Skin Infections in Young Athletes Demand 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. "You are going to be tricked and … 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.

Good hygiene is key to preventing MRSA, said Dr. Gregory of the departments of orthopaedics 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.

According to recommendations from the Centers for Disease Control and Prevention, 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

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. "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," Dr. Gregory 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, he said.

He reported having no conflicts of interest in association with his presentation.

'You are going to be tricked and … athletes are going to try to make lesions look like something else.' DR. GREGORY

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. "You are going to be tricked and … 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.

Good hygiene is key to preventing MRSA, said Dr. Gregory of the departments of orthopaedics 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.

According to recommendations from the Centers for Disease Control and Prevention, 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

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. "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," Dr. Gregory 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, he said.

He reported having no conflicts of interest in association with his presentation.

'You are going to be tricked and … athletes are going to try to make lesions look like something else.' DR. GREGORY

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. "You are going to be tricked and … 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.

Good hygiene is key to preventing MRSA, said Dr. Gregory of the departments of orthopaedics 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.

According to recommendations from the Centers for Disease Control and Prevention, 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

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. "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," Dr. Gregory 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, he said.

He reported having no conflicts of interest in association with his presentation.

'You are going to be tricked and … athletes are going to try to make lesions look like something else.' DR. GREGORY