Skin Infections: A Tough Opponent for Wrestlers

As a competitive wrestler in high school and college, I enjoyed the challenge of taking on a tough opponent. Many wrestlers battle another type of opponent that causes serious problems:skin infections are a fact of life in the sport.

Skin infections don’t affect only a few participants. The NCAA Injury Surveillance System states that 20% of time-loss injuries in wrestling are due to these infections.¹

In addition to physical discomfort and a long healing process, skin infections can cause emotional suffering as well. Dedicated wrestlers can become depressed when infections keep them from participating in the sport they love and visible lesions can make them self-conscious about their appearance.

Skin infections can occur in a number of ways. Since wrestling involves constant physical contact and collisions, breaks or cracks in skin integrity can be inoculated with bacteria, fungi, or viruses. Infections can also be spread through indirect contact—organisms on the skin of an infected wrestler can come into contact with a wrestling mat, then be transferred onto another wrestler.

The good news is that these infections can be treated successfully. Let’s examine the three types of skin infections and the best ways to resolve them.

Bacterial Infections—Bacteria are microscopic organisms in the air, in water and on a person’s skin. Since they’re the fastest-growing infections, they can be easily spread among athletes. The two major types are staph (Staphylococcal) and strep (Streptococcal).

These bacteria are a problem only when they get into and under the skin, usually from trauma or they enter an area of skin that is compromised. Bacterial infections can be spread via skin-to-skin contact or contact with wrestling mats or protective headgear.

Types of this infections are cellulitis, folliculitis, furuncles, impetigo, and MRSA abscess.

• Cellulitis looks like a bruise but doesn’t have the same course of healing as a bruise. It’s typically firm, red, warm and tender but without flaking or blistering.
• Folliculitis appears as a red pustule near a hair follicle
• Furuncles appear as redness or raised tissue near a hair follicle along with an underlying abscess that looks like a small grape under the skin. The abscess is tender and warm and often has a pustule on top of it.
• Impetigo appears as dry, reddish brown patches with a weepy, honey- colored crust
• MRSA abscesses usually cause painful sores or boils, but it can also cause more serious skin infections and can infect the bloodstream, lungs or urinary tract.

Treatment: Bacterial infections are treated with oral antibiotics such as cephalexin, cefadroxil or clindamycin. More resistant bacteria such as MRSA are treated with incision and drainage or high doses of septra or doxycycline. MRSA abscesses are generally treated with incision and drainage but for MRSA cellulitis only high doses of antibiotics are needed.

Fungal Infections—These infections spread either from organisms on surfaces or from direct contact with another person.

• Ringworm (tinea corporis gladiatorum) is caused by a fungus and can be the result of an injury. This infection can occur in epidemics on wrestling teams and the average infection rate from ringworm is 31%.² It appears as a flat, round lesion with a reddened, flaky area on the outer perimeter. The center of the lesion is clear and has no pus or raised area.

Treatment: For small lesions, antifungal creams are effective; oral antifungal medications are best for larger ones. Topical steroids like hydrocortisone are ineffective and often make the condition worse.

Viral Infections—Wrestlers can contract a viral infection called herpes gladiatorum (“mat herpes”), a skin infection caused by Herpes simplex type 1. This infection happens only through skin-to-skin contact, commonly from head-to-head or “lock-up” positions in wrestling.

• Herpes simplex type 1—Up to 30% of high school wrestlers and 40% of college wrestlers are affected by this type of infection. It’s usually seen as lesions on the head and face, less often on the trunk or extremities.. Initial symptoms of this virus are malaise, sort throat, high temperature and swollen lymph nodes, followed by grouped blistering lesions.

Treatment: Herpes gladiatorum is usually treated with an oral antiviral medication such as valacyclovir or acylovir for 10-14 days. When a wrestler contracts this virus, they are contagious and susceptible to future outbreaks. If a second outbreak occurs, skin lesions are usually smaller. Wrestlers with a history of this infection should take a daily oral medication throughout the entire season to reduce the chance of outbreaks and reduce the risk of spreading to other wrestlers.

I can’t stress enough the importance of taking steps to prevent skin infections from happening in the first place. These steps include:

• Closely observe any skin injury and report it to coaches, trainers and physicians
• Maintain good fingernail hygiene
• Properly launder wrestling attire and clean wrestling mats and wall padding daily
• Shower immediately after practices and matches
• Change workout clothes daily
• Wash hands throughout the day
• Don’t share wrestling equipment (e.g., protective headgear), personal hygiene items or clothing
• Coaches and trainers should present key messages about preventing and caring for skin infections and repeat the messages regularly

In some situations, an experienced athletic trainer may have more expertise in identifying wrestling related skin infections than a team physicianThe ideal way to handle infections is to have trainers, physicians and coaches working together for the well-being of the athletes.

References

1. Agel J, Ransone J, Dick R, et al. Descriptive epidemiology of collegiate men’s wrestling injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athl Train. 2007; Apr-Jun; 42(2): 303-310 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941299/

2. Adams BB. Tinea corporis gladiatorum. Am. Acad. Dermatol. 2002: 47(2), 286–290.
   http://www.ncbi.nlm.nih.gov/pubmed/12140477