Skin Infections in Young Athletes Demand Extra Vigilance

VANCOUVER, B.C. — Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks.

In addition, some athletes with skin infections must be cleared by a physician to return to play and will try to hide symptoms. “Realize that you are going to be tricked and that athletes are going to try to make lesions look like something else,” Dr. Andrew Gregory said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. They may try to abrade lesions with sandpaper, cover them with makeup, or bleach them.

“If methicillin-resistant Staphylococcus aureus [MRSA] is not in your community yet, it is going to be,” Dr. Gregory predicted, noting the prevalence of outbreaks on athletic teams in recent years. “You need to be more aware of this in the athletic population than in the rest of your practice because of the risk of spread.”

Good hygiene is a key to preventing MRSA, said Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University, Nashville, Tenn. Coaches and certified athletic trainers should encourage athletes to shower and clean their equipment regularly with soap and water and to avoid sharing equipment, clothing, towels, and razors. In addition, he recommends cleaning any shared equipment and surfaces with bleach and putting alcohol-based hand-sanitizing gels in training rooms, locker rooms, and bathrooms.

When MRSA is detected in one athlete, coaches and athletic trainers should talk with others on the team to see if any of them have lesions, Dr. Gregory advised. Treatment of MRSA in this population is the same as that in other children and adolescents—incision and drainage and antibiotic therapy appropriate for that specific community. “That's different for every community, so you need to be aware of what the sensitivities are locally,” he said.

According to recommendations from the CDC, athletes with any staphylococcal infection—including MRSA—should receive oral antibiotic therapy for a minimum of 3 days of before returning to play sports involving skin-to-skin contact, he noted (see www.cdc.gov/ncidod/dhqp/ar_MRSA_AthletesFAQ.html

Finally, Dr. Gregory cautioned, physicians and administrators should beware of sales pitches for products such as turf coatings that promise to protect athletes from MRSA. “There is no evidence that they do what they claim,” he said.

Tinea infection, called tinea gladiatorum in wrestlers, was historically attributed to dirty mats, but efforts to culture the fungus from this source have failed, so it is now believed to be passed primarily by skin-to-skin contact, Dr. Gregory said. “These lesions are tough to diagnose when they are pretty small, before they get the central clearing,” he observed.

Treatment consists of topical antifungal agents as first-line therapy and oral ones as second-line therapy. Wrestlers with this infection must be withheld from practice and competition until they have had treatment for 48-72 hours, and simply covering lesions is inadequate, Dr. Gregory said. He also recommended considering antifungal prophylaxis when athletes have recurrences or when outbreaks occur.

Herpes simplex I infection is spread by direct skin-to-skin contact and is also common among wrestlers, in whom the infection is called herpes gladiatorum. Typically, there are lesions on the right side of the head, related to the starting position for this sport, and it is important to prevent infection from spreading to the eye, which may lead to herpes conjunctivitis.

“It is a little bit difficult to tell that this is a herpes infection initially, before you get that characteristic vesicular rash,” he commented. Physicians should be suspicious whenever they see wrestlers with a raised erythematous rash. “The key is to recognize it early and initiate treatment early,” he said, with an appropriate course of an antiviral such as acyclovir. Antiviral prophylaxis should be considered for athletes with recurrences or when outbreaks occur.

Most physicians agree that wrestlers with herpes infections can return to play after all of their lesions have crusted over—usually in 10-14 days—although some advocate waiting until the lesions are completely healed, Dr. Gregory noted.

Dr. Gregory reported that he had no conflicts of interest in association with his presentation.

VANCOUVER, B.C. — Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks.

In addition, some athletes with skin infections must be cleared by a physician to return to play and will try to hide symptoms. “Realize that you are going to be tricked and that athletes are going to try to make lesions look like something else,” Dr. Andrew Gregory said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. They may try to abrade lesions with sandpaper, cover them with makeup, or bleach them.

“If methicillin-resistant Staphylococcus aureus [MRSA] is not in your community yet, it is going to be,” Dr. Gregory predicted, noting the prevalence of outbreaks on athletic teams in recent years. “You need to be more aware of this in the athletic population than in the rest of your practice because of the risk of spread.”

Good hygiene is a key to preventing MRSA, said Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University, Nashville, Tenn. Coaches and certified athletic trainers should encourage athletes to shower and clean their equipment regularly with soap and water and to avoid sharing equipment, clothing, towels, and razors. In addition, he recommends cleaning any shared equipment and surfaces with bleach and putting alcohol-based hand-sanitizing gels in training rooms, locker rooms, and bathrooms.

When MRSA is detected in one athlete, coaches and athletic trainers should talk with others on the team to see if any of them have lesions, Dr. Gregory advised. Treatment of MRSA in this population is the same as that in other children and adolescents—incision and drainage and antibiotic therapy appropriate for that specific community. “That's different for every community, so you need to be aware of what the sensitivities are locally,” he said.

According to recommendations from the CDC, athletes with any staphylococcal infection—including MRSA—should receive oral antibiotic therapy for a minimum of 3 days of before returning to play sports involving skin-to-skin contact, he noted (see www.cdc.gov/ncidod/dhqp/ar_MRSA_AthletesFAQ.html

Finally, Dr. Gregory cautioned, physicians and administrators should beware of sales pitches for products such as turf coatings that promise to protect athletes from MRSA. “There is no evidence that they do what they claim,” he said.

Tinea infection, called tinea gladiatorum in wrestlers, was historically attributed to dirty mats, but efforts to culture the fungus from this source have failed, so it is now believed to be passed primarily by skin-to-skin contact, Dr. Gregory said. “These lesions are tough to diagnose when they are pretty small, before they get the central clearing,” he observed.

Treatment consists of topical antifungal agents as first-line therapy and oral ones as second-line therapy. Wrestlers with this infection must be withheld from practice and competition until they have had treatment for 48-72 hours, and simply covering lesions is inadequate, Dr. Gregory said. He also recommended considering antifungal prophylaxis when athletes have recurrences or when outbreaks occur.

Herpes simplex I infection is spread by direct skin-to-skin contact and is also common among wrestlers, in whom the infection is called herpes gladiatorum. Typically, there are lesions on the right side of the head, related to the starting position for this sport, and it is important to prevent infection from spreading to the eye, which may lead to herpes conjunctivitis.

“It is a little bit difficult to tell that this is a herpes infection initially, before you get that characteristic vesicular rash,” he commented. Physicians should be suspicious whenever they see wrestlers with a raised erythematous rash. “The key is to recognize it early and initiate treatment early,” he said, with an appropriate course of an antiviral such as acyclovir. Antiviral prophylaxis should be considered for athletes with recurrences or when outbreaks occur.

Most physicians agree that wrestlers with herpes infections can return to play after all of their lesions have crusted over—usually in 10-14 days—although some advocate waiting until the lesions are completely healed, Dr. Gregory noted.

Dr. Gregory reported that he had no conflicts of interest in association with his presentation.

VANCOUVER, B.C. — Managing skin infections in young athletes can be more challenging than in the general pediatric population, because close physical contact and use of shared equipment can lead to rapid spread of infections and outbreaks.

In addition, some athletes with skin infections must be cleared by a physician to return to play and will try to hide symptoms. “Realize that you are going to be tricked and that athletes are going to try to make lesions look like something else,” Dr. Andrew Gregory said at a meeting on pediatric and adolescent sports medicine sponsored by the American Academy of Pediatrics. They may try to abrade lesions with sandpaper, cover them with makeup, or bleach them.

“If methicillin-resistant Staphylococcus aureus [MRSA] is not in your community yet, it is going to be,” Dr. Gregory predicted, noting the prevalence of outbreaks on athletic teams in recent years. “You need to be more aware of this in the athletic population than in the rest of your practice because of the risk of spread.”

Good hygiene is a key to preventing MRSA, said Dr. Gregory of the departments of orthopedics and pediatrics at Vanderbilt University, Nashville, Tenn. Coaches and certified athletic trainers should encourage athletes to shower and clean their equipment regularly with soap and water and to avoid sharing equipment, clothing, towels, and razors. In addition, he recommends cleaning any shared equipment and surfaces with bleach and putting alcohol-based hand-sanitizing gels in training rooms, locker rooms, and bathrooms.

When MRSA is detected in one athlete, coaches and athletic trainers should talk with others on the team to see if any of them have lesions, Dr. Gregory advised. Treatment of MRSA in this population is the same as that in other children and adolescents—incision and drainage and antibiotic therapy appropriate for that specific community. “That's different for every community, so you need to be aware of what the sensitivities are locally,” he said.

According to recommendations from the CDC, athletes with any staphylococcal infection—including MRSA—should receive oral antibiotic therapy for a minimum of 3 days of before returning to play sports involving skin-to-skin contact, he noted (see www.cdc.gov/ncidod/dhqp/ar_MRSA_AthletesFAQ.html

Finally, Dr. Gregory cautioned, physicians and administrators should beware of sales pitches for products such as turf coatings that promise to protect athletes from MRSA. “There is no evidence that they do what they claim,” he said.

Tinea infection, called tinea gladiatorum in wrestlers, was historically attributed to dirty mats, but efforts to culture the fungus from this source have failed, so it is now believed to be passed primarily by skin-to-skin contact, Dr. Gregory said. “These lesions are tough to diagnose when they are pretty small, before they get the central clearing,” he observed.

Treatment consists of topical antifungal agents as first-line therapy and oral ones as second-line therapy. Wrestlers with this infection must be withheld from practice and competition until they have had treatment for 48-72 hours, and simply covering lesions is inadequate, Dr. Gregory said. He also recommended considering antifungal prophylaxis when athletes have recurrences or when outbreaks occur.

Herpes simplex I infection is spread by direct skin-to-skin contact and is also common among wrestlers, in whom the infection is called herpes gladiatorum. Typically, there are lesions on the right side of the head, related to the starting position for this sport, and it is important to prevent infection from spreading to the eye, which may lead to herpes conjunctivitis.

“It is a little bit difficult to tell that this is a herpes infection initially, before you get that characteristic vesicular rash,” he commented. Physicians should be suspicious whenever they see wrestlers with a raised erythematous rash. “The key is to recognize it early and initiate treatment early,” he said, with an appropriate course of an antiviral such as acyclovir. Antiviral prophylaxis should be considered for athletes with recurrences or when outbreaks occur.

Most physicians agree that wrestlers with herpes infections can return to play after all of their lesions have crusted over—usually in 10-14 days—although some advocate waiting until the lesions are completely healed, Dr. Gregory noted.

Dr. Gregory reported that he had no conflicts of interest in association with his presentation.