Skin Infections in Wrestling

Randall R. Wroble MDEric O. DeLeon MD

• Tinea Lesions – ringworm of scalp or skin• Bacterial Disease – impetigo, boils• Conjuctivitis – Pink eye• Scabies, Head Lice• Molluscum Contagiosum

Fungal

• Tinea pedis and cruris– “athlete’s foot” and “jock itch”– Itching, scaling, maceration, vesicles, bullae– Interdigital spaces, sole and arch; groin area– Dermatophytes:

• Trichophyton mentagrophytes• Trichophyton rubrum• Epidermophyton floccosum

– Septated hyphae seen on KOH prep

Fungal• Tinea corporis

– “ringworm”; Tinea gladiatorum– Often grouped together, usually some itching– Pink-red annular raised patches, central clearing – Direct (other humans) and indirect (mats, etc.) acquisi– Dermatophytes:

• Trichophyton rubrum – most common• Trichophyton tonsurans – cultured in one outbreak among h• Microsporum canis – multiple lesions

Fungal

• Tinea versicolor • Variable presentation

– Commensal yeast infection– Benign, self-limited disorder– Treatment:

• Selenium sulfite 2.5 % lotion (Selsun)• Applied neck > waist, 10 minutes/day x 7 days, then every • Imidazole creams and po prn severe cases

Tinea corporis

Ringworm

Ringworm

Ringworm

Tinea pedis

Tinea versicolor

Bacterial• Impetigo – Staphylococci +/- Streptococci

– Face, nose, mouth, sites of trauma– Tender red papule > vesicle or bulla > pustule > weeping shallow ulcer >– “honey-colored” crust– Treat early and aggressively – can cause GMN

• Bid-tid cleansing w/ antibacterial soaps, chlorhexidine (Hibiclens)• Topical mupirocin (Bactroban) ointment tid x 7-10 days.• po antibiotics x 7-10 days

Bacterial• Folliculitis

– Inflammation of hair follicles, often in clusters– Usually Staphylococci; local or widespread– Can progress to furuncles, abscesses– Treatment:

• Topical scrubs (chlorhexidine)• Topical antibiotic gel pads• Same po options as impetigo

– If recurrent - consider carrier status,– mupirocin nasal treatment,– ? underlying immune deficiency or systemic disease (DM)

Furunculosis

• Furuncle/Abscess– Usually Staphylococci– +/- incision and drainage

Abscess

• Furuncle/Abscess

Bacterial

Bacterial

Viral• Herpes gladiatorum

– Herpes simplex 1 virus– College >> high school incidence– Head > extremities > trunk– Spreads very rapidly– Outbreaks reported (Belongia, et.al., 1991)– Less common in those with hx. cold sores (Becker et.a

Herpes gladiatorum

Herpes gladiatorum

Herpes gladiatorum

Herpes gladiatorum

Rule 4.2.3

• NFHS skin condition form is the OHSAA form

4.2.3 Documentation

• Pre-meet Designated Physician• Weigh-in OHSAA/NFHS form• New lesion, no form –NO Weigh-in• May weigh-in; awaiting designate physician

Rule 4.2.4 Designated Physician• Verify prior to or upon arrival• On site physician over rule forms• May not leave wrestling location for evaluation or second opinion

OHSAA

• Treatment start and when to return• Expiration 10 days after exam• No guidelines Rx

4.2.5 Non-Contagious Condition

• Appropriate NFHS/OHSAA form• Exact Body gram• Specific condition named• Denote non-contagious• Lesion may become secondarily infectious• On site physician can over rule

Guidelines

• Red• Raised (skin swollen, pustules)• Rough (skin flaking or irregular)• Runny (discharge of any color or colorless)

• Review and Verify• Discovery and Determine• Protect all wrestlers • Safety for everyone to include officials

Thank you!