol 1994; 19 (5): 418PubMedCrossRefGoogle Scholar
  33. 33.
    Leung AK, Grant RM, Truscott R. Exercise-induced purpura. J Sports Med Phys Fitness 1990; 30 (3): 329–30PubMedGoogle Scholar
  34. 34.
    Mailler-Savage E, Adams BB. Skin manifestations of running. J Am Acad Dermatol 2006; 55: 290–301PubMedCrossRefGoogle Scholar
  35. 35.
    Ramelet AA. Exercise-induced purpura. Dermatology 2004; 208 (4): 293–6PubMedCrossRefGoogle Scholar
  36. 36.
    Latenser BA, Hempstead RW. Exercise-associated solar purpura in an atypical location. Cutis 1985 Apr; 35 (4): 365–6PubMedGoogle Scholar
  37. 37.
    Siebenhaar F, Weller K, Mlynek A, et al. Acquired cold urticaria: clinical picture and update on diagnosis and treatment. Clin Exp Dermatol 2007; 32 (3): 241–5PubMedCrossRefGoogle Scholar
  38. 38.
    Adams BB. Dermatologic disorders of the athlete. Sports Med 2002; 32 (5): 309–21PubMedCrossRefGoogle Scholar
  39. 39.
    MacKnight JM, Mistry DJ. Allergic disorders in the athlete. Clin Sports Med 2005; 24 (3): 507–23, vii-viiiPubMedCrossRefGoogle Scholar
  40. 40.
    Jorizzo JL. Cholinergic urticaria. Arch Dermatol 1987; 123 (4): 455–7PubMedCrossRefGoogle Scholar
  41. 41.
    Claudy A. Cold urticaria. J Investig Dermatol Symp Proc 2001; 6 (2): 141–2PubMedCrossRefGoogle Scholar
  42. 42.
    Polat M, Dikilitas M, Gozubuyukogullari A, et al. Apocrine chromhidrosis. Clin Exp Dermatol 2009; 34 (7): e373–4CrossRefGoogle Scholar
  43. 43.
    Saff DM, Owens R, Kahn TA. Apocrine chromhidrosis involving the areolae in a 15-year-old amateur figure skater. Pediatr Dermatol 1995; 12 (1): 48–50PubMedCrossRefGoogle Scholar
  44. 44.
    Jonnalagadda SS, Ziegler PJ, Nelson JA. Food preferences, dieting behaviors, and body image perceptions of elite figure skaters. Int J Sport Nutr Exerc Metab 2004; 14 (5): 594–606PubMedGoogle Scholar
  45. 45.
    Ziegler PJ, Kannan S, Jonnalagadda SS, et al. Dietary intake, body image perceptions, and weight concerns of female U.S. international synchronized figure skating. teams Int J Sport Nutr Exerc Metab 2005; 15: 550–66PubMedGoogle Scholar
  46. 46.
    Zucker NL, Womble LG, Williamson DA, et al. Protective factors for eating disorders in female college athletes. Eating Disord 1999; 7: 207–18CrossRefGoogle Scholar
  47. 47.
    Strumia R. Skin signs in anorexia nervosa. Dermatoendocrinol 2009; 1 (5): 268–70PubMedCrossRefGoogle Scholar
  48. 48.
    Strumia R. Dermatologic signs in patients with eating disorders. Am J Clin Dermatol 2005; 6 (3): 165–73PubMedCrossRefGoogle Scholar
  49. 49.
    Heath ML, Sidbury R. Cutaneous manifestations of nutritional deficiency. Curr Opin Pediatr 2006; 18: 417–22PubMedCrossRefGoogle Scholar
  50. 50.
    Larson-Meyer DE, Willis KS. Vitamin D and athletes. Curr Sports Med Rep 2010; 9 (4): 220–6PubMedGoogle Scholar
  51. 51.
    Thevis M, Kuuranne T, Geyer H, et al. Annual bannedsubstance review: analytical approaches in human sports drug testing. Drug Test Analysis 2011; 3: 1–14CrossRefGoogle Scholar
  52. 52.
    Global Drug Reference. Easily accessible information for American athletes [online]. Available from URL: http://www.globaldro.org/us-en/ [Accessed 2011 Feb 27]

Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Brook E. Tlougan
    • 1
    Email author
  • Anthony J. Mancini
    • 2
    • 3
    • 4
  • Jenny A. Mandell
    • 5
  • David E. Cohen
    • 5
  • Miguel R. Sanchez
    • 5
    • 6
  1. 1.Department of DermatologyColumbia University Medical CenterNew YorkUSA
  2. 2.Department of Pediatrics, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.Department of Dermatology, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  4. 4.Division of DermatologyChildren’s Memorial HospitalChicagoUSA
  5. 5.Ronald O. Perelman Department of Dermatology, School of MedicineNew York UniversityNew YorkUSA
  6. 6.Department of DermatologyBellevue Hospital CenterNew YorkUSA

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