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Treating and Avoiding Herpes and Tinea Infections in Contact Sports

Gregory L. Landry, MD: Cindy J. Chang, MD; with Patricia D. Mees

Practice Essentials Series Editors:
Kimberly G. Harmon, MD; Aaron Rubin, MD


Sports that require skin-to-skin contact between competitors, such as wrestling, create environments where infections can spread. Skin screening checks are made before any wrestling competition, but this usually doesn't happen with other sports. Two of the most common skin infections are herpes gladiatorum (caused by the same virus that causes cold sores) and tinea gladiatorum, also known as ringworm (caused by a fungus). These skin infections can spread rapidly among teammates, coaches, and opponents, so it is very important to treat the infection as soon as it is discovered. Athletes who have active skin infections can be disqualified from competition and withheld from practice.

Q. How do I know it's not just an ordinary rash?

A. Herpes rash usually begins with tingling, burning, or itching at the infection site. This pain is a clue that it may be serious. Scattered clusters of tiny, red, blister-like lesions appear on the face, neck, arms, underarms, back, or chest (figure 1). The blisters are filled with clear fluid, but the tops may scrape off on the mat or clothing. The rash usually develops 2 to 5 days after exposure to another infected person. You may also have a fever or headache and feel very tired or not feel like eating.

Tinea (ringworm) appears as round or oval rough patches that have red or raised edges (figure 2). Wrestlers usually get them on the head, neck, arms, and upper back or chest. Sometimes they look like acne, impetigo (a bacterial infection), or early herpes rash.

Q. What should I do if I notice a skin outbreak that might be herpes or tinea?

A. Tell your coach or team doctor immediately! The sooner you begin treatment with an antiviral or antifungal cream or pill prescribed by your doctor, the sooner you can return to play. Early recognition will help prevent further spread. Having one person miss practice is far better than having an entire team disqualified from an important meet.

Q. How can I avoid catching a skin disease from another player?

A. A thorough shower with soap and hot water as soon as possible after every practice, meet, or tournament is the best defense. Wash athletic clothing in hot water after every use. Wrestlers should wear headgear to protect the scalp, and all athletes should shampoo thoroughly after every session. Even though these organisms don't survive long on dry surfaces, wrestling mats should be cleaned with disinfectant at least once a day.

Q. Will I be disqualified from play?

A. If you have a herpes rash that is oozing, yes. National Collegiate Athletic Association (NCAA) rules state that simply covering the rash will not allow you to compete. High school rules state that you must wait 48 hours after the last new blister forms, and all blisters must be dry and scabbed over with a firm crust before you can compete. (A doctor will decide this.) You must also be taking oral antiviral medicine for at least 5 days before and at the time of the meet or tournament.

If you have tinea, and you have only one spot, you may be allowed to participate if the rash is in an area that can be securely covered. The bandage must not come loose during competition. If the spot cannot be covered, or if you have more than one lesion, you must wait 72 hours after the last spot forms, and you must be using antifungal medicine. Again, your doctor decides on when you may participate.

Q. I had a rash and it went away, but now it keeps coming back. Can I prevent it?

A. A rash that comes back in the same place may be caused by a virus or fungus. The skin may heal, but the organisms stay in your system. New outbreaks happen when the skin is weakened. Ask your doctor if you need medication to get rid of it completely or to prevent outbreaks during the season. Cold sores can also be treated to stop them from coming back. A herpes infection will require taking pills, but your doctor may decide to treat a tinea infection with either pills or an ointment.

Teamwork with every player, coach, athletic trainer, and team doctor involved will help you defeat the spread of skin infections.

Remember: This information is not intended as a substitute for medical treatment. Before starting treatment, consult a physician.

Dr Landry is a professor of pediatrics and sports medicine at the University of Wisconsin Medical School in Madison, Wisconsin. Dr Chang is assistant clinical professor in the departments of family and community medicine at the University of California, Davis and the University of California, San Francisco. Patricia Mees is an assistant editor at THE PHYSICIAN AND SPORTSMEDICINE.

Disclosure information: Drs Landry and Chang disclose no significant relationship with any manufacturer of any commercial product mentioned in this article. No drug is mentioned in this article for an unlabeled use.

© 2004, by the McGraw-Hill Companies, Inc. Permission to photocopy is granted for educational purposes.

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