Nodular melanoma serendipitously detected by airport full body scanners.

BACKGROUND: Nodular melanoma is the most dangerous form of melanoma and often evades early detection. METHODS: We present a frequently traveling businessman whose nodular melanoma was detected by airport full body scanners. RESULTS: For about 20 flights over 2 months, the airport full body scanners singled out an area on his left lower leg for a pat-down. Dermatologic examination discovered a nodular melanoma in this area, and after surgical excision, the man traveled without incident. CONCLUSION: This case raises the possibility of using full body imaging in the detection of melanomas, especially of the nodular subtype. In its current form, full body scanning would most likely not be sensitive or specific enough to become a recommended screening tool. Nonetheless, for travelers with areas repeatedly singled out by the machines without a known justification, airport scanners could serve as incidental free screening for suspicious nodular lesions that should prompt dermatologist referral.

Resident rounds. Part III: case report: temporary traumatic discoloration from handling moss-covered firewood.

Pattern recognition remains a valuable tool in the accurate diagnosis of dermatologic disease. A comprehensive patient history and physical examination denote cornerstones of medical evaluation, and in our specialty, dermoscopy can supplement data gathering to allocate cutaneous eruptions into appropriate categories. We present a case of acute onset palmar discoloration occurring in an otherwise healthy patient. Correct diagnosis transpired in the clinical setting with tailored questioning based on careful examination and adjunct dermatoscopic evaluation.

Sunscreen use and availability among female collegiate athletes.

BACKGROUND: Each year more than 250,000 athletes participate on National Collegiate Athletic Association (NCAA) teams. The majority of outdoor NCAA athletes, however, do not use sunscreen on a daily basis. Previous research notes that sunscreen availability represents the main barrier to use among collegiate athletes. OBJECTIVE: We sought to explore the effect of sunscreen availability on its application among outdoor collegiate athletes. METHODS: Participants (n = 83) on NCAA Division IA female golf teams were randomized to form treatment and control groups. Treatment group players placed study-supplemented sunscreen in their golf bags and locker rooms during the study period. Both groups completed self-administered surveys at the beginning and end of the 4-week investigation. RESULTS: The athletes for whom sunscreen was placed in the locker room and bags exhibited a statistically greater use of sunscreen at the end of the study compared with the control group (P = .01). Provision of readily available sunscreen in the locker room resulted in an average of 1.13 more days per week of sunscreen use, after adjustment for baseline use (P = .008). In addition, players with ready access to sunscreen during competitions increased their reapplication, although not significantly, by nearly 20% (P = .10). Sunscreen reapplication during practice did not change for either group. LIMITATIONS: Future investigations should target a larger population of both male and female outdoor collegiate athletes. CONCLUSIONS: The application of sunscreen increased significantly when athletes had easy access to sunscreen during practice and competition. These findings highlight a major opportunity to improve sun-protective behaviors among this vulnerable population.

The psychiatric profile of patients with psychogenic excoriation.

BACKGROUND: Psychogenic excoriation describes patients who excoriate without apparent primary skin abnormality. OBJECTIVE: This study compares the psychiatric profile of patients with psychogenic excoriation with a control group. METHODS: Fifty consecutive patients with psychogenic excoriation were matched with 50 control patients and given a questionnaire related to psychiatric history. RESULTS: Study and control groups differed significantly in relation to psychiatric comorbidity, use of psychotropic drugs, history of depression, and history of bipolar disorder. Psychogenic excoriation was not associated with personal history of other psychiatric disorders or family history of psychiatric comorbidity, except alcoholism. LIMITATIONS: Nonpsychiatrists may have made the psychiatric diagnoses. CONCLUSION: Psychogenic excoriation is significantly associated with psychiatric comorbidity, especially depression and bipolar disorder. Awareness by the patient of a link between the psychiatric disorder and the cutaneous condition may help patients in dealing with the distress caused by the unknown nature of the excoriating behavior.

Winter sports dermatology: a review.

As more individuals choose to maintain their fitness level year-round, they inevitably encounter skin problems. During these athletic pursuits, the skin must endure ongoing insult, serving as the interface between the athlete and environmental factors unique to the sport and season. Therefore, primary care physicians and dermatologists must understand how athletic activity and weather contribute to the development of dermatoses. By appropriately recognizing winter sport dermatoses, the practitioner can best provide tailored effective treatment that enables the patient to quickly return to the winter sport.

Methicillin-resistant Staphylococcus aureus and athletes.

Methicillin-resistant Staphylococcus aureus infections have become an increasingly common condition among athletes. Physical contact, shared facilities and equipment, and hygienic practices of athletes all contribute to methicillin-resistant S. aureus transmission among sports participants. This review elucidates the risk factors predisposing to methicillin-resistant S. aureus infection in athletes and provides guidance for treatment and prevention.

Is levofloxacin necessary to prevent postoperative infections of auricular second-intention wounds?

BACKGROUND: Surgeons may prescribe oral quinolones after auricular procedures to prevent postoperative infections, especially those caused by Pseudomonas aeruginosa. OBJECTIVE: This study compares the efficacy of levofloxacin and local wound care to local wound care alone in preventing postoperative infection of auricular second-intention wounds. MATERIALS AND METHODS: This study was a prospective, randomized trial of 84 consecutive patients (82 in the final analysis) who underwent Mohs micrographic surgery for an auricular neoplasm and had a wound left to heal by second intention. After surgery, patients were randomly assigned to receive either local wound care or local wound care with concurrent 500 mg of levofloxacin by mouth daily. RESULTS: Overall, 85.4% of patients had no complications. Complications included 12.2% of patients with inflammatory chondritis and 2.4% of patients with infection. No infections with P. aeruginosa were observed. No statistical significance was observed between the two treatment groups. CONCLUSION: Levofloxacin is not necessary to prevent postoperative infections of auricular second-intention wounds after Mohs surgery.

Skin infections in athletes.

Athletes represent a unique group of dermatologic patients. Intense and close contact with others' skin primarily places the athlete at risk for infection. Failure to acknowledge the role of sports participation in the genesis of skin infections leads to delayed diagnoses, inappropriate therapy, and subsequent epidemics. Simple prevention measures curb epidemics and allow teams to practice and compete without disruption.

Contact dermatitis in athletes.

Athletes face numerous hazards in their daily activities. An athlete's skin, in particular, endures repeated exposure to trauma, heat, moisture, and numerous allergens and chemicals. These factors combine with other unique and less well-defined genetically predisposing factors in the athlete's skin to cause both allergic contact dermatitis (ACD) and irritant contact dermatitis (ICD). As with other cases of contact dermatitis, these eruptions in athletes present as a spectrum of acute to subacute to chronic dermatitis. Recognizing the unique environmental irritants and allergens encountered by athletes is paramount to facilitate appropriate therapy and prevention. This review comprehensively examines the literature on contact dermatitis in athletes. The different types of contact dermatitis have been classified under sport-specific subheadings. Furthermore, within each subheading, both ACD and ICD types are discussed.

Skin manifestations of running.

As the United States comes increasingly closer to being the heaviest nation on earth, many people are turning to exercise, especially running, to lose weight. Most runners, whether novice or professional, will have a skin disorder that may prompt them to seek medical attention. Although case reports and sports reviews have discussed, in a cursory fashion, the nature of these skin lesions, to our knowledge there has never been an extensive review of the literature that specifically addresses the skin diseases of runners. In this article, we present the epidemiology, origin, clinical characteristics, treatment, and prevention of skin diseases inherent to runners.

Sunscreen use among collegiate athletes.

BACKGROUND: College athletes participating in outdoor sports are a population with extensive exposure to ultraviolet radiation during the peak hours of the day. These relatively young athletes could represent a group with alterable habits. OBJECTIVE: We sought to assess the level of sunscreen use in college athletes who are at high risk for ultraviolet radiation exposure. METHODS: An anonymous survey was administered to NCAA soccer and cross-country teams at 4 universities. Answers were analyzed for proportions of sunscreen use and associations among various host variables. RESULTS: Of the surveyed athletes, 85% reported no sunscreen use in the previous 7 days and only 6% reported sunscreen use at least 3 of the previous 7 days. LIMITATIONS: The subject population is limited to one geographic area and includes athletes from only two sports. CONCLUSIONS: These results identify a need for improved primary prevention of ultraviolet damage among the more than 250,000 NCAA athletes participating in outdoor sports. A preventive program involving education, provision of readily available sunscreen, and coach participation is needed to target these individuals.

Common and uncommon hair and nail problems in sports.

We report an exhaustive review of the hair and nail conditions related to participation in sports. It is important that medical professionals who care for athletes recognize the unique dermatologic conditions that may affect those athletes.

Ominous Skin Lesion or Benign Sports-Related Imposter? The Most Common 'Don't Miss' Diagnoses.

Sports participants of all skill levels may develop sport-specific skin problems. Many skin disorders in athletes can mimic other potentially serious dermatologic entities that can be manifestations of musculoskeletal conditions, infections, inflammatory conditions, or carcinomas. Also, some skin conditions can alert the sports physician to look for possible anabolic steroid abuse. Physicians who are familiar with the relationship between the specific activities of various sports and skin disorders common to athletes will be able to properly diagnose, manage, and treat these conditions and educate players to prevent further injury.

Eosinophilic folliculitis occurring after stem cell transplant for acute lymphoblastic leukemia: a case report and review.

BACKGROUND: Eosinophilic folliculitis (EF) comprises classic eosinophilic pustular folliculitis (EPF), human immunodeficiency virus (HIV)-related EF, and infantile EPF subtypes. A fourth proposed subtype describes EF associated with hematologic malignancy. Recently, EF has occurred after bone marrow or stem cell transplantation (SCT). OBJECTIVES: We report a unique case of EF after haploidentical allogeneic SCT for acute lymphoblastic leukemia (ALL) and review the literature for similar cases. METHODS: A 56-year-old, HIV-negative ALL patient presented with an intensely pruritic papulopustular eruption. He had undergone haploidentical allogeneic SCT 65 days earlier, which he had tolerated well. Histopathology revealed a moderately dense perifollicular and perivascular lymphocytic infiltrate with many eosinophils extending from the superficial dermis to the subcutaneous fat. Fungal stains were negative. These findings were highly consistent with EF. RESULTS: Therapy with a class II topical corticosteroid ointment, oral doxepin, and emollients achieved near-resolution of the lesions within eight weeks. Transition to topical tacrolimus 0.1% ointment applied twice daily to residual lesions yielded complete clearance by 12 weeks with mild post-inflammatory hyperpigmentation. The patient's ALL remains in remission. CONCLUSIONS: A fourth proposed subtype of EF is associated with HIV-negative hematologic disease. This subtype is distinguished by a predictable timeframe to presentation and a relatively rapid response to therapy. Although EF is an important consideration in all patients with hematologic malignancy, clinically heightened suspicion is warranted during the 2-3 months after transplant.

Dermatologic disorders of the athlete.

The most common injuries afflicting the athlete affect the skin. The list of sports-related dermatoses is vast and includes infections, inflammatory conditions, traumatic entities, environmental encounters, and neoplasms. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete. Infections probably cause the most disruption to individual and team activities. Herpes gladiatorum, tinea corporis gladiatorum, impetigo, and furunculosis are sometimes found in epidemic proportions in athletes. Vigilant surveillance and early treatment help teams avoid these epidemics. Fortunately, several recent studies suggest that pharmacotherapeutic prevention may be effective for some of these sports-related infections. Inflammatory cutaneous conditions may be banal or potentially life threatening as in the case of exercise-induced anaphylaxis. Athletes who develop exercise-induced anaphylaxis may prevent outbreaks by avoiding food before exercise and extreme temperatures while they exercise. Almost all sports enthusiasts are at risk of developing traumatic entities such as nail dystrophies, calluses and blisters. Other more unusual traumatic skin conditions, such as talon noire, jogger's nipples and mogul's palm, occur in specific sports. Several techniques and special clothing exist to help prevent traumatic skin conditions in athletes. Almost all athletes, to some degree, interact with the environment. Winter sport athletes may develop frostbite and swimmers in both fresh and saltwater may develop swimmer's itch or seabather's eruption, respectively. Swimmers with fair skin and light hair may also present with unusual green hair that results from the deposition of copper within the hair. Finally, athletes are at risk of developing both benign and malignant neoplasms. Hockey players, surfers, boxers and football players can develop athlete's nodules. Outdoor sports enthusiasts are at greater risk of developing melanoma and non-melanoma skin cancer. Athletes spend a great deal of time outdoors, typically during peak hours of ultraviolet exposure. The frequent use of sunscreens and protective clothing will decrease the athlete's sun exposure. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete.