Wright State University Sports Medicine Blog


Skin infections in active populations

Skin infections continue to be a growing epidemic in the athletic population. We are going to identify and describe some of the more common types of skin infections found in/on active individuals. These include Bacterial, Viral and Fungal Infections and ways to avoid or treat these infections.

Bacterial Infections:

According to WebMD, Staphylococcal infection is the most common type of bacterial infection but streptococcal infections can also occur. Some disorders that present as a bacterial infection are impetigo, erysipelas, folliculitis and furnuncuosis.

Impetigo is a bacterial skin infection that causes red sores that can break open, ooze liquid and develop a yellow-brown crust. These sores can be located anywhere on the body but most often, they appear around the mouth and nose. According to WebMD, Impetigo is the most common skin infection in children and adults. Symptoms of impetigo include sores on the skin that are small and red. Typically, the sores change to blisters that eventually break open. These sores/blisters are not painful, but they can be itchy. The fluid that comes out of the sores tends to look crusty, making the sores look like they have been covered with a honey or a brown sugar crust. These sores can range in number and size; they can be as big as a coin or as small as a pimple. The treatment for impetigo is an antibiotic. For a mild impetigo breakout an antibiotic ointment or cream can be used to put on the sores. For more serious cases, an internal antibiotic may be necessary to get rid of the infection. After care has begun the infection is no longer contagious after 24 hours. After three days of treatments, there should be a sign of the infection actually decreasing and getting better.

Erysipelas is the medical term for cellulitis. Erysipelas is an infection of the superficial layer of the skin. This presents as a fiery red rash that has raised edges. The affected skin may be warm to the touch and is usually caused by a minor trauma like a burn, bruise, wound or incision. Treatment for Erysipelas is generally a penicillin medication first. The medication should be taken for the full amount for 10-20 days.

Folliculitis is an infection of the hair follicles. This can be caused by shaving, wearing clothes that can irritate the follicles, using a hot tub, whirlpool or swimming pool that is improperly treated with chlorine, using antibiotics or steroids for long periods, working with substances that can block the follicles, and have an infected cut, scrape or surgical wound. Symptoms of folliculitis are red looking pimples with the hair in the center of each one. When the pimples break open, they may drain purulent drainage, blood or both. Treatment for folliculitis is simple. It usually heals on its own in 2 weeks. Also warm compresses mixed with white vinegar can help with healing and ease itching. Also there are medicated shampoo’s that can be used to treat folliculitis on the scalp or beard. If a fever develops from the infection then a physician can prescribe an oral antibiotic to alleviate the infection.

Furuncle (or boil) is deep folliculitis. It is commonly caused by Staphylococcus aureus, resulting in a painful swollen area on the skin caused by an accumulation of purulent drainage and dead tissue. It is commonly caused by an infection of the hair follicle, local cellulitis and inflammation. Complications of boils are scarring and infection in the abscess of the skin. Infections may also spread to the blood stream and become life threatening. Some boils naturally burst and drain but in some instances, draining may be encouraged by application of a warm salt-water soaked cloth. Antibiotics are advised for large or recurrent boils.

Viral Infections:

There are three common types of viral infections that are found more prevalently on active individuals. These would be verruca, molluscum contagiosum, and herpes.

The plantar wart; also known as Verruca plantaris, is a wart caused by the human papillomavirus (HPV) occurring on the sole of the foot. These can be transmitted by direct contact but also by shared showers and locker room floors. Plantar warts are usually self-limiting, but treatments are generally recommended to decrease pain and duration as well as reduce transmission possibilities.

Molluscum contagiosum is a viral infection of the skin commonly at mucous membrane sites. This virus is commonly transmitted through skin-to-skin contact. This also includes contact with an infected persons skin but could also be transmitted by using a towel that was previously used by an infected person. Molluscum contagiosum is contagious until the bumps are gone. If untreated this can take up to six months or longer. Medications for treating these infections include an astringent to dry out the lesions or over the counter wart medicine. Surgical treatments include cryosurgery as well as scraping the lesions off.

Herpes simplex infection has been studied extensively and is typically found in sports with a lot of direct skin to skin contact (wrestling, rugby, etc.) It is stated that herpes can be transmitted from infected wrestlers’ mats but this is still being researched due to the fact that the virus cannot live long outside of the body. Spreading occurs when a sore is present but may also occur in its absence. Herpes patients may know that the virus is present on the skin when they experience the “prodromal symptoms”. These symptoms include itching or tingling on the skin right before a blister or lesions appear. Herpes infections are treated with antiviral medication to suppress or prevent outbreaks from occurring.

Fungal infections:

There are different types of fungal infections and each of the names is based on the body part that the disease infects. Fungal infections can be transmitted through direct skin contact with an infected person, animal-to-human transmission is common. Fungal infections usually live in crowded, humid conditions, places that sweat excessively. Also, athletes that wear tight constrictive clothing with poor ventilation can be more susceptible.

Tinea pedis is a fungal infection of the feet. This is characterized by scaling plaques along the plantar surfaces of the feet. This fungal infection can affect athletes because it thrives in warm moist environments. Affected athletes should be treated with antifungal agents and wear protective footwear when using shared facilities to decrease transmission to other athletes.

Tinea corporis, also known as ring worm, is the more common among the athletic population. This presents with an enlarged raised red ring with a central area of healing. The edge of the rash tends to look elevated and scaly to touch.

Treatment of fungal infections includes application of a topical antifungal cream to the skin. In extensive of cases of fungal infections, treatment with an oral medication may be necessary.

Prevention of fungal infections include: washing hands regularly, avoiding lesions of other people, wearing loose-fitting clothing, and practicing good hygiene when participating in sports involving physical contact with other people. Also, not sharing towels and using caution when utilizing community showers or ice baths can help prevent the spread of fungal infections.

The National Federation of State High School Associations (NFHS) and the Sports Medicine Advisory Committee (SMAC) have both come up with a Sports Related Skin Infections Position Statement and Guidelines. This is a guideline that has information about the skin infections themselves but also the treatment and amount of time an athlete must be removed from participation. For ringworm, an athlete much be treated with an oral or topical antifungal mediation for a minimum of 72 hours prior to participation. Impetigo, Folliculitis, Carbuncle and Furuncle is treated with oral antibiotic and 72 hours of removal of participation and signs of the infection resolving. Herpes infections must be scabbed over with no oozing or discharge and no new lesions in the preceding 48 hours.

Skin infections are not something to be taken lightly. Some are very contagious and spread rapidly if not treated. Early diagnosis and treatment is the best option for controlling an outbreak. It is good for athletes to know their body and be able to pick up on infections early but also for Athletic Trainers, coaches and other staff members to be able to look out for signs of skin infections as well.

Helpful Sites:

· Sports Related Skin Infections Position Statement and Guidelines as defined by The National Federation of State High School Associations (NFHS) and the Sports Medicine Advisory Committee (SMAC)

http://ncasb.org/Documents/SportsMedicine/SportsRelatedSkinInfections.pdf

· The site below is the Ohio High School Athletic Association’s stance and information on skin disorders.

http://www.ohsaa.org/medicine/skininfections.pdf

· The following site is about different infections that can be transmitted between athletes.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071398/


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