Massage & Bodywork

September/October 2012

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PATHOLOGY PERSPECTIVES amount absorbed would be extremely low because of the short contact time. Risk is further decreased when the massage therapist immediately washes his or her hands and forearms after the session. Clients can help decrease the risk of skin-to-skin transference if they wash the treated area or cover the affected skin beforehand. Massage therapists are advised to follow these commonsense precautions: 1. Ask the client about medication use, and be sure to include topical medications within that discussion. 2. If topicals are used, find out how recently each dose was applied. In general, the more time that has passed since application, the better. 3. Avoid directly touching the area treated with topical medications. Cover the area, if possible. A good general rule is to avoid the skin within several inches of the treated area. 4. Wash hands and forearms immediately after the massage. 5. Gloves may offer some protection, but the level of protection depends on the substance in question. Some topical medications may penetrate gloves, so don't count on these to keep you safe all the time. Safe, appropriate skin-to-skin contact within massage therapy is one of the qualities that makes this profession unique within the health-care field. Unfortunately, it also carries some unique occupational hazards. Accidental exposure to topical medications is a small but not inconsequential risk that can be easily avoided with simple precautions—starting with good communication between the therapist and the client. Notes 1. G.N. Stamatas et al., "Infant Skin Microstructure Assessed In Vivo Differs from Adult Skin in Organization and at the Cellular Level," Pediatric Dermatology 27, no. 2 (2010): 125–31; P.M. Elias and R. Ghadially, "The Aged Epidermal Permeability Barrier: Basis for Functional Abnormalities," Clinics in Geriatric Medicine 18, no. 1 (2002): 103–20. 2. J. Stahlman et al., "Serum Testosterone Levels in Non-Dosed Females after Secondary Exposure to 1.62% Testosterone Gel: Effects of Clothing Barrier on Testosterone Absorption," Current Medical Research & Opinion 28, no. 2 (2012): 291–301. 3. A.S. Kathiresan et al., "Virilization from Partner's Use of Topical Androgen in a Reproductive-Aged Woman," American Journal of Obstetrics & Gynecology 205 no. 3 (2011): e3–4; W. de Ronde, "Hyperandrogenism After Transfer of Topical Testosterone Gel: Case Report and Review of Published and Unpublished Studies," Human Reproduction 24, no. 2 (2009): 425–8; C.M. Ogilvie et al., "Bioidentical Testosterone Cream: A Rare Cause of Postmenopausal Virilisation," The Australian and New Zealand Journal of Obstetrics and Gynaecology 49, no. 1 (2009): 116–7. 4. R.J. Schumacher et al., "The Effects of Skin-to-Skin Contact, Application Site Washing, and Sunscreen Use on the Pharmacokinetics of Estradiol from a Metered- Dose Transdermal Spray," Menopause 16, no. 1 (2009): 177–83; M.B. Taylor and M.J. Gutierrez, "Absorption, Bioavailability, and Partner Transfer of Estradiol from a Topical Emulsion," Pharmacotherapy 28, no. 6 (2008): 712–8. 5. A. Mason et al., "Sexual Precocity in a 4 Year Old Boy," British Medical Journal 340 (2010): c2319; C. Brachet et al., "Children's Virilization and the Use of a Testosterone Gel by their Fathers," European Journal of Pediatrics 164, no. 10 (2005): 646–7; Food and Drug Administration Pediatric Advisory Committee, "Review of Pediatric AERS Reports of Secondary Testosterone Exposure Associated with AndroGel Topical Testosterone," accessed July 2012, downloads/AdvisoryCommittees/CommitteesMeetingMaterials/ PediatricAdvisoryCommittee/UCM166691.pdf. 6. S.L. Franklin, "Effects of Unintentional Exposure of Children to Compounded Transdermal Sex Hormone Therapy," Pediatric Endocrinology Reviews 8, no. 3 (2011): 208–12. Ruth Werner is a writer and educator approved by the National Certification Board for Therapeutic Massage & Bodywork as a provider of continuing education. She wrote A Massage Therapist's Guide to Pathology (Lippincott Williams & Wilkins, 2012), now in its fifth edition, which is used in massage schools worldwide. Contact her at or Annie Morien, PhD, is a licensed massage therapist and dermatology physician assistant with extensive clinical experience in evaluating and treating patients with various skin diseases. She received her doctorate in physiology, and teaches and writes about pathophysiology, research, and skin disease. Contact her at Visit the newly designed Log in. Explore. Enjoy. 51

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