How To Identify And Treat Pruritic Conditions In Athletes

Start Page: 84
Impetigo contagiosa, a common pruritic skin infection, occurs frequently among groups of individuals, such as athletes, who have an increased risk of bruising injuries and who are in close contact with each other.
Chronic interdigital tinea pedis usually starts in the toe web spaces and is characterized by scaling, maceration and itching. (Photo courtesy of Gary Dockery, DPM)
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Author(s): 
By Mark Caselli, DPM

What You Should Know About Other Common Causes Of Pruritis

   Insect bites and stings can present as pruritic skin conditions in athletes. In most cases, the areas of itching are associated with the location of the insect attack. The athlete will usually give a history of such an episode and one can accordingly take appropriate measures to treat the condition (see “Recognizing And Treating Insect Bites And Stings In Athletes,” pg. 84, August 2004 issue).

   Systemic allergic reactions resulting in pruritis require a thorough history as identifying the allergen is essential to providing appropriate treatment. Besides being subject to the same food and food-additive allergies that occur in the general population, athletes often use vitamins, food supplements and other performance enhancers that are potential allergens. A thorough history should include specific questions about the use of these and other over-the-counter products. Difficult cases may require allergy testing.

   Finally, when attempting to diagnose a difficult case of generalized pruritis and excoriations without a specific history or primary lesion, one must consider the possibility of systemic disease. The prevalence of pruritis in systemic disorders ranges from quite high in renal disease and liver stasis to less frequent in thyroid disease and diabetes. Occult malignancies, especially of the lymphoreticular types and polycythemia vera, and iron deficiency anemia are also associated with pruritis. In addition, one should question athletes about anabolic steroid use. If they have used steroids, one should consider the possibility of liver disease.

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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