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Athletes should seek early diagnosis and treatment for skin infections
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The physical closeness that engenders cooperation and teamwork among athletes is also a perfect breeding ground for a variety of contagious skin infections, according to a presenter at the 69th Annual American Academy of Dermatology Meeting in New Orleans this week.
Dermatologist Brian B. Adams, MD, MPH, discussed skin conditions likely to result from skin-to-skin contact among athletes, as well as how to prevent the spread of these infections from one player to another.
"Outbreaks of ringworm, herpes and methicillin-resistant Staphylococcus aureus infection have occurred at the high school, collegiate and professional levels throughout the world," Adams said in a press release. "These skin conditions are highly contagious and can spread through sports teams quite quickly, especially if they are not immediately diagnosed and contained. That is why athletes need to be aware of these risks and how to spot the warning signs of a skin infection."
MRSA is a particularly dangerous bacterial threat facing athletes. An outbreak may appear as a pimple, boil or abscess, with or without draining fluid or pus. MRSA lesions may be swollen, warm and tender to the touch, Adams said. In a recent published review of MRSA in athletes, he found that physical contact, shared facilities and equipment and poor hygiene were all major risk factors. MRSA infection was most common in football players, he said.
"Football players experience a variety of factors predisposing them to MRSA infections," said Adams. "These include skin injuries that can occur on the playing field, turf burns from artificial turf that can worsen skin trauma and even an athlete's ingrown toenail can lead to a MRSA infection. Some athletes are even carriers of the bacteria in their noses."
The proper treatment of MRSA requires rapid diagnosis and treatment, thereby preventing the spread to other team members, Adams said. A topical application called mupirocin can be effective in some patients. Those who are resistant to the topical treatment may require an oral antibiotic, he added.
Viral infections are easily spread and very difficult to contain, Adams said, highlighting herpes simplex virus. Herpes usually presents as blisters and sores around the mouth, nose, genitals and buttocks, but it can appear anywhere on the body — especially the athlete’s body. Early treatment is the only way to guarantee the virus is not spread to other team members. Typically, the athlete can return to practice and competition after 4 to 5 days of treatment, Adams said.
"Herpes simplex is so common among wrestlers — where skin-to-skin contact is unavoidable — that the condition is termed herpes gladiatorum," he said. “Wrestlers who spar with an infected partner have a one in three chance of contracting this skin infection, so it is crucial that the virus is treated and athletes avoid competition during the period of infection."
Also common among wrestlers is the fungal infection tinea corporis gladiatorum. "Any athlete with skin-to-skin contact could develop ringworm, but the intensity of close contact and exposed skin makes wrestling the highest risk sport for this particular fungal infection,” Adams said.
Like MRSA and herpes, early detection and treatment are essential in containing the spread of infection. Athletes should see their dermatologist as soon as they notice any unusual lesions on their skin, Adams said. He added that topical or oral antifungal medications are effective in clearing the infection, but added that “there are no evidence-based recommendations as to how long athletes with ringworm should avoid competition.”
Tinea pedis is a fungal infection that flourishes in dark, moist and warm environments. Sweaty feet encased in athletic shoes are prime targets. Some victims may experience peeling, cracking or scaling between the toes. Others will experience symptoms on the soles and along the sides of the feet, Adams said.
"Athlete's foot can be treated successfully with one of the many over-the-counter topical antifungal creams, but there are also preventive steps that all athletes can take to reduce the spread of this fungus," said Adams. "Moisture-wicking socks are a must, as cotton socks trap moisture and should not be worn by athletes. After working out or competing, athletes should shower immediately and make sure they wear flip flops in the shower or locker room."
Disclosure: Dr. Adams reports no relevant financial disclosures.
Staphylococcus aureus is mainly spread by person-to-person, contact as well as sharing contaminated items such as towels or surfaces such as wrestling mats. Thus, it is no surprise that sports activities with close contact between participants or those requiring equipment that is heavily shared would be associated with S. aureus infections. As with community-associated MRSA infections in general, skin and soft-tissue infections predominate, but serious life-threatening MRSA infections can occur and are particularly a concern among adolescents. For reasons that are still unclear, the major MRSA USA300 clone circulating in the United States appears to have unique properties, allowing it to spread, colonize and subsequently cause infections more readily than other S. aureus clones. The combination of methicillin resistance and increased frequency of infection has led to greater awareness of S. aureus infections among athletes than has been the case previously. The CDC developed very helpful information on MRSA infections for athletes, parents and coaches, which is available at www.cdc.gov/mrsa/prevent/athletic.html. Following the CDC advice hopefully will minimize the risk among athletes participating in contact sports to develop these MRSA infections.
— Sheldon L. Kaplan, MD
Infectious Diseases in Children Editorial
Board member
Disclosure: Dr. Kaplan reports no relevant financial disclosures.
For more information:
- Adams BB. Sports Dermatology - Skin Infections in Athletes. Presented at: 69th Annual American Academy of Dermatology Meeting. Feb. 4-8, 2011. New Orleans.
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