Polar thigh: Difference between revisions

Revision as of 15:09, 8 September 2019

Background

Rash-like injury characteristic of extended time in polar environments.
Form of mechanical abrasion combined with air temperature fluctuations/variations in pockets of air trapped beneath clothing layers
Generally only seen in polar environments
Frequently seen in skiers in Arctic environments due to frequent hip extension which stretches clothing overing the thigh, necessity of wearing multiple layers of clothes, and copious amounts of heat locally produced by such exercise

Clinical Features

Rash: erythematous, often urticarial in appearance
Frequently on anterior thigh, though can also appear on medial/posterior thigh

Differential Diagnosis

Frostbite
Allergic reaction
Infection (e.g. cellulitis, fungal/bacterial/viral)

Management

Topical corticosteroid, e.g. betamethasone valerate 0.025% or 0.05% for non-ulcerated rashes
Ulceration present
- Corticosteroid bandage or Granuflex
- General wound care
- If severe ulceration, may require plastic surgery consult or transfer to burn unit
No antibiotics necessary

Prevention

Long silk shorts or undergarments to prevent mechanical abrasion and improve temperature regulation OR
Use of emollient or aloe vera

Disposition

Discharge
If behavioral modifications are not taken, existing polar thigh can progress to frank ulceration.

References

Rhodes, M & Sorenson, HC. Polar Medicine. In: Auerbach, PS,Auerbach's Wilderness Medicine. 7th ed. Elsevier; 2017.

<https://www-clinicalkey-com.ezproxy2.umc.edu/#!/content/book/3-s2.0-B9780323359429000115>

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
- A rash like injury characteristic of extended time in polar environments.
+*[[Rash]]-like injury characteristic of extended time in polar environments.
+*Form of mechanical abrasion combined with air temperature fluctuations/variations in pockets of air trapped beneath clothing layers
+*Generally only seen in polar environments
+*Frequently seen in skiers in Arctic environments due to frequent hip extension which stretches clothing overing the thigh, necessity of wearing multiple layers of clothes, and copious amounts of heat locally produced by such exercise
 ==Clinical Features==
-Erythematous and often urticarial in appearance. Frequently seen on the anterior thigh, this injury can also appear on the medial and posterior thigh. Polar thigh can be seen in both genders. Although generally only seen in polar environments, polar thigh is actually thought to be a form of mechanical abrasion combined with air temperature fluctuations and variations in pockets of air trapped beneath clothing layers. This is frequently seen in skiers in Arctic environments due to : the frequent hip extension which stretches clothing overing the thigh, necessity of wearing multiple layers of clothes, and copious amounts of heat locally produced by such exercise. This theory is further supported by the fact that this injury is not seen in the upper arms which are subject to the same or similar wind, temperature, and clothing layers.
+*[[Rash]]: erythematous, often urticarial in appearance
+*Frequently on anterior thigh, though can also appear on medial/posterior thigh
-[[File:polar thigh 2.png|200px|thumb|left|early polar thigh]]
-[[File:polar thigh 3.png|200px|thumb|left|late stage polar thigh]]
 ==Differential Diagnosis==
-*Frostbite
+*[[Frostbite]]
-*Allergic skin reaction
+*[[Allergic reaction]]
-*Infection (Fungal/Bacterial/Viral)
+*Infection (e.g. [[cellulitis]], fungal/bacterial/viral)
-[[File:polar thigh.png|200px|thumb|left|posterior polar thigh]]
 ==Management==
+*[[Topical corticosteroid]], e.g. [[betamethasone]] valerate 0.025% or 0.05% for non-ulcerated rashes
-A topical corticosteroid (e.g, betamethasone valerate 0.025% or 0.05%) cream improves non-ulcerated rashes but should not be applied to polar thigh which has begun to ulcerate. If ulceration is present, apply a corticosteroid bandage or Granuflex. Proceed with general wound care. No antibiotics are necessary. If ulceration is severe, transfer to plastic surgery or burn unit might be necessary.
+*Ulceration present
+**Corticosteroid bandage or Granuflex
-[[File:polar thigh 4.png|200px|thumb|left|candidate for transfer]]
+**General wound care
+**If severe ulceration, may require plastic surgery consult or transfer to burn unit
+*No antibiotics necessary
+===Prevention===
+*Long silk shorts or undergarments to prevent mechanical abrasion and improve temperature regulation OR
+*Use of emollient or aloe vera
 ==Disposition==
-If behavioral modifications are not taken, existing polar thigh can progress to frank ulceration.
+*Discharge
+*If behavioral modifications are not taken, existing polar thigh can progress to frank ulceration.
-==Prevention==
-Polar thigh can be prevented by the use of long silk shorts or undergarments which prevent mechanical abrasion and improve temperature regulation or though the use of an emollient or aloe vera.
 ==See Also==
+*[[Frostbite]]
-Frostbite
 ==References==