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July 23, 2005 Dr. Jane Fore

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July 23, 2005 Dr. Jane Fore

  1. 1. July 23, 2005 Dr. Jane Fore Idaho State Athletic Trainers Conference A Brief Overview of Athletic Dermatology Skin injuries and conditions are the most common athletic injury
  2. 2. Dermatology and Athletes • The most common injuries afflicting the athlete affects the skin. • These include infections, inflammatory conditions, traumatic, environmental encounters and neoplasms. • Teaching good principles of skin and wound care to the athlete is a great preventive step.
  3. 3. Common Infections • Fungal- Tinea corporis, Tinea Pedis • Viral- Herpes simplex, Warts • Bacterial- impetigo, furunculosis, pitted keratolysis, hot tub folliculitus • Atypical mycobacterial- swimming pool granuloma • Parasitic- cutaneous larva migrans
  4. 4. Pitted Keratolysis Caused by Corynebacterium or Micrococcus
  5. 5. Erythrasma Caused by Corynebacterium
  6. 6. Cellulitus
  7. 7. Boils/ Abcess
  8. 8. Folliculitus
  9. 9. Impetigo Usually caused by Staphylococcus or Streptococcus
  10. 10. Pseudomonas Hot tub folliculitus Pseudomonas infection with distinctive green drainage
  11. 11. Meningococcus
  12. 12. Herpes Simplex Herpes Gladitorum can be type I or II
  13. 13. More Herpes Simplex
  14. 14. Herpes Zoster Commonly called “shingles”
  15. 15. Tinea Versicolor
  16. 16. Tinea Pedis
  17. 17. Fungal Nail Infections
  18. 18. Tinea Pedis- fungal skin infection
  19. 19. Tinea Cruris- “jock itch”
  20. 20. Tinea Corporis- “ringworm”
  21. 21. Other common conditions • Allergic and contact dermatitis • Urticaria- hives • Nail dystrophies, calluses and blisters, acne mechanica • Warts, jogger’s nipples, intraepidermal bleeding leading to Talon Noire and Mogul’s palm • Frostbite • Nodules on the skin due to recurrent trauma
  22. 22. In some ways, almost everyone is an athlete.
  23. 23. July 23, 2005 Dr. Jane Fore Idaho State Athletic Trainers Conference Methacillin Resistant Staph Aureus Not just in sick people anymore
  24. 24. Goals for today: • AWARENESS • Prevention • Diagnosis • Presentation • Therapy
  25. 25. MRSA WAS: • Something in chronically ill, hospitalized, institutionalized people. • Rarely diagnosed- first recognized in 1961, with initial outbreaks in the 1970’s. • Rarely seen in outpatient clinics and usual staph and strep skin and soft tissue (SSTI) infections were covered by the usual, commonly prescribed medications
  26. 26. MRSA IS: • A Staphylococcus aureus variant with unique virulence features. • Can be the cause of aggressive SSTI in healthy individuals. • Requires a culture of the wound to be properly diagnosed. • Responds to a limited number of antibiotics. • Something that anyone in this room can have and will be encountered by you. • Accounts for 40-70% of the ICU Staph aureus infections.
  27. 27. Types of MRSA • Hospital-acquired infection (nosocomial)- likely to be a form that is more resistant to antibiotics. • Community-acquired MRSA (CA-MRSA) – no health care association. • CA- MRSA with health care association. • There are several strains and the source makes certain strains more or less likely and influences their virulence and their response to antibiotics.
  28. 28. CA-MRSA • The MRSA produces an altered Penicillin Binding Protein 2a that renders antibiotic resistance to methacillin. • The most common CA-MRSA is type IV with the Panton-Valentine leudocidin, or the Leukocyte- killing/ perforating toxin. • Able to colonize for long periods of time without clinical infection. Colonizes skin and nasal passages but also urine, stool and lungs. • Majority of cases are non-healthcare associated CA-MRSA. • Colonization is a significant risk factor for future infection with MRSA.
  29. 29. Prevalence • 1-2% of people in the community will have colonization of the skin or nose. • In LA county emergency depts, the incidence of MRSA in SSTI rose from 29% (2001) to 64% (2003-2004) • In one survey, 40% of children with SSTI had Staph aureus and 45% of the Staph was MRSA. (2001-2003) • About 30% of the hospital MRSA is community acquired infections. • A pediatric survey of healthy children found 0.8% colonization (2001) verses 9.2% (2004) on nasal swabs.
  30. 30. MRSA IS:
  31. 31. Presentations of Disease • Skin boils, cellulitus and abscesses, furuncles located on the trunk, buttock and axilla are most common. “spider bite” • Due to the P-V leucocidin necrotic or very inflamed aggressive infections may result. • The CA-MRSA is usually not associated with invasive disease, but reports of MRSA and rapidly progressive necrotizing lung infections are a new entity emerging as a new MRSA infection process. • Other possibilities include impetigo, osteomyelitis, scalded skin syndrome, toxic shock, septic shock and endocarditis. • Significant pain with a robust inflammatory reaction associated with fever and chills is a common finding.
  32. 32. Risk Factors for CA-MRSA • Many with disease have no risk factors • Antibiotics within the last three months • A hospital stay within 12 months • HIV or Drug abuser • Colonization history with MRSA • Exposure to someone associated with the health-related industry or around someone who has been in the hospital or has had MRSA.
  33. 33. Risk Factors and Athletics • Direct skin contact, especially on injured skin i.e., wrestling, tackling • Shared equipment such as towels, soap, balms, lotions, towels, clothing, whirlpool water • Prolonged coverage of wounds, maceration of skin, cosmetic shaving, turf burns all injure the skin increasing susceptibility • Shared dorm rooms and bathrooms
  34. 34. Prevention • Avoid contact with infected individuals • Infected people to cover wounds • Good hygiene • Do not share clothing (Including towel) • Scheduled cleaning of equipment • Players to report skin problems and coaches inspect players for problems • Risk of cosmetic shaving • Prevention of turf burns • Whirlpool disinfection • HANDWASHING! • Prevention and treatment of skin injuries in an efficient/effective manner • Clearing MRSA infections in players once diagnosed • Teaching players about the principles of skin and wound care
  35. 35. Diagnosis: • Awareness of skin infection symptoms • Culturing the drainage • Following symptoms once treatment is initiated is important • Unresolving/ worsening despite treatment is a red flag • Learn to evaluate skin rashes common to athletics to recognize early the need for intervention
  36. 36. Treatment • Antibiotics, tailored towards treatment of MRSA, is necessary when suspected. Commonly used medications for CA-MRSA include Bactrim DS, Minocycline, Zyvox, Rifampin, Cleocin, but running a sensitivity is necessary. Intravenous therapy may include daptomycin, synercid and vancomycin. • Nasal mupiricone may be prescribed to eradicate nasal colonization since antibiotics do not penetrate the area well. • Topical cleaning with chlorhexidine, hexachlorphene, or povodine-iodine soap, even after clinical clearance of the infection • Incising and drainage of any abcess. • Use of antimicrobial wound sprays, alcohol-based antimicrobial soaps and gels for prevention is also helpful.
  37. 37. References:  Risk Factors for Colonization with Methicillin-Resistant Staphylococcus aureus in Patients Admitted to an Urban Hospital: Emergence of Community-Associated MRSA Nasal Carriage, Hidron Alicia et al, Clin Inf Dis 2005;41:159-66.  Cutaneous Community-acquired Methicillin=resistant Staphylococcus aureus Infection in Participants of Athletic Activities, Cohen PR, Southern Med J 2005;98:6.  A High-morbidity Outbreak of Methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis.2004;39:10, 1446-53.  Community-acquired Meticillin-resistant Staphylococcus aureus: an emerging threat. Zetola N, et al, Lancet Infect Dis 2005;5:275-86.  Methicillin-resistant Staphylococcus aureus: clinical manifestations and antimicrobial therapy. Cunha BA, Clin Microbiol Infect 2005;11(suppl.4):33-42.  Dermatologic Disorders of the athlete, Adams BB, Sports Med 2002, 32;5:309-321.
  38. 38. Thank you for your attention The real voyage of discovery consists not in seeking new landscapes but in having new eyes. Marcel Proust Jane Fore Tri-State Wound Care and Hyperbaric Center Office 1-509-758-1119 Cell phone 1-208-305-0000