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The Use of Cosmetics in Sport

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Abstract

Introduction Our objective was to search the literature for cosmetic and pharmaceutical products that are frequently used or specially designed around the specific needs of sport activities and athletes. A narrative literature search was performed using the online databases Pubmed and Google Scholar. The authors choose to differentiate between pharmaceuticals and cosmetic products not by following the definition of an “active” or “inert“ action on the skin but by restricting to products that may be sold directly to a consumer without a prescription from a health care professional. These products can be classified into five functional groups of cosmetic products with a potential biological effect to skin. 1. The use of aesthetic cosmetic products in sports is well established, especially in aesthetic sports such as gymnastics, ice skating, and synchronized swimming where an attractive appearance supports the self-confidence of the athlete. Not only the individual performance will benefit but also beauty and attractiveness can influence the scores given by the judges committee. 2. During a sport, the skin of an athlete is often exposed to harsh environmental conditions. In order to protect and to prevent damage to the skin, the cosmetic industry has developed special preventive and protective skin care products, meeting the requirements of the individual sportsperson. 3. Cosmeceuticals are cosmetic products that exert a pharmaceutical therapeutic benefit without having a biological effect on living tissue. Cosmeceuticals are effective in the treatment of sport-related dermatological disorders and can be a useful adjunct to prescription medications. 4. Stimulating products especially those with a hyperaemising or cooling capacity are frequently used by athletes in the preparation for sport or to stimulate the body in order to enhance physical performance. 5. After physical activity, adequate personal hygiene is important in maintaining the body healthy and vital. Intensive showering after each training session requires a cosmetic cleansing formulation that supports the natural skin balance with regard to pH value, moisture content, and cleansing capacity.
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50
IntroductIon
Our objective was to search the literature for cosmetic and
pharmaceutical products that are frequently used or specially
designed around the specic needs of sport activities and ath-
letes. A narrative literature search was performed using the
online databases Pubmed and Google Scholar. The authors
choose to differentiate between pharmaceuticals and cos-
metic products not by following the denition of an “active
or “inert“ action on the skin but by restricting to products that
may be sold directly to a consumer without a prescription
from a health care professional. These products can be clas-
sied into ve functional groups of cosmetic products with a
potential biological effect to skin.
1. The use of aesthetic cosmetic products in sports is
well established, especially in aesthetic sports such
as gymnastics, ice skating, and synchronized swim-
ming where an attractive appearance supports the
self-condence of the athlete. Not only the indi-
vidual performance will benet but also beauty and
attractiveness can inuence the scores given by the
judges committee.
2. During a sport, the skin of an athlete is often
exposed to harsh environmental conditions. In order
to protect and to prevent damage to the skin, the
cosmetic industry has developed special preven-
tive and protective skin care products, meeting the
requirements of the individual sportsperson.
3. Cosmeceuticals are cosmetic products that exert a
pharmaceutical therapeutic benet without having
a biological effect on living tissue. Cosmeceuticals
are effective in the treatment of sport-related der-
matological disorders and can be a useful adjunct to
prescription medications.
4. Stimulating products especially those with a hyper-
aemising or cooling capacity are frequently used by
athletes in the preparation for sport or to stimulate
the body in order to enhance physical performance.
5. After physical activity, adequate personal hygiene
is important in maintaining the body healthy and
vital. Intensive showering after each training ses-
sion requires a cosmetic cleansing formulation that
supports the natural skin balance with regard to pH
value, moisture content, and cleansing capacity.
AesthetIc sport cosmetIcs
It is well known that sport and physical activity have a
positive effect on medical health and subjective well-being.
Sport has a positive effect on our attitude to our own body
image and our feelings of strength and tness. To participate
in sports because of “body and appearance” is, through an
interaction between age and gender, clearly more important
in women than in men, as the women’s body image is more
closely linked to overall self-esteem than men’s [1].
In modern society, the perception of health and beauty
and the desire to maintain youthfulness are considered to be
of great importance. As people wish to maintain a youthful
look as long as possible, the demand for products designed
to treat and reduce the cosmetic effects of aging continues to
grow [2]. Attractiveness and beauty have gained importance
since the media started to broadcast sporting competition and
events on television. Millions of people are watching, the ath-
letes perform, and in the prize-giving ceremonies, the media
is highlighting and focusing on the athlete in person [3]. The
appropriate use of cosmetics and the feeling of looking good
and happiness positively support the self-condence and
self-esteem of an athlete. Happy and attractive personalities
attract the interest of media and sponsors; the combination
of being successful and media publicity can have a major
impact on the career of an athlete. Today, sport equipment
companies bring out their own cosmetic line, with colors in
line with the clothing, supporting the appearance and attrac-
tiveness of the athlete on the track. These sport cosmetics are
adapted to the needs of the individual athlete, with water-
proof and sweat resistant makeup and deodorant fragrances.
depIlAtory creAms
It is a common practice for professional and amateur road
cyclist to remove leg hair for a number of reasons. The
absence of hair increases the comfort and effectiveness of
a massage, as the therapist can efeurage the skin without
irritating the hair follicles. In the case of a crash, the absence
of the leg hair reduces friction on the skin during a sliding
fall reducing skin damage. “Road rash“ and the affected area
can be treated more efciently. Also, professional swimmers
remove hair off their legs not to prevent drag with the water
from slowing them down as is commonly believed but to
remove a dead layer of skin, providing a heightened “feel”
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Use of Cosmetics in Sports
Ron Clijsen, André O. Barel, and Peter Clarys
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516 Handbook of Cosmetic Science and Technology
for the water. Depilatory hair removal is an economical and
easy method, which can be performed at home. Chemical
depilatories function by damaging the hair to the point
where it breaks at the skin surface; they contain detergents
to remove the protective sebum from the hair and adhesives
that aid the depilatory in sticking to the hair shaft. Disulde
bond-breaking chemicals with a high degree of acidity such
as sodium thioglycolate, or calcium thioglycolate, react with
the keratin structure of the hair and break down and dissolve
hair within the follicle. Depending on hair coarseness, the
process takes from 5 to 15 min; during that time, the hair is
dissolved into a glop, which can then be washed away. As
the hair shaft and skin have a similar keratin composition,
most chemical depilatories interact with the skin and hold a
high irritancy potential if the manufacturer’s recommenda-
tions are not carefully followed [4]. Adverse effects from the
use of thioglycolates include burning, itching sensations, and
allergic contact dermatitis [5].
preventIve And protectIve
sport cosmetIcs
SunScreenS and uV Protection
Outdoor sports with sun exposure can cause both local and
systemic immunosuppression depending on the area of expo-
sure and the dosage of UV radiation. The immunosuppres-
sive and carcinogenic effects of UV light on the skin are
complex, involving a variety of cell types, including antigen-
presenting cells, lymphocytes, and cytokines. UV radiation
can cause dysregulation of antigen-presenting cells such as
Langerhans cells and dermal dendritic cells, which, in turn,
can activate regulatory T cells to suppress the immune sys-
tem [6].
Epidemiological studies show that participating in out-
door sport activities and sun exposure during leisure time
activities and outdoor sport in general can increase the risk of
developing basal cell carcinoma (BCC) and cutaneous mela-
noma (CM) [7–9]. In cutaneous photobiology, radiant expo-
sure is often expressed as multiples of “standard erythema
dose” (SED); one SED corresponds to 100 J/m2. In various
dosimeter studies, the anatomical distribution of sunlight
and UV exposure during physical activity was documented.
Playing golf or tennis or participation in sailing was associ-
ated with relatively high UV exposure ranging from 3.5 up to
5.4 SED per hour [10]. In the Tour the Swiss cycling race, the
daily average personal UV exposure of a professional cyclist
was determined to be 20.3 SED [11]. Three triathletes partic-
ipating at the 1999 Ironman Triathlon World Championships
in Hawaii had a mean personal UV exposure of 20.8 SED
[12]. The study conducted by Rigel et al. [13] showed that
skiers with an average skin type and without sunscreen pro-
tection started to get sunburned only after 6 min at an alti-
tude of 11,000 ft. [13]. Sweating induced by physical exercise
in warm environmental conditions increases the stratum
corneum hydration, which can signicantly contribute to
UV-related skin damage as it increases the photosensitivity
of the skin, facilitating the risk of sunburns [14,15]. Although
studies indicate that a single application of sunscreen ef-
ciently reduces sunburn [16–18], it should be considered that
despite the use of water-resistant sunscreen preparations,
protection might be less effective because of water expo-
sure, sweating, friction, and possible interaction of clothing
with the sunscreen formulation. Sport sunscreens specially
designed for outdoor sport activities should be very water
resistant, have a higher sun protection factor (SPF), and block
both UVA and UVB rays.
Since 2002, FDA regulations have required companies to
eliminate the use of the words “Sunblock,“Sweat proof,“
and “Waterproof” when referring to sunscreens as these claims
cannot be substantiated. Instead, the label on the front of
the package can only read either “water resistant (40 min-
utes)” or “water resistant (80 minutes).Also, sunscreens
may no longer claim to provide “instant protection” nor can
they claim to maintain efcacy for more than 2 h without
reapplication [6].
Unfortunately, athletes frequently seem to know little
about the risk of sun exposure and do not apply sunscreen,
and those who initially apply it do not reapply it after per-
spiration or water exposure [19]. Therefore, the use of water-
resistant sunscreen and the need to reapply it every 2 h, after
swimming, or after heavy perspiration still needs to be pro-
moted in the community of an outdoor sportsman [15].
Petroleum Jelly
Petroleum jelly, petrolatum, white petrolatum, soft parafn,
or better known as “Vaseline“ (trademarked brand of petro-
leum jelly) is a semisolid mixture of saturated hydrocarbons,
originally promoted as a topical ointment for its healing
properties [20]. Petroleum jelly is recognized by the US FDA
as an approved over-the-counter (OTC) drug and is widely
used in cosmetic skin care as skin protectant.
In sporting activities, athletes use petroleum jelly as a top-
ical agent in the prevention of blisters [21–23], chang and
abrasions [19,24,25], and otitis externa (swimmer’s ear) [26]
and as protecting ointment to cold environmental conditions
[27,28].
Blisters affect athletes who sustain mechanical friction on
the sole of the feet in an environment of increased tempera-
ture, dryness, or moisture. Horizontal shearing forces cause
epidermal splits, leading the separated layers to be lled with
tissue transudate or blood [29]. Prevention of blisters should
primarily focus on measures reducing the mechanical aspect
of friction by the use of well-tting shoes (with appropriated
space around the toes) and moisture-wicking socks. Several
studies reported the topical application of petrolatum to
decrease the risk of blisters and an acceleration of the heal-
ing process [21–23,29–32]. Besides these measures, running
athletes can promote the hardening of the skin with 10% tan-
nic acid soaks [21,22,24,31,33].
Chang is a supercial inammatory dermatitis appear-
ing on skin surfaces subjected to increased moisture, friction,
and maceration [30,34]. Jogger’s nipples, a particular form of
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517Use of Cosmetics in Sports
chang, is a common phenomenon in long distance runners
as a result of repetitive friction between a runner’s shirt and
their nipples [19,24,25]. Prevention of chang is best accom-
plished by wearing dry, synthetic moisture-wicking clothes.
Talcum and alum powders are mildly helpful for drying, and
the use of petroleum jelly, patches, or adhesive tape over the
nipples is effective in reducing friction [29,30,34].
Cotton wool coated in petroleum jelly was reported to be
the most effective method of ear protection and was found
to be a comfortable and easy-to-use method in the preven-
tion of otitis externa (swimmer’s ear) [26,35]. Long distance
swimmers and triathletes coat themselves in petroleumjelly
as a protection against the stingers of jellysh and as a ther-
mal isolation in cold water when doing training or long ocean
swims. Some controversial reports were found on the ther-
mal insulation provided by petroleum jelly in cold environ-
mental conditions. The in vivo study from Lehmuskallio
et al. [27] showed that subjects with petroleum jelly applied
thickly on half of the face cooled at least as quickly as the
untreated half; however, white petrolatum often produced a
subjectively warming skin sensation. The authors concluded
that “protecting” emollients can provoke a false sensation of
safety leading to an increased risk of frostbite by neglecting
efcient protective measures [27].
inSect rePellentS
Besides children and occupational groups such as farmers,
the outdoor sport enthusiast is frequently a victim of insect
stings and bites [36]. In a prospective study by Dannenberg
et al. [37], the most frequent overuse injuries and medical
problems in Cycle Across Maryland tour in 1994 were eval-
uated. Next to common overuse injuries such as knee pain,
hand or wrist numbness, and dehydration, this study revealed
that insect stings and bites had high incidence rate among
cyclists [37]. Arthropods, notably insects and arachnids, are
vectors of potentially serious ailments and remain a major
cause of patient morbidity. Measures to curtail the impact
of insect bites are important in the worldwide public health
effort to protect people and to prevent the spread of disease
[38]. The use of a skin-based insect repellent, combined
with protective clothing, limiting outdoor time and chance
in patterns of activity or behavior, are elementary in the
prevention of bites. A variety of formulations of different
insect repellents are available including pump sprays, aero-
sols, lotions, creams, grease sticks, and cloth-impregnating
laundry emulsions [39]. Repellents containing DEET (N,N-
diethylmetatoluamide) as an active ingredient are considered
to be effective broad-spectrum, insect repellents and are rec-
ommended by most authorities. Formulations containingless
than 35% DEET are recommended and provide adequatepro-
tectionagainstmosquitoes, ticks, and other arthropods [40].
Permethrin-containing repellents are recommendedforuse
onlyonclothing,shoes,bednets, and camping gear. Permeth-
rin is a highly effective insecticide–acaricide and repellent.
Permethrin-treated clothing repels and kills ticks, mos-
quitoes, and other biting and nuisance arthropods [40,41].
Repellents that are applied according to label instructions
may be used with sunscreen with no reduction in repellent
activity; however, limited data show a one-third decrease in
the SPF of sunscreens when DEET-containing insect repel-
lents are used after a sunscreen is applied. Products that com-
bine sunscreen and repellent are not recommended, because
sunscreen may need to be reapplied more often and in larger
amounts than needed for the repellent component to provide
protection from biting insects. In general, the recommenda-
tion is to use separate products, applying sunscreen rst and
then applying the repellent [40,42,43].
PreVention of JellyfiSh StingS
Jellysh stings are a common occurrence among people
swimming, wading, or diving in seawaters [44]. In the United
States, 500,000 jellysh stings are estimated to occur in the
Chesapeake Bay and up to 200,000 stings in Florida waters
annually [45]. Contact with the tentacles trailing from the
jellysh body can discharge microscopic barbed stingers
thatrelease venom into the skin, causing skin irritation and
sometimes-severe manifestations [44–46]. In the randomized
control trial of Boulware [44], the efcacy of a jellysh sting
inhibitor lotion (Safe Sea) was evaluated. In comparison to
the placebo product, the Safe Sea topical barrier cream was
effective in preventing >80% jellysh stings. In the studies
of Kimball et al. [47] and Tønseth et al. [46], the prophy-
lactic and protective effects of a jellysh sting inhibitor for-
mulated in sunscreen lotion versus a conventional sunscreen
was investigated. The authors concluded that the prophylac-
tic treatment with jellysh sting inhibitor did not eliminate
but signicantly reduced the frequency and severity of stings
[46,47].
effIcAcy of topIcAl AntIfungAls In
the treAtment of dermAtomycosIs
Epidemiological studies show that tinea pedis, formerly
known as athlete’s foot, tinea corporis gladiatorum, and ony-
chomycosis are common sport-related dermatoses affecting
the athletes’ skin [24]. Dermatomycosis are fungal infec-
tions that are widespread throughout the world, which are
an important cause of morbidity [48–50]. Dermatophytosis
is the most common, caused by different species of dermato-
phytes particularly Trichophyton rubrum and Trichophyton
mentagrophytes, followed by Candida species and nonder-
matophytic molds [51]. The prevalence of dermatomyco-
sis is increased in population with avid sport participation.
Athletic activities with an increased incidence are wrestling,
judo, swimming, gymnastic, cycling, horse riding, and in gen-
eral sports with occlusive footwear. The athletes are mainly
exposed to fungal contamination at places where sports
are practiced barefooted such as public swimming or using
showers and changing rooms [24,52]. The treatment of these
conditions often consists of the use of topical or oral anti-
fungal agents or a combination of these, depending on the
site, extent of infection, and the causative organism [53–56].
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518 Handbook of Cosmetic Science and Technology
There is good evidence for the effectiveness of topical anti-
fungals in the treatment of dermatomycosis. In the systematic
review and meta-analysis (k = 135) of Rotta et al. [56], the
efcacy and safety of topical antifungals versus placebo in
the treatment of tinea pedis and onychomycosis were eval-
uated. The authors concluded that azoles, allylamines, and
other antifungals, such as butenane and ciclopirox olamine,
are all efcacious in the management of any dermatomyco-
sis compared to placebo treatment. These results are in line
with other published systematic reviews with meta-analysis
conducted by Hart et al. [57] and Crawford and Hollis [58]
investigating the management of tinea pedis.
stImulAtIng And performAnce-
enhAncIng sport cosmetIcs
liquidS with cooling ProPertieS
Our literature search revealed a study from Leite et al. [59],
evaluating the therapeutic efciency of a cooling liquid ver-
sus conventional cryotherapy. Liquid Ice is an all-natural
liquid cooling solution including menthol and alcohol and is
applied soaked in a wrap [59]. The manufacturer claims that
the product was designed to cool efciently and effectively
though natural evaporative cooling. The two cryotherapy
modalities compared included crushed ice in a room tem-
perature wet towel and Liquid Ice. The crushed ice induced
lower skin surface temperatures compared to the Liquid Ice
application. The authors concluded that Liquid Ice is not use-
ful as a clinical cryotherapy modality.
cooling liquidS to increaSe PhySical Performance
Heat production by intense prolonged exercise induces a
decrease in physical performance. Over the last decade, sev-
eral studies have been conducted to investigate the effects of
local cryotherapy on physical performance.
Dufeld et al. [60] conducted a study on the effect of cool-
ing the skin with an ice jacket before and between repeated
sprint exercises in warm, humid conditions. There was no
improvement in physical performance, although the percep-
tion of thermal load was reduced [60]. Under warm and humid
environmental conditions, evaporation is the primary mecha-
nism for muscle heat dissipation [61].
In our own study, we evaluated the effects of local upper
arms cooling, upper body cooling, and combined cooling of
the upper arms and upper body on the endurance capacity dur-
ing cycling in warm (35°C) humid (40%) conditions. For cool-
ing, we used Energicer bands and cotton vests saturated with a
cooling liquid, based on alcohol and menthol and produced by
the Swiss company Liquid Ice Cosmedicals. The manufacturer
claims that the use of Energicer Bands regulates the body tem-
perature, optimizes the heart rate, reduces the lactate buildup
in the muscle, and increases the power during exercise.
In a randomized crossover study design, we conducted
a standardized incremental bike ergometer test, where time
to exhaustion was determined and used as the independent
variable for endurance capacity. At the end of each incre-
mental step, the following variables were measured: blood
lactate, heart rate, body temperature, and perceived exhaus-
tion (BORG scale). Mean time to exhaustion did not differ
between the four conditions (p > 0.05). We observed no sig-
nicant differences at blood lactate, heart rate, and body tem-
perature during examination between the four conditions.
However, all participants mentioned to feel more comfortable
when wearing the cooling vest under the used environmen-
tal conditions. This effect might aggravate with the airow
when cycling under outdoor conditions, which may lead to
psychological advantages for the athlete [62].
topIcAl muscle And JoInt AnAlgesIcs
During recent years, the use of OTC topical muscle and
joint analgesics has become increasingly common in sports.
Topical analgesics are applied to the skin for temporary
treatment and management of musculoskeletal injuries and
disorders. Topical OTC analgesic products are available in
a variety of formulations, including gels, ointments, creams,
lotions, and patches in single-entity or combination formula-
tions. In clinical use, topical analgesics can be divided into
four basic groups: nonsteroidal anti-inammatory drugs
(NSAIDs), local anesthetics, capsaicin, counterirritants, and
other agents. As this chapter is mainly focusing on cosmetic
and cosmeceuticals, we will discuss only revulsive products
such as capsaicin and nicotinates.
Revulsive products produce a reddening of the skin. This
erythema is due to an increased perfusion of the microcircu-
lation after a vasodilation of the arterial plexus at the differ-
ent skin levels. Nicotinates act via an endothelium relaxant
factor, while capsaicin uses a neurogenic cascade with the
involvement of substance P.
Revulsive products (i.e., rubefacients and urticants) are
known for several clinical and nonclinical applications. Clin-
ically, they are used in the treatment of neuropathological
(diabetic neuropathy, postherpetic neuralgia [PHN]) and/or
musculoskeletal disorders (e.g., osteoarthritis, rheumatoid
arthritis, muscle soreness, and back pain). Nonclinically, they
are used in some sports as passive warming-up products and
in the cosmetic industry as an ingredient in skin products [63].
Despite the widespread use of revulsive products in sport
ointments, patches, wraps, gels, sprays, and balms, studies
reporting on the nonclinical effectiveness of these products
are scarce. Clarys et al. [64] reported only signicant warm-
ing of the supercial skin after application of nicotinate con-
taining revulsive products.
FDA is alerting the public that the use of certain (OTC)
topical muscle and joint analgesic products has been reported
to cause rare cases of serious skin injuries, ranging from
rst- to third-degree chemical burns, where the products
were applied. Consumers using an OTC topical muscle and
joint pain reliever who experience signs of skin injury where
the product was applied, such as pain, swelling, or blistering
of the skin, should stop using the product and seek medical
attention immediately [65].
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519Use of Cosmetics in Sports
cleAnsIng products
Skin cleansing is essential for maintaining healthy skin and
hygiene. Its primary function is to remove dirt, soil, bac-
teria, and dead cells from skin. The athletes’ skin is more
exposed to intense sunlight, dirt, bacteria, and excessive
sweat. Showering after each training session prevents dirt
and bacteria from clogging the pores and is an important
aspect of skin care. Frequently cleansing with commonly
used soap-based shower and bath products induces skin dry-
ness and leads to a weakening of the stratum corneum bar-
rier. Over the last decades, the personal cleansing market has
evolved greatly manufacturing mild cleansing formulations
that remove oils and soil from skin, but without the dryness
and irritation that accompanied typical soap-based products.
Frequently cleansing with water alone does not prevent the
skin from getting dry, as the contact to water only hydrates
skin transiently, leaving the skin after evaporation as dry or
drier than before [66].
For regular body cleansing, athletes should use mild
emollient-rich body washes as they have been shown to be
milder and more moisturizing than regular body washes [67].
Also, daily skin care using a moisturizing emollient-rich
cream or lotion containing a lipid system is an effective treat-
ment to rehydrate and restore dry skin.
conclusIon
The terminology “sport cosmetic“ is used by the cosmetic
industry to commercialize a wide range of cosmetic prod-
ucts. Some are specially developed for the use in sport and
well adapted to needs of sporting people. Others are normal
cosmetics using the co-notations associated with the term
“sport” intending to provide a subjective feeling associated
with being physically active. Some products are widely used
without any prove of efciency. There is a need for further
studies concerning the efcacy of different mentioned sport
cosmetics. Equally no data are available regarding possible
side effects on the skin of repetitive and long-term use of
these products.
references
1. Seippel Ø. The meaning of sport: Fun, health, beauty or com-
munity? Sport Soc 2006;9(1):51–70.
2. Manela-Azulay M, Bagatin E. Cosmeceuticals vitamins. Clin
Dermatol 2009;27(5):469–74.
3. Greiter F. Sport and cosmetics. Sport Med 1985;2:248–53.
4. Trüeb RM. Causes and management of hypertrichosis. Am J
Clin Dermatol 2002;3:617–27.
5. Yamasaki R, Dekio S, Jidio J. Allergic contact dermati-
tis to ammonium thioglycolate [letter]. Contact Dermatitis
1984;11:255.
6. Jou PC, Feldman RJ, Tomecki TJ. UV protection and
sunscreens: what to tell patients. Cleve Clin J Med
2012;79(6):427–36.
7. Garbe C, Buttner P, Weiss J et al. Risk factors for developing
cutaneous melanoma and criteria for identifying persons at
risk: Multicenter case-control study of the Central Malignant
Melanoma Registry of the German Dermatological Society.
JInvest Dermatol 1994;102:695–9.
8. Dozier S, Wagner RFJ, Black SA et al. Beachfront screen-
ing for skin cancer in Texas Gulf coast surfers. South Med J
1997;90:55–8.
9. Ambros-Rudolph C, Hofmann-Wellenhof R, Richtig E et al.
Malignant melanoma in marathon runners. Arch Dermatol
2006;142:1471–4.
10. Herlihy E, Gies PH, Roy CR et al. Personal dosimetry of
solar UV radiation for different outdoor activities. Photochem
Photobiol 1994;60:288–94.
11. Moehrle M, Heinrich L, Schmid A, Garbe C. Extreme
UV exposure of professional cyclists. Dermatology 2000;
201:44–5.
12. Moehrle M. Ultraviolet exposure in the ironman triathlon.
Med Sci Sports Exerc 2001;33:1385–6.
13. Rigel DS, Rigel EG, Rigel AC. Effects of altitude and lati-
tude on ambient UVB radiation. J Am Acad Dermatol 1999;
40:114–6.
14. Moehrle M, Koehle W, Dietz K et al. Reduction of minimal
erythema dose by sweating. Photodermatol Photoimmunol
Photomed 2000;16:260–2.
15. Moehrle M. Outdoor sport and skin cancer. Clin Dermatol
2008;26:12–5.
16. Agin PP, Levine DJ. Sunscreens retain their efcacy on human
skin for up to 8 h after application. J Photochem Photobiol B
1992;15:371–4.
17. Eaglstein WH, Taplin D, Mertz P, Smiles KA. An all-day test
for the evaluation of a topical sunscreen. J Am Acad Dermatol
1980;2:513–20.
18. Bodekaer M, Faurschou A, Philipsen PA, Wulf HC. Sun pro-
tection factor persistence during a day with physical activ-
ity and bathing. Photodermatol Photoimmunol Photomed
2008;24:296–300.
19. Adams BB. Dermatologic disorders of the athlete. Sports Med
2002;32(5):309–21.
20. “Petrolatum (White)” inchem.org. International Programme
on Chemical Safety and the Commission of the European
Communities, March 2002. Retrieved August 5, 2011.
21. Levine N. Friction blisters. Phys Sportsmed 1982;10:84–92.
22. Knapik JJ, Reynolds KL, Duplantis KL, Jones BH. Friction
blisters: Pathophysiology, prevention and treatment. Sports
Med 1995;20:136–47.
23. Cortese TA, Fukuyama K, Edstein WL. Treatment of friction
blisters. Arch Dermatol 1968;97:717–21.
24. Adams BB. Sports dermatology. Adolesc Med 2001;12:305–22.
25. Adams BB. Skin and sports: Common skin conditions in ath-
letes and tips on treatments. Skin Aging 2003;11:65–70.
26. Robinson AC. Evaluation for waterproof ear protectors in
swimmers. J Laryngol Otol 1989;103(12):1154–7.
27. Lehmuskallio E, Rintamäki H, Anttonen H. Thermal effects
of emollients on facial skin in the cold: Clinical report. Acta
Derm Venerol 2000;80(3):203–7.
28. Hassi J, Lehmuskallio E, Juhani J, Rytkönen M. Frostbite
and other problems of skin expose to cold. Duodecim 2005;
121(4):454–61.
29. Mailler-Savage EA, Adams BB. Skin manifestations of run-
ning. J Am Acad Dermatol 2006;55:290–301.
30. Mailler EA, Adams BB. The wear and tear of 26.2: Derma-
tological injuries reported on marathon day. Br J Sports Med
2004;38:498–501.
31. Bart B. Skin problems in athletics. Minn Med 1986;66:239–41.
32. Klein AW, Rish DC. Sports related skin problems. Compr
Ther 1992;18:2–4.
Q4
H100492_C050.indd 519 11/10/2013 8:54:37 AM
520 Handbook of Cosmetic Science and Technology
33. Basler RSW. Skin lesions related to sports activity. Prim Care
1983;10:479–94.
34. Eiland G, Ridley D. Dermatologic problems in the athlete.
JOrthop Sports Phys Ther 1996;23:388–402.
35. Chisholm EJ, Kuchai R, Mc Partlin D. An objective evalua-
tion of the waterproong qualities, ease of insertion and com-
fort of commonly available earplugs. Clin Otolaryngol Allied
Sci 2004;29:128–32.
36. Frazier CA. Insect reactions related to sports. Cutis 1977;
19(4):439–44.
37. Dannenberg AL, Needle S, Mullady D, Kolodner KB.
Predictors of injury among 1638 riders in a recreational long-
distance bicycle tour: Cycle across Maryland. Am J Sports
Med 1996;24:747–53.
38. Katz TM, Miller JH, Herbert A. Insect repellents: Historical
perspectives and new developments. J Am Acad Dermatol
2008;58(5):865–71.
39. Brown M, Hebert AA. Insects repellents: An overview. J Am
Acad Dermatol 1997;36:243–9.
40. Centers for Disease Control and Prevention. Protection
against mosquitoes and other arthropods. Available at http://
www.cdc.gov.
41. Stafford KC. Tick bite prevention and the use of insect repel-
lents. Available at http://www.caes.state.ct.us/FactSheetFiles/
Entomology/TickBitePrevention05.pdf.
42. Montemarano AD, Gupta RK, Burge JR, Klein K. Insect
repellents and the efcacy of sunscreens. Lancet 1997;
349(9066):1670–1.
43. Murphy ME, Montemarano AD, Debboun M, Gupta R. The
effect of sunscreen on the efcacy of insect repellent: A clini-
cal trial. J Am Acad Dermatol 2000;43(2 Pt 1):219–22.
44. Boulware DR. A randomized, controlled eld trial for the
prevention of jellysh stings with a topical sting inhibitor.
JTravel Med 2006;13(3):166–71.
45. Burnett JW. Human injuries following jellysh stings. Md
Med J 1992;41:509–13.
46. Tønseth KA, Andersen TS, Pripp AH, Karlsen HE. Prophy-
lactic treatment of jellysh stings—a randomised trial. Tidsskr
Nor Laegeforen 2012;132(12–13):1446–9.
47. Kimball AB, Arambula KZ, Stauffer AR, Levy V, Davis VW,
Liu M, Rehmus WE, Lotan A, Auerbach PS. Efcacy of a jelly-
sh sting inhibitor in preventing jellysh stings in normal vol-
unteers. Wilderness Environ Med 2004;15:102–8.
48. Borgers M, Degreef H, Cauwenbergh G. Fungal infections
of the skin: Infection process and antimycotic therapy. Curr
Drug Targets 2005;6:849–62.
49. Charles AJ. Supercial cutaneous fungal infections in tropical
countries. Dermatol Ther 2009;22:550–9.
50. Garber G. An overview of fungal infections. Drugs 2001;61
(Suppl. 1):1–12.
51. Singal A, Khanna D. Onychomycosis: Diagnosis and manage-
ment. Indian J Dermatol Venereol Leprol 2011;77(6):659–72.
52. Bassiri-Jahromi S, Sadeghi G, Paskiaee FA. Evaluation of the
association of supercial dermatophytosis and athletic activi-
ties with special reference to its prevention and control. Int J
Dermatol 2010;49(10):1159–64.
53. Gupta AK, Cooper EA. Update in antifungal therapy of der-
matophytosis. Mycopathologia 2008;166:353–67.
54. Meis JF, Verweij PE. Current management of fungal infec-
tions. Drugs 2001;1:13–25.
55. Severo LC, Londero AT. Tratado de Infectologia. São Paulo:
Atheneu, 2002.
56. Rotta I, Sanchez A, Gonçalves PR, Otuki MF, Correr CJ.
Efcacy and safety of topical antifungals in the treatment
of dermatomycosis: A systematic review. Br J Dermatol
2012;166(5):927–33.
57. Hart R, Bell-Syer SE, Crawford F et al. Systematic review of
topical treatments for fungal infections of the skin and nails of
the feet. BMJ 1999;319:79–82.
58. Crawford F, Hollis S. Topical treatments for fungal infections
of the skin and nails of the foot. Cochrane Database Syst Rev
2007;3:1–157.
59. Leite M, Ribeiro F. Liquid IceTM fails to cool the skin surface
as effectively as crushed ice in a wet towel. Physiother Theory
Pract 2010;26(6):393–8.
60. Dufeld R, Dawson B, Bishop D, Fitzsimons M, Lawrence S.
Effect of wearing an ice jacket on repeat sprint performance in
warm/humid conditions. Br J Sports Med 2003;37(2):164–9.
61. Nybo L. Exercise and heat stress: Cerebral challenges and
consequences. Exerc Sport Sci Rev 2007;35(3):110–8.
62. Hohenauer E, Clijsen R, Cabri J, Clarys P. Effects of different
local cooling applications on the endurance capacity during
cycling. Book of Abstracts, 14th Annual Congress of the
European College of Sport Science, Oslo/Norway, 2009, 321.
63. Caselli A, Hanane T, Jane B et al. Topic methyl nicotinate-
induced skin vasodilatation in diabetic neuropathy. J Diabetes
Complications 2003;17:205–10.
64. Clarys P, Barel AO, Taeymans J. Can ointments replace warm-
ing up? Sportverletzungen Sportschaden 1998;18(4):167–71.
65. Available at http://www.fda.gov/safety/MedWatch/
SafetyInformation/SafetyAlertsforHumanMedicalProducts/
ucm319353.htm.
66. Johnson AW. Overview: Fundamental skin care-protecting
thebarrier. Dermatol Ther 2004;17:1–5.
67. Abbas S, Weiss Goldberg J, Massaro M. Personal cleanser tech-
nology and clinical performance. Dermatol Ther 2004;17: 35–42.
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Article
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