When sport impacts on skin health
Whether daily or just at the weekend, being physically active has become part of our lives. Adults squeeze in workouts at the gym or tennis matches after work. Kids are shuttled between soccer leagues and swimming team practice. As the number of people participating in sporting activities increases, so do the number of sports-related skin conditions. Most of these conditions are more nuisances than serious health hazards, but knowing how to treat and prevent them keeps you in the game.
Reducing rubbing
When we move, our clothing and shoes don't necessarily move with us, and the skin is subject to chaffing and rubbing. Friction blisters on the feet are a common result. The best way to avoid them is to have well-fitting shoes and well-cushioned acrylic or synthetic-blend socks. A layer of petroleum jelly or other lubricant under the socks helps reduce the friction further. Once a blister forms, it can be punctured and drained, but the roof should be left intact to protect the sensitive wound beneath. Use a simple non-stick dressing or one of the newly available absorbent, cushioned 'blister bandages' will speed healing.
Rubbing is also the cause of 'jogger's nipples'. Over the course of a long run, the athlete's shirt rubs against the nipples, causing painful abrasions and splits which can bleed. This condition can be avoided by wearing a soft bra or tee shirt made of silk or synthetic fibres that are smoother and cause less friction. Preventing it by applying a lubricant or adhesive tape are tricks used by marathon runners and triathletes.
Fighting fungus & yeast
Clothing can also cause problems by holding in moisture as the athlete sweats. The sweat softens the skin, disrupting its protective barrier. Wet clothing traps moisture against the skin making a welcome environment for bacteria, fungus, and yeast. 'Athlete's foot' (tinea pedis), for instance, is caused by a fungus, commonly known as ringworm. The affected area is red and itchy, with scale, particularly at the borders. Classic ringworm on the face, trunk or extremities looks like a scaly red ring and can be spread by skin-to-skin contact, for example, between wrestlers. When the foot is affected, a clue is moist scale between the 4th and 5th toes.
On the other hand, yeast (candida), which occurs in skin creases like the groin and under the breasts, involves the entire area with a red, moist rash covered in tiny pustules. Prevention involves keeping those areas dry with absorbent powders and wearing fabrics that wick moisture away from the skin. Treatment with over-the-counter anti-fungal creams is generally effective. Treatment of the feet should include the entire 'moccasin' distribution (all the skin a moccasin would cover), not just the patches seen.
Banishing bacterial infections
Wet clothing that does not 'breathe', like traditional 100% cotton, is also a culprit in bacterial infections. Staphylococcal and streptococcal impetigo, weeping red areas with golden yellow crusts, can spread by direct skin contact. Damp, tight-fitting clothing and athletic gear occlude the hair follicles causing folliculitis, a rash seen as small red bumps and pustules in hair follicles. 'Bikini bottom' is the description of a deep bacterial folliculitis seen as painful, hard red nodules on the buttocks of swimmers. Treatment of bacterial infections with topical and/or oral antibiotics usually requires a visit to the dermatologist. Prevention includes layering fabrics that pull moisture away from the skin, changing out of occlusive athletic attire and showering as soon as possible after the activity.
Although not really an infection, 'bacne', or acne of the shoulders, chest and back, can have a similar etiology. The combination of heat, moisture, pressure, and friction from athletic gear like football shoulder pads can cause acne that can be hard to treat as long as the gear is in use. Called 'acne mechanica', this eruption can also be seen on the forehead and chin from wearing a helmet and chin strap. Padding or lining the contact areas of the offending item with fabric or clothing, removing it and showering as soon as possible after use will help prevent it. Using a salicylic acid, alpha hydroxy acid or benzoyl peroxide solution or wash is helpful.
Say no to nasty nails
Repetitive mechanical trauma is the cause of 'jogger's toenail'. One or more toenails develop a dark brown or black area without the patient remembering a specific accident or injury. This darkening of the nail is actually blood. Constant pounding of the toes into the toe-box of the trainer or sneaker causes bleeding, the equivalent of a bruise, and can be painful or asymptomatic. Prevention requires wearing a well-fitted athletic shoe with a snug mid-section to avoid forward movement and ensure an adequate toe-box. It is important to distinguish this condition from a subungual malignant melanoma, so a dermatologist should be consulted if the discoloration persists or extends beyond the nail onto the cuticle or skin. Of note, small bruises can also be seen under the fingernails of golfers whose grip is too tight.
Beware of the sun
No dermatological discussion of sports would be complete without mentioning the importance of sun protection. Whether a participant or a spectator, use a broad spectrum sun blocking cream, lotion or gel. To avoid the 'dreaded' sunblock-stinging-my-eyes scenario, apply a waterproof sunblock prior to sweating (e.g. before leaving the house). Re-apply every one to two hours while outdoors, using a solid waxy preparation that stays put. These are now widely available in the form of stick applicators and little pots that resemble lip balm. When possible, schedule outdoor sports before 10 am or after 4 pm to avoid peak sun.
