Letters
Author Affiliations: Department of Dermatology, Massachusetts General Hospital, Boston (Pascoe, Kimball); Harvard Medical School, Boston, Massachusetts (Kimball). Corresponding Author: Alexandra B. Kimball, MD, MPH, Clinical Unit for Research Trials and Outcomes in Skin, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, Ste 240, Boston, MA 02114 ([email protected]).
2. Food and Drug Administration. Briefing Documents for iPLEDGE, United States Department of Health and Human Services. http://www.fda.gov/ohrms/dockets /ac/07/briefing/2007-4311b1-02-ipledge.pdf and http://www.fda.gov/downloads /AdvisoryCommittees/%E2%80%A6/UCM281376.pdf. Accessed July 3, 2014. 3. Arnold T. Physician assistants in dermatology. J Clin Aesthet Dermatol. 2008;1 (2):28-31.
Conflict of Interest Disclosures: None reported.
4. Resneck JS Jr, Kimball AB. Who else is providing care in dermatology practices? trends in the use of nonphysician clinicians. J Am Acad Dermatol. 2008;58(2):211-216.
1. Coldiron B, Ratnarathorn M. Scope of physician procedures independently billed by mid-level providers in the office setting [published online August 11, 2014]. JAMA Dermatol. 2014. doi:10.1001/jamadermatol.2014.1773.
5. Jalian HR, Avram MM. Mid-level practitioners in dermatology: a need for further study and oversight [published online August 11, 2014]. JAMA Dermatol. 2014. doi:10.1001/jamadermatol.2014.1992.
Published Online: October 15, 2014. doi:10.1001/jamadermatol.2014.3295.
NOTABLE NOTES
A Championship Quiz on Sports-Related Dermatoses Walter H. C. Burgdorf, MD; Leonard J. Hoenig, MD
Author Affiliations: Retired (Burgdorf); private practice (Hoenig). Corresponding Author: Leonard J. Hoenig, MD, 601 N Flamingo Rd, No. 201, Pembroke Pines, FL 33028 ([email protected]). 1. Pheidippides. http://en.wikipedia.org/wiki/Pheidippides. Accessed April 27, 2014. 2. Adams BB. Sports Dermatology. New York, NY: Springer Verlag; 2006. 3. Blum A. Sports dermatology. In: Burgdorf WHC, Plewig G, Wolff HH, Landthaler M, eds. Braun-Falco’s Dermatology. Heidelberg, Germany: Springer-Verlag; 2009:1200-1206.
Figure. Quiz Sport
Dermatologic Disorder
1. Running
A. Reactive fibrous nodule in perineum
2. Surfing
B. Nipple irritation from garment
3. Table tennis
C. Annular purpura
4. Skiing
D. Alopecia of lateral thighs
5. Bicycling
E. Welts and abrasions on volar forearm
6. Swimming
F. Subcorneal palmar hemorrhage
7. Gymnastics
G. Abrasions on shoulder
8. Sliding
H. Reactive fibrous nodule on back of foot
9. Archery
I. Acne prominent on forehead
10. American football
J. Alopecia on top of head
Answers: 1, B: Jogger’s nipple: combination of rubbing and moisture from jersey leads to nipple irritation. 2, H: Surfer’s nodule: pressure on back of foot on older, heavier boards led to reactive nodule; uncommon today. 3, C: Ping-pong patches: impact of ball moving at speeds of up to 100 miles per hour can produce annular bruise; also seen in handball, squash, and racquetball. 4, F: Mogul skier’s palm: pressure on ski poles leads to subcorneal hemorrhage, analogous to black heel. 5, A: Bicyclist’s third testicle: pressure from seat produces a reactive fibrous nodule in perineum that has been fancifully compared to a third testicle. 6, G: Swimmer’s shoulder: repeated rubbing of beard area on shoulder as the head is turned for breathing produces trauma. 7, J: Balance beam alopecia: pressure on scalp and twisting of hairs from balance beam lead to traumatic alopecia. 8, D: Aqua slide alopecia: lateral pressure on slide to control speed produces traumatic alopecia of lateral thighs. 9, E: Archer’s arm: twanging of bowstring on forearm used to hold bow producing welts and other signs of trauma. 10, I: Helmet acne: repeated pressure from helmet on forehead in acne-prone individuals produces mechanical acne that is primarily comedonal. Shoulder pads can produce a similar reaction.
It has long been known that physical exertion, as in long-distance running, can cause medical problems. Think of Pheidippides, a Greek soldier who died after a long run to Athens bringing news of the Athenian victory in the Battle of Marathon in 490 BC. He found the major officials waiting anxiously for news. After gasping “Joy, we win,”1 he died. The current marathon distance of 26 miles 385 yards is roughly the distance from Marathon to Athens. Most athletic medical problems are not as dramatic as Pheidippides’ story. The skin is subjected to a variety of unusual forces and pressures, producing reactive changes that are often pathognomonic for the sporting activity.2,3 The quiz (Figure) tests your knowledge of some of these sportsrelated reactive dermatoses. Match the sport (left column number) with the clinical description (right column letter) and provide the colloquial name for the sports-related disorder. For example, 1: B, jogger’s nipple.
jamadermatology.com
JAMA Dermatology January 2015 Volume 151, Number 1
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a J H Quillen College User on 05/27/2015
107
Author Affiliations: Department of Dermatology, Massachusetts General Hospital, Boston (Pascoe, Kimball); Harvard Medical School, Boston, Massachusetts (Kimball). Corresponding Author: Alexandra B. Kimball, MD, MPH, Clinical Unit for Research Trials and Outcomes in Skin, Department of Dermatology, Massachusetts General Hospital, 50 Staniford St, Ste 240, Boston, MA 02114 ([email protected]).
2. Food and Drug Administration. Briefing Documents for iPLEDGE, United States Department of Health and Human Services. http://www.fda.gov/ohrms/dockets /ac/07/briefing/2007-4311b1-02-ipledge.pdf and http://www.fda.gov/downloads /AdvisoryCommittees/%E2%80%A6/UCM281376.pdf. Accessed July 3, 2014. 3. Arnold T. Physician assistants in dermatology. J Clin Aesthet Dermatol. 2008;1 (2):28-31.
Conflict of Interest Disclosures: None reported.
4. Resneck JS Jr, Kimball AB. Who else is providing care in dermatology practices? trends in the use of nonphysician clinicians. J Am Acad Dermatol. 2008;58(2):211-216.
1. Coldiron B, Ratnarathorn M. Scope of physician procedures independently billed by mid-level providers in the office setting [published online August 11, 2014]. JAMA Dermatol. 2014. doi:10.1001/jamadermatol.2014.1773.
5. Jalian HR, Avram MM. Mid-level practitioners in dermatology: a need for further study and oversight [published online August 11, 2014]. JAMA Dermatol. 2014. doi:10.1001/jamadermatol.2014.1992.
Published Online: October 15, 2014. doi:10.1001/jamadermatol.2014.3295.
NOTABLE NOTES
A Championship Quiz on Sports-Related Dermatoses Walter H. C. Burgdorf, MD; Leonard J. Hoenig, MD
Author Affiliations: Retired (Burgdorf); private practice (Hoenig). Corresponding Author: Leonard J. Hoenig, MD, 601 N Flamingo Rd, No. 201, Pembroke Pines, FL 33028 ([email protected]). 1. Pheidippides. http://en.wikipedia.org/wiki/Pheidippides. Accessed April 27, 2014. 2. Adams BB. Sports Dermatology. New York, NY: Springer Verlag; 2006. 3. Blum A. Sports dermatology. In: Burgdorf WHC, Plewig G, Wolff HH, Landthaler M, eds. Braun-Falco’s Dermatology. Heidelberg, Germany: Springer-Verlag; 2009:1200-1206.
Figure. Quiz Sport
Dermatologic Disorder
1. Running
A. Reactive fibrous nodule in perineum
2. Surfing
B. Nipple irritation from garment
3. Table tennis
C. Annular purpura
4. Skiing
D. Alopecia of lateral thighs
5. Bicycling
E. Welts and abrasions on volar forearm
6. Swimming
F. Subcorneal palmar hemorrhage
7. Gymnastics
G. Abrasions on shoulder
8. Sliding
H. Reactive fibrous nodule on back of foot
9. Archery
I. Acne prominent on forehead
10. American football
J. Alopecia on top of head
Answers: 1, B: Jogger’s nipple: combination of rubbing and moisture from jersey leads to nipple irritation. 2, H: Surfer’s nodule: pressure on back of foot on older, heavier boards led to reactive nodule; uncommon today. 3, C: Ping-pong patches: impact of ball moving at speeds of up to 100 miles per hour can produce annular bruise; also seen in handball, squash, and racquetball. 4, F: Mogul skier’s palm: pressure on ski poles leads to subcorneal hemorrhage, analogous to black heel. 5, A: Bicyclist’s third testicle: pressure from seat produces a reactive fibrous nodule in perineum that has been fancifully compared to a third testicle. 6, G: Swimmer’s shoulder: repeated rubbing of beard area on shoulder as the head is turned for breathing produces trauma. 7, J: Balance beam alopecia: pressure on scalp and twisting of hairs from balance beam lead to traumatic alopecia. 8, D: Aqua slide alopecia: lateral pressure on slide to control speed produces traumatic alopecia of lateral thighs. 9, E: Archer’s arm: twanging of bowstring on forearm used to hold bow producing welts and other signs of trauma. 10, I: Helmet acne: repeated pressure from helmet on forehead in acne-prone individuals produces mechanical acne that is primarily comedonal. Shoulder pads can produce a similar reaction.
It has long been known that physical exertion, as in long-distance running, can cause medical problems. Think of Pheidippides, a Greek soldier who died after a long run to Athens bringing news of the Athenian victory in the Battle of Marathon in 490 BC. He found the major officials waiting anxiously for news. After gasping “Joy, we win,”1 he died. The current marathon distance of 26 miles 385 yards is roughly the distance from Marathon to Athens. Most athletic medical problems are not as dramatic as Pheidippides’ story. The skin is subjected to a variety of unusual forces and pressures, producing reactive changes that are often pathognomonic for the sporting activity.2,3 The quiz (Figure) tests your knowledge of some of these sportsrelated reactive dermatoses. Match the sport (left column number) with the clinical description (right column letter) and provide the colloquial name for the sports-related disorder. For example, 1: B, jogger’s nipple.
jamadermatology.com
JAMA Dermatology January 2015 Volume 151, Number 1
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archderm.jamanetwork.com/ by a J H Quillen College User on 05/27/2015
107
