Ringworm, Staph, & Herpes in Wrestlers

Transcription

1 Ringworm, Staph, & Herpes in Wrestlers Sonia I. Millán P., MD NOT choke (for me) Identify concerning skin lesions Preventive measures Return to play guidelines Objectives ~8.5% HS athletes ~21% college athletes Disruption of participation Increased morbidity Cutaneous Infections in Wrestlers 1

2 Warm, moist environment Skin-to-skin contact Gear and mats Abrasions Predisposing Factors Ringworm A misnomer Fungal infection of skin (tinea) Tinea Corporis Gladiatorum (body) Ringworm 2

3 Well-defined round, erythematous, scaly plaque Raised borders & central clearing Presentation Head, face, neck and upper extremities Presentation +/- itching +/- burning Presentation 3

4 Mostly skin-toskin Asymptomatic carrier, likely scalp (Tinea Capitis) Transmission Dx: mainly clinical Tx: Oral or creams -zoles or nafines Diagnosis & Treatment Min 72h topical tx for t. corporis Min 2 weeks oral tx for t. capitis Lesions may be covered with dressing after adequate tx 2014 RTP- NCAA/ NFHS/ FHSAA 4

5 gas permeable dressing pre-wrap & stretch tape anchored so as not to be dislodged throughout sport activity Adequately Covered (NATA) Dressings should be changed after each match NATA Adequate personal hygiene Adequate equipment disinfection procedures Prevention 5

6 Early Identification Withhold from contact? Seasonal prophylaxis Prevention Herpes Viral Infection (HSV1) Herpes Gladiatorum (HG) On wrestler s dominant side ( lock-up position) HSV 6

7 Primary Infection HSV replicates in skin cells & neurons Travels to sensory root ganglion & remains latent Reactivation Milder At site of initial outbreak Triggers HSV- 1 & Reactivation Flu-like symptoms Disseminated skin lesions Cervical lymph nodes Presentation- 1 Outbreak Prodrome Grouped vesicles on an erythematous base crusted plaques Presentation- Reactivation 7

8 Face, head, neck, ears, upper extremities Complications Transmission Ocular involvement Skin-to-skin corneal scarring, blindness Viral shedding at any time, but greatest JUST BEFORE & during lesions HSV Dx: mainly clinical Tx: oral meds -clovir Diagnosis & Treatment 8

9 Early Detection Withhold from contact Rx within 24h? Season long prophylaxis? Annual HSV serology Prevention No new lesions in last 72h Resolution of systemic sx in 1 cases Antiviral tx for at least 120h before & at time of competition 2014 RTP- NCAA All lesions must be dry and crusted Moist active lesions CANNOT be covered RTP- NCAA 9

10 In addition: Contacts 3 days prior to outbreak must be isolated for 8 days Daily skin exam 2013 RTP- NFHS In addition, for 1 infection- No competition for 10 days 2011 RTP- FHSS Staph Infections 10

11 S. aureus or Strep Bullous Non-bullous Impetigo Bullous Non-Bullous Impetigo Caused by S. aureus Pustules on hairbearing areas Treat with topical abx Folliculitis 11

12 infection extends from follicle into dermis erythematous nodular areas Tx: Warm compresses +/- I&D Furuncles (Boils) coalesced furuncles purulent mass Tx: I&D +/- oral abx Carbuncles No new lesions for 48h 72h of topical or oral abx No moist or draining lesions Active lesions shall not be covered 2014 RTP- NCAA 12

13 Treat as MRSA Dried lesion should be covered NFHS- add l guidelines Kohl, Thomas D., and Mary Lisney. "Tinea Gladiatorum, Wrestling's Merging Foe." Sports Medicine 29.6 (2000): Print. Likness, DO, Lincoln P. "Common Dermatologic Infections in Athletes and Return-to-Play Guidelines." The Journal of the American Osteopathic Association (2011): Print. Zinder, PhD, ATC, Steven M., Rodney S.W. Basler, MD, Jack Foley, ATC, Chris Scarlata, ATC, and David B. Vasily, MDII. "National Athletic Trainers' Association Position Statement: Skin Diseases." Journal of Athletic Training 45.4 (2010): Print. Wilson, MD, Eugene K., Kevin DeWeber, MD, FAAFP, FACSM, James W. Berry, ATC, and John H. Wilckens, MD. "Cutaneous Infections in Wrestlers." Sports Health 5.5 (2013): Print. Estes, DNP, FNP-C, Krista R. "Skin Infections in High School Wrestlers: A Nurse Practitioner's Guide to Diagnosis, Treatment, and Return to Participation." Journal of the American Association of Nurse Practitioners (2013): 1-7. Print "Sports Related Skin Infections Position Statement and Guidelines." National Federation of State High School Associations. 21 Nov Web. < " NCAA Sports Medicine Handbook." Ed. John T. Parsons, PhD, ATC. 1 Aug Web. References 13