1/6/2019. Dermatology for the Athletic Trainer. AzATA Program Faculty Disclaimer. Objectives. Disclosures

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Flora May Crawford
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1 AzATA Program Faculty Disclaimer Dermatology for the Athletic Trainer Michael Lehrer, MD 1. Insert the game code: 1. Insert the game code: The views expressed in these slides and today s discussion are mine My views may not be the same as the views of my company s clients or my colleagues Participants must use discretion when using information contained in this presentation 2018 MFMER slide-2 Disclosures No financial relationships Disclaimer Evidence based information Frequently dermatology products are off label Frequently over the counter products have no studies Objectives Identify common infections in the athlete and be comfortable with treatment and isolation strategies. Diagnose other common conditions in athletes Understand unique challenges present for athletes with chronic skin conditions Appreciate the burden of skin cancer and the increased risk athletes face MFMER slide-4 Questions 1-16 The faster you answer the more points You cannot change your answer There is a bonus for answering questions correctly in succession There may be more than one correct answer 2018 MFMER slide MFMER slide-6 1

Folliculitis Diagnosis: Clinical Appearance, Swab of pustule. Most commonly staph. Lives on spectrum with carbuncle (Abscess). Treatment: Topical antimicrobials, good hygiene.

Covering active lesions is not considered sufficient to allow for participation 2018 MFMER slide-7 2018 MFMER slide-8 Carbuncle/Abccess Diagnosis: Clinical Appearance, culture.

strain of bacteria that has developed resistance to common oral antibiotics. Keflex, Amoxicillin not generally effective. Bactrim, Clindamycin, Doxycycline more effective.

athletes colonized with MRSA. MRSA colonization higher in those with frequent healthcare exposure MRSA infections are typically purulent.

2 Folliculitis Diagnosis: Clinical Appearance, Swab of pustule. Most commonly staph. Lives on spectrum with carbuncle (Abscess). Treatment: Topical antimicrobials, good hygiene. Hibaclens washes, Bleach Baths. Return: 1. No new lesions 48 hours 2. Complete 72 hours Abx 3. No drainage/exudate 4. Covering active lesions is not considered sufficient to allow for participation 2018 MFMER slide MFMER slide-8 Carbuncle/Abccess Diagnosis: Clinical Appearance, culture. Most commonly staph. Treatment: Incision and Drainage. Oral antibiotics (Bactrim, Clinda). May be MRSA. Return: 1. No new lesions 48 hours 2. Complete 72 hours Abx 3. No drainage/exudate 4. Covering active lesions is not considered sufficient to allow for participation 2018 MFMER slide MFMER slide-10 MRSA Methicillin resistant Staph Aureus (MRSA) is a strain of bacteria that has developed resistance to common oral antibiotics. Keflex, Amoxicillin not generally effective. Bactrim, Clindamycin, Doxycycline more effective. Culture and susceptibility testing required to diagnose MRSA Approximately 6% of athletes are a colonized by MRSA (not same as infection) Infection rates are 7X higher in athletes colonized with MRSA. MRSA colonization higher in those with frequent healthcare exposure MRSA infections are typically purulent. Pus evidence on surface, or area is fluctuant/indurated with pus below surface 2018 MFMER slide-11 Recurrent infections: 1. Consider decolonization protocol. Mupirocin ointment in orifices. 2. Hibaclens washes or bleach baths 1. ¼ cup bleach in tub. Or. ½ teaspoon per gallon. 3. Make sure all wound or cuts are covered and minimized 1. Use electric razor instead of razor blade. 2. Moisturize to reduce dry skin (xerosis) 2018 MFMER slide-12 2

Diagnosis: Clinical Appearance, Viral Swab

Some patients may need chronic suppressive

7% reported transmission rate in sparring

3 2018 MFMER slide MFMER slide-14 Herpes Simplex Virus (Herpes Gladiatorum) Diagnosis: Clinical Appearance, Viral Swab (PCR) Treatment: Isolation of athlete, prescription antivirals (Acyclovir, valacyclovir) Return: 5 Days oral antiviral therapy and all lesions have dried and crusted. Some patients may need chronic suppressive therapy. Multiple outbreaks in a season. 32.7% reported transmission rate in sparring partners * MFMER slide-15 *Anderson BJ Clin J Sport Med MFMER slide MFMER slide MFMER slide-18 3

Herpes Simplex Virus HSV Keratitis HSV infection involving

Eczema Herpeticum Athletes who have eczema can get

2018 MFMER slide-19 https://seer.cancer.

gov/data/ Minimize exposure during peak sun hours Seek

4 Herpes Simplex Virus HSV Keratitis HSV infection involving the eye can lead to corneal scarring and blindness. Eczema Herpeticum Athletes who have eczema can get disseminated herpes infection that is a potential emergency 2018 MFMER slide-19 Estimated million skin cancer cases per year. Minimize exposure during peak sun hours Seek shade, especially during peak sun hours Wear sun protective clothing (UPF) Wear broad spectrum (UVA/UVB) sunscreen Avoid tanning beds MFMER slide-24 4

Minimize exposure during peak sun hours (10:00 4:00) 2. Sunscreen Products Best Sunscreen?

(Anthelios, La Roche Posay). Controversies Safety of active ingredients Systemic Absorption, Local reactions/rashes Banned in Hawaii, concern for reefs Oxybenzone, Octinoxate Endocrine disruptor?

gov Electromagnetic spectrum and biologic effects on the skin http://www.mdpi.com/1422-0067/14/6/12222/htm 2. Sunscreen Products Best Sunscreen? Carcinogen?

com/1422-0067/14/6/12222/htm 2018 MFMER slide-27 Sun Protection and the Athlete Sun protection behavior is low in adolescents and young adults.

5 Minimize exposure during peak sun hours (10:00 4:00) 2. Sunscreen Products Best Sunscreen? Regulate as Drug by FDA, active ingredients must prove safety and efficacy Manufactured products must prove SPF Consumer reports 2018 Equate (Wal-Mart Brand) outperformed every sunscreen but one (Anthelios, La Roche Posay). Controversies Safety of active ingredients Systemic Absorption, Local reactions/rashes Banned in Hawaii, concern for reefs Oxybenzone, Octinoxate Endocrine disruptor? Carcinogen? Natural Products When not marketed as sunscreen, not required to be tested FDA.gov Electromagnetic spectrum and biologic effects on the skin 2. Sunscreen Products Best Sunscreen? Regulate as Drug by FDA, active ingredients must prove safety and efficacy Manufactured products must prove SPF Consumer reports 2018 Equate (Wal-Mart Brand) outperformed every sunscreen but one (Anthelios, La Roche Posay). Controversies Safety of active ingredients Systemic Absorption, Local reactions/rashes Banned in Hawaii, concern for reefs Oxybenzone, Octinoxate Endocrine disruptor? Carcinogen? Natural Products When not marketed as sunscreen, not required to be tested FDA.gov Electromagnetic spectrum and biologic effects on the skin MFMER slide-27 Sun Protection and the Athlete Sun protection behavior is low in adolescents and young adults. Athletes spend significant time outdoors training and rarely wear sunscreen. Regular use of sunscreen reduces skin cancer Sun exposure, specifically, burning sunburns are the greatest modifiable risk factor for the development of melanoma A significant proportion of sun exposure occurs during youth and young adulthood Rates of sunburn are higher amongst youths and young adults. Athlete s use of sunscreen is associated with frequency of use by coaches and athletic trainers MFMER slide MFMER slide MFMER slide-30 5

6 Questions MFMER slide MFMER slide MFMER slide MFMER slide MFMER slide-35 6

Sun Protection Behaviours in Primary Care. Dr. Christie Freeman Dr. Lisa Graves Dr. Patricia Mousmanis

Sun Protection Behaviours in Primary Care Dr. Christie Freeman Dr. Lisa Graves Dr. Patricia Mousmanis FMF 2015 1 What talk about sun protection? Skin cancer is the most common cancer diagnosis in Canada