A Closer Look At Eczematous Dermatitis In Athletes

By Mark A. Caselli, DPM

   Pruritis, or generalized itching, is the most common presenting skin complaint. It can be a particularly annoying and sometimes debilitating problem for athletes, who place great demands on their skin. Since pruritis may be caused by a particular skin disease or may occur without evidence of any specific skin disorder, diagnosis can be challenging for the clinician.    Making the diagnosis even more difficult is the fact that athletes often attempt various treatment regimens, including the use of over-the-counter remedies, which can alter the appearance of the skin, before seeking professional advice. When an athlete presents with a complaint of itching, one should consider eczematous dermatitis, infections, parasite infestations, insect bites and systemic diseases. For the purposes of this column, let us take a closer look at eczematous dermatitis.    Eczematous dermatitis represents an inflammatory response of the skin to many different external and internal stimulants or agents. It is the most common cause of pruritis in the athlete. The most frequently encountered conditions that fall into this category include xerosis, atopic dermatitis, lichen simplex chronicus and contact dermatitis.

How To Detect And Treat Xerotic Eczema

   Also known as chronic winter itch or winter dry skin, xerotic eczema represents the most frequent cause of itching in the athlete. This condition is characterized by dehydration with redness, dry scaling and fine superficial cracking of the skin. Although these changes can occur in patches over several parts of the body, one commonly sees these changes on the lower legs.    This xerotic and pruritic condition frequently occurs during the winter and in areas where the humidity is very low. The skin becomes extremely dry and scaly, and starts to show accentuated skin lines (xerosis). If the process continues, there is redness with thin, long, horizontal superficial cracks appearing in the skin. The most severe form of this condition can result in deep fissuring that becomes secondarily infected. At this point, pain becomes the primary symptom as opposed to pruritis.    Xerotic eczema develops as a result of decreased skin surface lipids. Cleansers and deodorant soaps predispose the patient to water loss and a decrease in the water reservoir within the stratum corneum. This dryness causes generalized pruritis, which, in turn, leads to rubbing and scratching, causing disorganization of the surface lipid balance. Frequent bathing in hot water increases water loss from the skin while it dries.    Treatment of xerotic eczema involves educating the athlete about skin care. Talk to athletes about decreasing their number of baths or, better yet, taking only one short, lukewarm shower a day. Emphasize the use of mild, unscented, moisturizing soaps. Encourage them to use topical emollients containing lanolin, glycerin, urea, lactic acid or other alpha-hydroxy acids. In severe cases of pruritis, patients should apply group V or VI topical corticosteroids two to three times daily.    Using a room humidifier can also be very helpful for patients. Also encourage them to lower the heat in their home since it will help reduce skin water loss due to evaporation. Remind them that less moisture is needed to maintain a high relative humidity at the lower temperatures.

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