Saturday, February 28, 2015

Skin Problems in Athletes

It was zero-degrees-Farenheit and -17-degrees-Celsius this morning. What better day to talk about how winter weather can affect the skin…

Miss Rosy Cheeks :)
Over the last month, my daughter has had the cutest rosy cheeks, and my hands and face have been getting cracked and dry, battling worsening winter eczema. Cold weather, especially for outdoor athletes, makes skincare even more important. I thought of writing this blog last month when we were just entering the harsher winter weather, and I had forgotten my facial moisturizer for a run but contemplated returning home during the first mile for my face mask because my face was stinging in the wind. With weather like that, you start to think about skin problems in athletes, and voila this beautiful blog was born! For related tips on winter outdoor training and gear, please see last January's blogs: winter training and gear.


What is it and what causes it?

Eczema is a dry skin rash caused by defects in skin barrier function, immune abnormalities, and environmental and infectious agents. The immunologic abnormalities and the skin barrier are genetic and related to problems with filagrin, a structural protein that helps the skin barrier hold in moisture. The only reason I tell you all this medical mumbo-jumbo is because it shows the importance of fragrance-free emollient use for the treatment of eczema- you need to help your skin replenish the moisture that it is constantly losing because it has no filagrin to help keep the skin barrier intact and hold in the skin’s moisture. One of the other issues with atopic (allergic) skin is deficient in stratum corneum lipids (fats in a particular layer of the skin) such as ceramide, which is why using lotionss with ceramide such as CeraVe can help. Fragrant perfumes and dyes can further irritate skin, especially atopic or eczematous skin, so it is important to choose emollients that do not have these additives.

What to do?

Swimmers – Swimmers are especially at risk due to continued submerging in water as well as chlorine’s chemical irritation of the skin. It’s important to take a quick shower after the pool to rinse off any chlorine and to apply fragrance-free emollients (Aquaphor, Cetaphil, Eucerin, Vaseline) to skin that is still moist after showering in order to lock in the moisture and protect skin. Then reapply 3-4 times per day to the driest areas.

Outdoor athletes – Winter, wind, sun can really affect skin. Always apply sunscreen prior to outdoor workouts (go here for a nice rundown on how sun exposure affects skin). In the winter, we often skip the sunscreen hoping to get our daily dose of Vitamin D, as sunlight allows the skin to produce vitamin D; however, in doing so, you are probably missing out on an emollient that you don’t even think about. Moisturizers with sunscreen are first and foremost moisturizers. I always wear facial moisturizer while running (a small amount of water-based moisturizer helps protect the skin from the wind without causing breakouts- look for noncomedogenic moisturizers), and I usually put Aquaphor on my hands underneath my gloves or longer shirt that I pull over my hands to keep them warm. It’s like a mini-hand treatment while running since you are moisturizing and then heating up your hands as you vasoconstrict your peripheral body during your workout, so instead of having hands exposed to cold weather getting dried out, frozen, and chaffed, they are actually benefiting from a moisturizing treatment. Try it and see what you think! When you come in from your cold workouts, avoid long hot showers. Longer water exposure and hot water exposure can dry out the skin even more. Stick to a short, moderately warm shower, and apply your emollient of choice to moist skin after showering to lock in moisture and give skin back the natural barrier it is missing. Protecting your skin from the wind while outside and not over-drying it with long, hot showers while inside can work wonders for your eczema.

Tinea / dermatophyte infections

You can see why tinea corporis is called ring worm!
Photo credit: Uptodate (Yes, I used Uptodate, don't judge).
Tinea capitis, black dot tinea type, with surrounding alopecia.
Tinea corporis (ring worm), tinea capitis (scalp ringworm), and tinea unguium (fungal infection of the nails, a.k.a. onychomycosis) affect many athletes. Athletes are at risk for tinea corporis and tinea capitis due to excessive sweating that produces humid conditions on the skin. Typical sports are wrestling, rugby, and soccer, due to the close contact in these sports. Good hygiene (showering after practice and games, ensuring that feet are dry when placed in clean socks, etc.) can prevent transmission of these infections. Tinea corporis and tinea cruris (“jock itch”) can be treated with topical clotrimazole or other over-the-counter antifungal creams for 2-3 weeks. Rash may resolve after 1-2 weeks but another week of treatment ensures eradication of the infection. If infection is not improved, oral treatment with terbinifine or fluconazole is recommended and requires a prescription from your physician. Tinea capitis causes ring worm on the scalp, which can look like a scaly, red plaque that may not be noticed until it results in surrounding hair loss (alopecia). This infection can be very, very difficult to eradicate, especially in younger children, and it can persist indefinitely and lead to permanent hair loss if not treated. Treatment is with oral griseofulvin for 8 weeks, which is difficult for children and parents, especially since it must be taken twice daily and must be taken with high-fat containing foods for best absorption. Terbinafine is a similar medication which is approved for adults and only requires 4 weeks of treatment. Other members of the household are often asymptomatic carriers of the disease, including pets! Family members should be cultured by their physicians and treated with ketoconazole 2% or selenium sulfide 2.5% (Selsun Blue!) shampoo 3 times weekly to help prevent reinfection in the person receiving griseofulvin therapy. Moral of the story: don’t share hats, hairbows, etc.

Plantar warts (verrucae)

Human papillomaviruses cause a number of warts. Athletes are often affected by plantar warts, which are caused by HPV 1 and occur on the plantar surface (or sole) of the foot. Most adult athletes aren’t affected by these because they have already been exposed to the virus as children. Children and adolescents who walk barefoot on locker room floors are commonly affected, swimmers particularly as they often walk to the pool barefoot. There are many treatments for plantar warts, but two-thirds spontaneously regress 2 years after occurrence. Treatments include salicylic acid and liquid nitrogen. Duct tape, a home remedy, has been studied as a treatment, and studies are inconclusive. Treatments may take several weeks to months, and this can be a very annoyingly painful problem for an athlete (or anyone for that matter)! Moral of the story: shower shoes and flip-flops in the locker room and on the way to the pool.

Remember your emollients!

 On deck for the blog:
-winter running (how to fall)
-foot health
-spine health

Ameen M. Epidemiology of superficial fungal infections. Clin Dermatol 2010; 28: 197.
de Haen M, Spigt MG, van Uden CJ, et al. Efficacy of duct tape vs placebo in the treatment of verruca vulgaris (warts) in primary school children. Arch Pediatr Adolesc Med 2006; 160:1121.
Fu T, Keiser E, Linos E, et al. Eczema and sensitization to common allergens in the United States: a multiethnic, population-based study. Pediatr Dermatol 2014; 31:21.

Kakourou T, Uksal U, European Society for Pediatric Dermatology. Guidelines for the management of tinea capitis in children. Pediatr Dermatol 2010; 27:226.