17. Chemical Deposition
This book reviews many diseases of athletes acquired through interaction with other competitors and their equipment. This section focuses on the interaction between athletes and the environment in which they compete.
Even perfectly trained and prepared athletes are at the mercy of the venue’s environment. Athletes are exposed to chemicals, anabolic steroids, thermal changes, and animals in the various venues. Some exposures are unique to specific sports, such as a swimmer’s exposure to copper in the swimming pool.
Other exposures, such as to cold temperatures, relate to sports that share only cold venues.
Chapter 18 reviews the cutaneous manifestations of anabolic steroid use.
Chapter 19 focuses on the thermal effects of the environment on athletes’ skin.
Both acute and chronic extreme temperatures (cold or hot) pose difficulties for all athletes. Chapter 20, the last of this section and the last of the book, reviews the myriad encounters that athletes have with animals. Most of these encounters discussed occur in the sea or lakes. Land encounters with nonhuman competi- tors also are discussed.
Chapter 17, the first in this section, focuses on chemical deposition, the first of the four general categories of environmental exposure for athletes, specifi- cally the effect of chlorine and copper on the hair of swimmers and nitrogen in the subcutaneous tissue of scuba divers.
Green Hair Epidemiology
There have been no epidemiologic studies of green hair in swimmers. Cli- nicians have stated that the condition is more common than the rare cases reported in the literature (Sarnaik et al., 1986). Epidemics have occurred in pools with high levels of copper. One such epidemic occurred in Framingham, Massachusetts, when fluoridation treatment made the water much more acidic and the copper content in the water increased. Children and women are more likely to develop green hair after swimming (Basler et al., 2000). At-risk sports include diving, synchronized swimming, swimming, watersliding, and water polo.
The cause of green hair is copper and not chlorine, as is often mentioned.
(In fact, one large cosmeceutical company even ran television advertisements incorrectly stating that their marketed shampoo protects swimmer’s hair from becoming green by blocking the effects of chlorine.) Pools have varying levels of copper in the water. The copper originates as a naturally occurring ion in the water, from the copper pipes related to the pool, or from copper-containing algaecides. The acidity of water increases leaching from old pipes; hence, the
level of copper in the water increases as the pH of the water decreases (Person, 1985).
Clinical Presentation
The greenish hue of hair is most easily appreciated in individuals with white, blonde, or very light hair.
Diagnosis
The diagnosis is unmistakable. Wet hair in bright light best demonstrates the greenish hue imparted on affected hair (Goette, 1978).
Treatment
Although there is no medical reason to treat the green hair, its appearance may disturb the athlete, who may wish to alter the hair color. Some have rec- ommended heated vegetable [salad] oil (Goldschmidt, 1989). Over-the-counter copper chelating shampoos are readily available at any pharmacy. Applying 3%
to 5% hydrogen peroxide to the green hair for 30 minutes also removes the color.
This method essentially bleaches the hair. For treatment-resistant green hair, one author created a penicillamine shampoo by dissolving a 250-mg capsule of the medicine in 5 ml water and 5 ml shampoo. This shampoo cleared the green hair in several days (Person, 1985).
Prevention
Regular and immediate shampooing after swimming should be effective in preventing green hair. Athletes should fully rinse their hair after shampooing to ensure that the residual shampoo does not create an ideal microenvironment for precipitation of copper salt in the hair (Person, 1985). Others also recommend shampooing twice per season with a copper chelating shampoo to deter the production of green hair (Goldschmidt, 1989). It is very important that the pH of the pool be properly maintained. The ideal pH is between 7.4 and 7.6.
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Blonding and Drying of Hair Epidemiology
Not uncommonly, avid swimmers who use chlorinated pools find their hair has been bleached and made much drier because of the chlorine. At-risk sports include diving, synchronized swimming, swimming, and water polo.
Clinical Presentation
Depending on the concentration of chlorine and the duration of time spent in the chlorinated pool, the swimmer’s hair will become dry and bleached.
Diagnosis
Dry and bleached hair is self-evident.
Treatment and Prevention
Swimmers should use a conditioning shampoo or rinse immediately after swimming in pools.
Skin Bends Epidemiology
This condition is also known as “nitrogen rash.” It occurs when divers exceed their allowable time deep underwater. Nitrogen supersaturates the blood and dis- solves in the subcutaneous tissue.
Clinical Presentation
Affected divers notice a pruritic, reticulated, cyanotic, purpuric eruption on the elbows and lateral abdomen.
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Diagnosis
The diagnosis is straightforward after the history is obtained and is corre- lated with the clinical presentation.
Treatment and Prevention
Nitrogen rash self-subsides, but divers should not continue to dive until the eruption has cleared.
Bibliography
Basler RS, Basler GC, Palmer AH, et al. Special skin symptoms in swimmers. J Am Acad Dermatol 2000;43:299–305.
Goette DK. Swimmer’s green hair. Arch Dermatol 1978;114:127–128.
Goldschmidt H. Green hair. Arch Dermatol 1979;115:1288.
Person JR. Green hair: treatment with a penicillamine shampoo. Arch Dermatol 1985;
121:717–718.
Sarnaik A, Vohra, Sturman SW, et al. Medical problems of the swimmer. Clin Sports Med 1986;5:47–64.
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