A Closer Look At Eczematous Dermatitis In Athletes

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A Closer Look At Eczematous Dermatitis In Athletes
Note the isolated plaques of thick lichenified skin of this patient, who has lichen simplex chronicus. (Photo courtesy of Jack Haddad, DPM.)
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Author(s): 
By Mark A. Caselli, DPM

   Contact dermatitis arises from mechanically or chemically irritating substances. Since this condition is not immunologically mediated, the concentration of the irritant must exceed a threshold before the reaction can take place. Since sensitization is not necessary, an irritant reaction may occur immediately after the athlete comes in contact with the material. Irritant contact dermatitis may be caused by adhesive tape, topical medications, antiseptics, insect repellents, cosmetics or sunscreens.

   Allergic contact dermatitis, in contrast, is secondary to acquired hypersensitivity to a specific allergen. Unlike irritant contact dermatitis, this condition has an induction period of five to seven days before the first appearance of hypersensitivity. The peak reaction of the skin occurs 24 to 48 hours after contact with the same antigen, resulting in erythematous pruritic vesicles and papules. Common allergens include the resins from the Rhus plants (poison ivy, oak and sumac), paraphenylenediamines (blue/black dyes), nickel compounds, rubber compounds and chromates (tanned leather and metal parts). Topical medications such as antibiotics, antihistamines, menthol and salicylate products can also act as allergens.

   It is often difficult to tell the difference between irritant contact dermatitis and allergic contact dermatitis. In general, allergic contact dermatitis appears more polymorphic with erythema and vesiculation. Irritant contact dermatitis is generally localized and looks more like a severe burn with large blisters or marked erythema and edema.

   The first step for either of these conditions is avoiding exposure to the suspected causative agent throughout the treatment program and afterward. Use wet dressings and cold compresses to dry oozing secretions, soften scales and crusts, cleanse purulent wounds and relieve itching and burning. Use topical corticosteroids in the strength necessary to relieve the pruritis and reduce the erythema. This can usually be accomplished within seven to 14 days. Oral antihistamines are often helpful in reducing the itching and, in severe cases, a brief regimen of oral corticosteroids may be indicated.

In Conclusion

   Although pruritic conditions can be potentially debilitating for athletes, treatment can sometimes be simple. However, it is important to understand how dermatitis and other conditions can contribute to pruritis in order to make appropriate treatment recommendations.

Dr. Caselli (pictured) is a staff podiatrist at the VA Hudson Valley Health Care System in Montrose, N.Y. He is also an Adjunct Professor at the New York College of Podiatric Medicine and a Fellow of the American College of Sports Medicine.




References:

1. Caselli MA: How to handle contact dermatitis in athletes. Podiatry Today 2003; 16(12)
2. Dockery GL, Crawford ME: Cutaneous Disorders of the Lower Extremity, W.B. Saunders Company, Philadelphia, 1997.
3. Knopp WD: Dermatology. In Sallis RE, Massimino F (eds), Essentials of Sports Medicine, Mosby, St. Louis, 1997.
4. Leshaw SM: Itching in active patients: causes and cures. Phys Sportsmed 1998; 26(1)
5. Samitz MH, Dana AS: Cutaneous Lesions of the Lower Extremities. J. B. Lippincott Company, Philadephia, 1971.
6. Scheman AJ, Severson DL: Pocket Guide to Medications Used in Dermatology. Lippincott Williams & Wilkins, Philadephia, 2003.




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