In all my years as a sports physiotherapist, I've spent a lot of time thinking about skin. Not because I set out to become a skin health specialist, but because it kept showing up. Every session, every assessment, every massage. Skin is the largest organ we interact with in clinical practice, and it turns out it has a lot to tell us if we're paying attention.
Most musculoskeletal clinicians were not taught to pay much attention to it. Skin got a brief mention in anatomy, a paragraph or two in pathology, and then we moved on to joints, muscles, and nerves. The result is a profession that is well equipped to manage a hamstring tear but considerably less confident when a suspicious lesion appears on the back of a patient who came in for a shoulder assessment.
That gap is worth closing, and the evidence suggests it matters more than most of us realise.
What we're already doing
Every hands-on clinical assessment involves skin contact and skin observation. We see the back, the shoulders, the legs, the feet, the scalp margin. We palpate through skin. We apply products to skin. We watch it respond to treatment and load over weeks and months of rehabilitation.
A UK survey of 120 manual therapists found that more than 90% said they regularly had the opportunity to inspect skin during clinical examination. That is not a small number. It suggests that allied health practitioners are, session by session, in a position that most people never occupy in relation to their own skin: close, repeated, and systematic contact with large areas of the body.
The question is whether we are doing anything useful with that position.
The referral data
In that same UK survey, roughly one third of respondents had referred suspicious lesions in the previous 12 months, totalling 80 lesions, and 67% of those referrals were judged to warrant further investigation. That is a meaningful detection rate. These were not dermatologists making those referrals. They were manual therapists doing what we all do every day, assessing patients and noticing what was in front of them.
A more recent physiotherapy-specific survey found that 75% of physical therapists considered melanoma detection part of their professional duties, yet 59% reported insufficient knowledge to identify suspicious lesions and only 44% actively referred patients with suspicious lesions to dermatologists. The gap between what clinicians believe they should be doing and what they actually do is a knowledge and confidence problem. The willingness is already there.
The athlete-specific load
For clinicians working in sport and exercise settings, skin health carries an additional clinical dimension beyond lesion detection. Athletes subject their skin to stressors that most people never encounter at the same intensity or frequency. Sustained friction, heavy sweat loads, UV and wind exposure, chlorine immersion, repeated wet and dry cycles. These stressors produce a recognisable set of skin conditions, from blisters and chafing to folliculitis and contact dermatitis, that are routine presentations in sport and exercise practice even when they are not the primary complaint.
Research published in 2024 found that 57% of sports students reported blistering as a recurrent problem, 57% reported dry skin, 45% redness, and 34% chafing. These are not rare or exotic presentations. They are common, they affect training and performance, and they are almost always preventable with the right clinical advice.
Practitioners who understand what causes them and how to manage them are adding genuine clinical value in every sport-related consultation.
What skin health in clinical practice actually means
It does not mean becoming a dermatologist. The clinical role for musculoskeletal and sports medicine practitioners in skin health is well defined and fits comfortably within existing scope of practice.
It means observing skin during assessment as a routine part of the clinical examination. Asking a brief skin history for new patients in sport settings. Recognising the common sport-related skin conditions and knowing how to advise on prevention and basic management. Identifying presentations that look atypical, suspicious, or outside the scope of standard sport dermatology, and referring promptly.
None of that requires additional qualifications, specialist training, or significant consultation time. It requires a structured approach and enough knowledge to know what you're looking at.
The professional case
There is also a professional development argument here that does not get made often enough. Skin health is an area where allied health practitioners can demonstrably improve patient outcomes through observation, brief advice, and timely referral. The evidence that clinician counselling changes sun-protective behaviour is robust. The evidence that referrals from manual therapists identify clinically significant lesions is compelling.
This is not a marginal add-on to clinical practice. It is a legitimate extension of what we already do, grounded in evidence, within scope, and with real consequences for patients when it is done well or not done at all.
The Clinician's Guide to Skin Health in Sport & Exercise covers the full framework for integrating skin health into clinical practice, from lesion recognition to hand health to athlete-specific skin conditions.
