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Health & Safety Resources

Infectious Skin Disorders In Athletes

The skin serves as the major barrier to protect us from infections.  When that barrier breaks down, as in cuts or abrasions, we are subject to a number of viruses, bacteria and fungi.  Skin infections are most commonly seen in wrestlers, gymnasts and swimmers.  These skin infections can be rapidly transmitted by teammates and opponents via the use of shared equipment and mats or skin-to-skin contact.  Recognizing these infections is imperative in slowing their spread.  In the following paragraphs, we will explore the common types of skin infections seen in athletes.

(The links take you to the Web site of the New Zealand Dermatological Society where photos and more information can be found.)

BACTERIAL INFECTIONS

1.  Impetigo: Impetigo appears as a cluster of honey or gold-crusted pustules.  It can ooze and crust and can be seen on both sides of a skinfold ("kissing lesions").  Lesions occur on the limbs, trunk, and near the mouth.  Treatment is with oral and/or topical antibiotics.  Impetigo is highly contagious.  Athletes participating in contact sports or swimming SHOULD NOT participate until ALL lesions have stopped draining, there have been no new lesions within 48 hours of participation, and the participant have been on antibiotics for 48-72 hours.  (MHSAA recommends a minimum of 48 hours.)

2. Boils: Boils are larger pustules (abscesses) and are usually white on a reddened base.  Boils are highly contagious especially if leaking.  In athletes, they are commonly found in the hairy areas of the armpits, buttocks and groin.  Outbreaks are known to occur in team sports, probably due to close contact and poor hygiene practices.  Treatment consists of warm compresses, oral antibiotics and often, incision and drainage of the abscess.  Return to participation guidelines are the same as in impetigo.

3.  MSRA (Methicillin-resistant Staph Aureas infections): MRSA is becoming a more common skin infection in athletes, especially in the past few years.  It is a bacterial infection, commonly seen on the limbs of the athletes, that is resistant to the common antibiotics that successfully treat other bacterial infections.  MRSA is usually quite red in appearance, raised and thick.  It is treated with certain antibiotics:  rifampin and sulfa-type antibiotics.  It is felt to be spread via use of common equipment.  Prompt recognition and treatment is imperative.

VIRAL INFECTIONS

1.  Herpes Infections - Herpes Gladiatorum, Herpes labialis (fever blister), Herpes zoster (shingles): Herpes gladiatroum is common amongst wrestlers and rugby players.  It is caused by the Herpes Simplex Virus (HSV1) and is typified by a cluster of painful clear vesicles on a red base located on the face.  The virus is passed by face-to-face contact.  (Headgear does not decrease the transmission). 

Herpes labialis (fever blister) is a cluster of the painful lesions near or on the lips of the mouth.  It is spread by face-to-face contact.

Herpes zoster (shingles) is more common in middle-aged and older adults, but can occasionally occur in adolescents.  It is a reactivation of the varicella (chickenpox) virus.  It also can occur on the face or limbs, but more commonly on the trunk.  It occurs as a grouping of painful blisters on reddened bases.  The groupings are commonly in a linear pattern only over one side of the body.

These lesions will generally start to resolve within 7-10 days of onset.  The resolution may be quickened by the use of anti-viral medications (valaciclovir, or acyclovir), but only if the medication is started within the first 48 hours of the first eruptions.  Return to participation can occur when there have been no new lesions within 48 hours AND all lesions have crusted over.

2. Verrucae (warts): Warts appear as flesh-colored thickened areas of the skin and can have finger-like projections.  Plantar warts occur on the bottoms of feet and may contain small black dots, which are the small blood vessels that feed the wart.  The virus is transmitted through a break in the skin, usually unbeknownst to the athlete. 

Treatment consists of salicylic acid solutions like Compound W, liquid nitrogen, and/or occlusion (i.e. duct tape).  Athletes with warts may participate as long as the lesions are covered in a manner that provides reasonable assurance that the cover will stay in place during the practice or competition.

3. Molluscum Contagiosum: These lesions are caused by the pox virus and are very contagious.  It is spread by skin-to-skin contact, water transmission and shared gymnastics or wrestling equipment.  The molluscum are small, flesh-colored dome lesions which may have a small indentation in the center.  They can resolve spontaneously over several weeks.  The quickest treatments are: removal by sharp curettage, or a liquid nitrogen application.  These treatments are performed by a physician.  An athlete may compete 24 hours after the curettage.  It is best if the treated area is covered by a gas-permeable dressing, pre-wrap and tape. ( Examples of the gas-permeable dressing include Opsite and Bioclusive)

FUNGAL

1.  Tinea Corporis (Ringworm): Ringworm appears as annular (ringlike) lesions with reddened borders and clearing in the center.  These lesions are commonly seen on the head, neck and arms.  However, they can occur anywhere on the body.  It can be pruritic (itchy).  It is highly contagious.  Treatment consists of antifungal creams and/or oral medications.  MHSAA requires a minimum treatment of 7 days.  If the lesions occur in the scalp, the minimum treatment is 14 days.  It is recommended that even after the treatment, any remaining healing lesion be dressed with the gas-permeable dressing, pre-wrap, and tape.

2.  Tinea Cruris (jock itch): Tinea cruris is an itchy reddish-pink thickened rash in the groin areas that typically have scaly edges.  It generally does not affect the scrotal area.  It is treated with over-the-counter anti-fungal creams.  Tough cases may require oral anti-cungal medications.

3.  Tinea Pedis (athlete's foot): Athlete's foot is typified by an itchy, red, scaly rash on the soles of the feet and sometimes in between the toes.  It is treated by over-the-counter anti-fungal creams and powders.  Athletes are allowed to participate in sports with athlete's foot either by wearing shoes or using the taping method described above.

CONCLUSION

In conclusion, there are several types of infectious skin diseases that can disallow an athlete to participate in practice or competition.  It is imperative that these skin lesions be recognized early and treated.  It is also imperative that equipment and mats be routinely cleaned and disinfected to protect against spread of the infections. 

MHSAA has devised a Communicable Disease Physician Evaluation Form which can be used for documenting evaluation and treatment of these infections by physicians.  It is currently used by the MHSAA wrestling community. 

For further information on this article or for priority appointments for sports injuries please contact Henry Ford Center for Athletic Medicine at 313-972-4216.

Written by: Nancy White, M.D., Henry Ford Center for Athletic Medicine

Henry Ford Health System’s Center for Athletic Medicine offers a comprehensive approach to sports medicine, including surgical and non-surgical care, sports rehabilitation, injury prevention, and performance enhancement programs.  The HFHS treatment team includes sports medicine fellowship trained orthopedic surgeons, sports medicine fellowship trained primary care physicians, as well as certified athletic trainers and physical therapists.  These health care professionals are supported by the HFHS nationally recognized bone and joint research facility, including the prestigious Herrick Davis Motion Analysis Lab.  HFHS is proud to be health care providers to the Detroit area’s premier sports programs including professional, collegiate, and high school athletes.

 

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