Avoiding flare-ups: Athletes must take proper precautions for chronic skin conditions

August 1, 2008

Atopic dermatitis and photosensitivity can cause enough problems for victims of these conditions, but when the sufferers are also active in sports, the conditions can become even more aggravating, and there's not much that can be done other than treating and coping with the ailments.

Key Points

Wexford, Pa. - It is imperative to teach athletes to take proper precautions, so that their participation in sports doesn't make their existing skin ailments even harder to control and more uncomfortable.

Douglas Kress, M.D., chief of the division of pediatric dermatology at the Children's Hospital of Pittsburgh and clinical associate professor, dermatology, University of Pittsburgh School of Medicine, who practices in Wexford, Pa., says swimming poses particular problems for sufferers of atopic dermatitis, and often the dermatologist must take steps to protect their patients.

"When we add a lot of sports - swimming, in particular - the chlorine is terribly drying, so when kids start swimming, whether it be at school in the winter, or over the summer in chlorinated pools, it flares the eczema terribly.

"I continually have to write notes in the winter for kids who have swimming in school, to excuse them from class.

"The way swimming works in the schools is that there is seldom time to shower after getting out of the pool. Schools don't have the locker room facilities and don't allow time to shower.

"So, if a child has eczema, swims early in the day, comes out of the chlorine, throws dry clothes on and doesn't shower for several hours, when they get home at night, their eczema will flare horribly."

Dr. Kress tells Dermatology Times that showering immediately after getting out of the pool and re-applying moisturizer and sunscreen if swimming outdoors are imperative.

Skin barrier dysfunction

The other side of atopic dermatitis problems comes from skin barrier dysfunction, Dr. Kress says.

"The skin is not a good barrier to fluid. It loses fluid to the environment and dries out. On the other hand, it is not a good barrier to infection either.

"So, kids are more likely to pick up skin infections from other kids.

"For example, a child with eczema who wrestles is more likely to pick up warts, molluscum or impetigo. We also hear more and more about methicillin-resistant Staphylococcus aureus (MRSA) now in the high schools.

"So, when we talk about predisposing conditions, eczema is really at the top of the list for both - irritation that comes from swimming, and also from the increased risk of infection that comes from any sort of contact sport.

"Basketball players rub up against each other - they can spread infection. Football players do, too, but wrestling is the big bad one."

Another pitfall athletes face is photosensitivity, be it from polymorphous light eruption or drug-induced photosensitivity, Dr. Kress says.

"I would say the bigger problem is that kids are taking more medicines now that make them very sensitive to the sun."

Dr. Kress explains that the only thing athletes can do to is take the right steps to reduce the effects of existing skin conditions.

"Swimmers must shower, (and) apply their moisturizer and sunscreens right after swimming.

"Wrestlers and others involved in contact sports should be aware of the various skin conditions that can be spread by contact.

"If anyone has an unidentified rash, it really needs to be evaluated by a physician."

And for athletes who compete outdoors and are taking medications, Dr. Kress says they have to use a sunscreen with an SPF of no less than 30.