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Most Common Skin Conditions in Wrestling

Viral
Herpes Gladiatorum (Herpes Simplex)
Molluscum Contagiosum (poxvirus)

Viral Quick Facts:

  • >40% of infections are viral
  • Very contagious, when an outbreak occurs on a team every member has a 30% chance of becoming infected.
  • Studies have shown use of Valacyclovir prophylactically can reduce outbreak of herpes up to 83%
  • One study showed that when wrestling athletes took 1 gram of valacyclovir each eay it decreased their chances of an infection by 89.5% regardless of whether she/he had a history of herpes infection.

Herpes Gladiatorum (Herpes Simplex)
Acute vs. Recurrent Herpes Simplex

  • The herpes virus is a frequent cause of skin infections in wrestlers. Unfortunately, once an individual is infected with the herpes virus the virus is not rid from the body and the infection can recur.
  • These infections are easily spread through contact; however, herpes outbreaks are treatable and preventable with medication.

Possible Symptoms:

  • First time infections are usually more severe and often last longer than recurrences.
  • First time infections often included:
    • Pharyngitis (sore throat)
    • Fever
    • Adenopathy (swollen lymph nodes)
    • Vesiculopapular lesion (sores, papules, collection of fluid to form vesicles – small fluid-filled sacs)
    • Malaise (uneasiness – feeling fatigued or “not right”, these are common symptoms during incubation period of an infection)
  • Typically, a recurrent infection will include typical vesicuopapular rash. In most instances, other symptoms are minimal in the patient with recurrent herpes rash.

How to contract?

  • Skin – to – skin contact

Most commonly found

  • Head, neck or face

When can a wrestler return to play after having Herpes Simplex?

  • Athlete must be symptom-free
  • No new blisters/sores may develop for 72 consecutive hours.
  • All lesions that have no yet healed must at least have a firm adherent crust on the entire lesion
  • Any active lesion may not be covered to allow for participation.
  • Athlete must complete 120 hours of systemic antiviral therapy

What may increase the chances of a reoccurrence?

  • Abrasions, trauma, or other irritations to skin – especially facial.
  • Stress
  • Drastic weight changes
  • Prolonged or intense exposure to the sun

Things to look out for that may actually be Herpes Simplex

  • Recurrent folliculitis in the same area
  • Any rash that always comes back in the same location
  • Cold sores
  • Unexplainable lymph node swelling or feeling out of the ordinary for multiple days in a row.
  • Any rash or possible infection on the face, near the eyes, or along or in the hairline.

Molluscum Contagiosum (poxvirus)

Possible Symptoms:

  • Skin lesions or growths know has Mollusca. Lesions are usually skin tone, white, or pink in color. Lesions may appear anywhere on the body. These lesions usually have a dimple or pit in the center, are usually hard and smooth, and are about 2-5mm long.
  • Itchy, sore, red, or swollen Mollusca are common
  • These Mollusca may appear along or in clusters.
  • Many times there are no symptoms

How to contract?

  • Skin – to – skin contact
  • Objects and equipment can be contaminated with the virus. Examples include clothing, headgear, mouth pieces, knee pads, mats, towels, shoes, razors, bars of soap, etc.
  • A person who has molluscum can spread it on their own body by touching or scratching a Mollusca then touching another part of their body.
  • Molluscum contagiosum cannot spread through coughing or sneezing. This virus is contained to the skin and is not systemic (it does not run through the entire body)
  • Since the virus is only on the top layer of skin once the Mollusca’s are gone the virus is gone.

Most commonly found

  • Anywhere on the body – it is usually not found on the soles of the feet or palms or the hand.

When can a wrestler return to play?

  • Lesions should be curetted (scraped) at least 24 hours prior to participation.
  • Lesions should be covered with a gas-permeable membrane. These bandages can then be covered with pre-wrap or tape.

What may increase the chances of a reoccurrence?

  • This virus is not like other viruses such as Herpes. It does not lay dormant in your body and reappear. Once the virus is gone it will not reoccur unless contracted again.
  • Keeping these lesions covered is important at all times. Although this virus does not reoccur once it is cleared, it can continue much longer if more lesions occur. If one Mollusca is uncovered a person is more likely to transfer the virus to another part of the skin and develop another Mollusca.

Bacterial

  • Impetigo
  • Folliculitis, furuncles, carbuncles – infected hair
  • Staphylococcus Aureus/CA-MRSA/Abscesses/Cellulitisfollicles

Bacterial Quick Facts:

  • Usually from Group A Streptococcus or Staphylococcus aureus

1. Impetigo

Possible Symptoms

  • Red sores. Sores often pop and leave a yellow discharge and yellow crust.
  • Itchy sores/rash
  • Skin Lesions
  • Fluid-filled blisters
  • Adenopathy (swollen lymph nodes)

How to contract?

  • Skin – to – skin contact from people with infected wounds or sores
  • Through mucus from the nose or throat – sneezing or coughing.
  • The bacteria may also be spread through people who do not currently have symptoms but do carry the bacteria in their throat, mucus, or on their skin.
  • Bacteria on inanimate objects such as shoes, knee pads, headgear, mats, towels, bar soap, razors, etc.
  • Open wounds with improper hygiene/care

Most commonly found

  • Face, head, and neck

When can a wrestler return to play?

  • At least 72 hours of oral antibiotic treatment prior to return to play
  • No active, oozing, draining, moist, or open lesions.
  • If symptoms do not improve in 72 hours re-consult a physician.
  • Irritations to the skin such as rash’s, inflammation, itchiness, sometimes these can be caused by an allergic reaction.

Folliculitis, furuncles, carbuncles – infected hair follicles

Possible Symptoms:

  • Pimples or pustules near a hair follicle – these may crust over
  • Rash
  • Itching

How to contract?

  • Skin – to – skin contact from people with infected wounds or sores
  • Through mucus from the nose or throat – sneezing or coughing.
  • The bacteria may also be spread through people who do not currently have symptoms but do carry the bacteria in their throat, mucus, or on their skin.
  • Bacteria on inanimate objects such as shoes, knee pads, headgear, mats, towels, bar soap, razors, etc.
  • Open wounds with improper hygiene/care

Most commonly found

  • Neck, groin, or genital area

How long does it last?

  • Re-evaluate with a physician if it lasts longer than three days

When can a wrestler return to play?

  • At least 72 hours of oral antibiotic treatment prior to return to play
  • No active, oozing, draining, moist, or open lesions.
  • If symptoms do not improve in 72 hours re-consult a physician.
  • Irritations to the skin such as rash’s, inflammation, itchiness, sometimes these can be caused by an allergic reaction.

Things to look out for

  • Pimples in areas with more hair growth
  • Painful areas around hair follicles

Staphylococcus Aureus/CA-MRSA/Abscesses/Cellulitis

Staphylcoccus aureus (Staph) vs. MRSA (Methicillin-resistant staphylococcal aureus)

  • MRSA is a strain of staph that is resistant to many antibiotics.
  • If a person is diagnosed with a staph infection and it does not begin to resolve within 72 hours after the beginning of an antibiotic they should be re-evaluated by a physician.
  • MRSA will not be treatable with the same medications as other staph infections therefore determining if a staph infection is a MRSA infection is important. This determination should be done by a physician..
  • MRSA can only be diagnosed through a culture (a special lab ordered by a health care provider) of the infection.
  • CA-MRSA refers to Community Associated MRSA. These infections occur in public rather than from a hospital.

Possible Symptoms:

  • Can sometimes have an appearance that may be confused with a spider bite – redness and inflammation on the skin. This may or may not have oozing, draining, discharge, or even a cavity. This may be hard or soft to the touch. This may be referred to as cellulitis or an abscess.
  • Itching
  • Pain.
  • Fever.
  • Adenopathy (swollen lymph nodes)
  • Warmth

How to contract?

  • Skin – to – skin contact from people with infected wounds or sores
  • Through mucus from the nose or throat – sneezing or coughing.
  • The bacteria may also be spread through people who do not currently have symptoms but do carry the bacteria in their throat, mucus, or on their skin.
  • Bacteria on inanimate objects such as shoes, knee pads, headgear, mats, towels, bar soap, razors, whirlpools, saunas, lockers, etc.
  • Open wounds with improper hygiene/care.

Most commonly found

  • Usually on the extremities

When can a wrestler return to play?

  • Staphylococcus Aureus
    • At least 72 hours of oral antibiotic treatment prior to return to play
  • CA-MRSA
    • At least 10 full days withheld from practice or competition while undergoing proper antibiotic treatment.
  • No active, oozing, draining, moist, or open lesions.
  • If symptoms do not improve in 72 hours re-consult a physician.
  • Irritations to the skin such as rash’s, inflammation, itchiness, sometimes these can be caused by an allergic reaction.
  • For MRSA specifically the treatment times may be longer as well as the return to play due to the bacteria’s resistance.
  • No new lesions should have occurred in the preceding 48 hours.

Fungal
Tinea Corporis Gladiatorum (Ringworm)

Possible Symptoms

  • Redness in an area on the skin with a darker red perimeter almost like a Ring
  • Flaky reddened skin
  • Rash
  • Raised spots or pimples
  • Itchy

How to contract

  • Skin – to – skin contact
  • The organism on inanimate objects such as shoes, knee pads, headgear, mats, weight room equipment, towels, bar soap, razors, etc.
    Most commonly found
  • Head, neck, and arms

When can a wrestler return to play?

  • Oral/topical treatment for 72 hours for skin lesions EXCEPT on scalp. Scalp lesions are the same treatment for 14 days.
  • aLesions must be covered with a gas-permeable dressing as well as a wrap and tape to hold on the bandage and for more coverage.

Resources

• National Athletic Trainers’ Association Position Statement: Skin Disease
https://www.nata.org/sites/default/files/position-statement-skin-disease.pdf