Athletes and acne mechanica: Look to nonporous materials in frequent contact with skin

August 1, 2008

Physicians who work with teens, athletes or even musicians are likely to encounter acne mechanica. Characterized by small red bumps, acne mechanica typically occurs when nonporous material, such as a strap or helmet, is in regular contact with the skin.

Key Points

Deerfield Beach, Fla. - Just as physicians who see lots of teens can expect to see plenty of acne cases, those who see athletic patients can expect to see acne mechanica at some point.

"In working with the team, in addition to high school athletes and football players, I see a quite a bit of acne mechanica," he says.

For hockey or football players, that could be heavy pads, straps or helmets.

The condition could also extend to musicians, such as violinists, for instance, who continuously are rubbing against a chin pad, or even a woman wearing a certain kind of tight bra.

"It could even result from continuously carrying a weapon around, as a soldier might have to do," Dr. Bader tells Dermatology Times.

"It can pop up in any situation where the skin is being occluded, so among people wearing helmets or helmet straps, it's very common, or if patients are wearing headbands or carrying backpacks," he says.

Acne mechanica typically presents as small red bumps, and can show up in some unexpected places, such as the thigh.

It tends to be more common among patients who would be predisposed to acne anyway, and, although it can be a nuisance and should be treated, acne mechanica is typically not severe.

"It will be mostly just the little red bumps. The hockey players can get some pretty bad cases, but it usually doesn't impact their ability to perform in their sport," Dr. Bader says.

A common misdiagnosis for acne mechanica would be folliculitis, but that is in the same family as acne mechanica, and would be treated similarly, Dr. Bader says.

Cotton barrier

In addition to recommending that patients avoid contact with the inciting factor, physicians can suggest putting a fabric, such as cotton, between the skin and the uniform or equipment causing the condition.

"Something like a cotton T-shirt under a uniform can help reduce the friction, and we recommend that, if the patient is an athlete, they shower when the sporting event is over - and wash especially well under the equipment, such as straps or shoulder pads.

"Another suggestion is to use liquid cleansers, including salicylic acid, which does a good job of unclogging the pores," Dr. Bader says.

"Benzoyl peroxide, also over-the -counter - or, in more severe cases, you could use anti-inflammatories or antibiotics, which can help reduce the inflammation," he says.

While there is a risk of infection, Dr. Bader says the condition typically resolves before developing into anything worse.

"Any time there is inflammation of the skin or follicular units, it could be colonized with Staphylococcus, but once you get the pads or the causing material off and cleaned, it typically resolves by itself.

"Sometimes, there may well be some MRSA folliculitis at play, but even that is usually mild; and once you take the occlusion away, even those lesions resolve by themselves."

An intriguing variation of acne mechanica, called 'stump acne,' reported in the literature in the 1970s, was observed in patients who used prosthetics, and, as in acne mechanica, the cause was believed to be the nonporous devices rubbing against the skin.

"Most of the prosthetics used to be a plastic cup that was put on with a sock and then stuck to the leg by suction, so you would see the same problem that you might have with a helmet strap - the plastic would be placed right against the skin, and those patients would have the same problem," Dr. Bader says.

The key to prevention is to keep the skin separate from the nonporous material.

"We recommend to athletes that they wear cotton underwear with their gear, because it breathes better and absorbs moisture. Some of the synthetic fibers just don't breathe as well, and that's when you start having problems," he says. "The skin isn't meant to be occluded."