Common Contagious Skin Conditions in Amateur Wrestling
It is that time of year again. The weather is getting colder and
the amateur wrestling pre-season is in full gear. Amateur wrestling
is unique for several reasons. For example, most of the
participants must train long and hard to make their wrestling
weight. Wrestling is a contact sport, but it allows for the wearing
of very little protective equipment, thus the athletes wrestle
through various injuries that are usually only seen in wrestling,
such as cauliflower ear. Perhaps the aspect that most makes
wrestling unique in the sporting world is that the athletes must be
concerned about contracting one of many contagious skin conditions
that can render them ineligible for competition until the lesion
has entered a non-contagious phase. These skin conditions can be
frustrating not only for the athletes and their parents, but for
the coaching and sports medicine staff as well. The purpose of this
article is to inform athletes, their parents, coaches, and athletic
trainers about the common types of contagious skin conditions seen
in wrestling, how to assess the condition, treatment options for
each type, and finally how to prevent contracting these skin
conditions.
The most common types of contagious skin lesions are bacterial,
fungal, or viral in nature. They are usually transmitted through
close body contact, touching an infected surface or object with an
abrasion or open wound, or by sharing clothes, towels and other
equipment such as headgear.
The two most common types of bacterial lesions are impetigo
contagiosa (impetigo) and staphylococcus. Impetigo is a very
contagious lesion that can be caused by staphylococcus, or less
likely, streptococcus bacteriae, which are normally carried in a
person's skin, nose, throat, and respiratory tract. Impetigo has
been known to thrive on inanimate objects such as wrestling mats,
towels, and doorknobs and has been responsible for significant
amounts of wrestling time lost. It can be easily spread to an
entire team if not recognized quickly. Symptoms of impetigo include
an itchy cluster of small lesions that become honey colored
crustations that "weep" or ooze. It feels similar to a scab if it
is palpated. Athletes that suspect that they may have impetigo
should not engage in contact sports while contagious and should
practice good hygiene to protect other athletes with whom they may
come into contact. They should follow up with a physician and are
usually treated with prescription topical and systemic
antibiotics.
Staphylococcus, or staph infections, are another form of bacterial
lesion. Most types of staph are harmless to humans, but some
strains can be very aggressive. Staph has made headlines as of late
due to the recent outbreak of a rare form of antibiotic resistant
staph that plagued several Miami Dolphins in September 2003. The
case in Miami is the exception, not the rule, but it goes to
illustrate how bacterial lesions can spread. Staph is usually
treated with oral or IV antibiotics. Staph is transmitted in the
same manner as impetigo through direct contact with an open wound.
It is characterized by redness, tenderness, and swelling. It can
also cause lesions that will weep or ooze pus. The athlete with
these symptoms should be held out of contact and should follow up
with a physician as soon as possible.
Bacterial infections are less common than fungal infections in
wrestling. Fungi are plants closely related to mushrooms and are
spread by seeds called spores. Fungi spores thrive in warm, dark,
humid and moist areas such as a locker room or a basement. They
spread by person-to-person contact. The spores may incubate on the
body for up to two weeks before symptoms are noted, so it is
difficult to pinpoint the exact source of infection. The most
common type of contagious fungal lesions in wrestling is tinea
infections such as ringworm.
Ringworm, (tinea corporis), is characterized by reddish, ring-like
lesions that can be scaly or crusted. They are fairly obvious to
identify given their ring-like shape. These lesions itch and are
transmitted when moist, such as when sweaty. Suspected cases of
ringworm should be seen by a physician. These athletes should be
held out of contact drills. Ringworm can be treated over the
counter with anti-fungal medications such as Lamisil or Lotrimin,
but a prescription topical anti-fungal ointment would be
optimal.
Viral infections are less common than bacterial or fungal
infections, but they can mean for a longer period of inactivity for
the affected wrestler. The most common types of viral infections in
wrestling are from the herpes simplex (type 1) virus. Herpes virus
lesions are commonly called "cold sores" or "fever blisters". Most
people carry the herpes virus but the condition does not erupt
until the person's immune response is diminished due to fever,
stress, or excessive fatigue due to over training. Herpes virus
usually affects the border of the mouth, lips, and cheeks, but may
occur on any skin surface. Initially a burning or tingling
sensation on the skin will precede an outbreak of blister-like
lesions that can rupture and crust over. These conditions usually
last between 7-14 days, with a maximum contagious period of about 5
days after the onset of eruptions. Herpes is transmitted from
body-to-body contact and contact with shared items such as towels
and wrestling mats. Currently there is no cure for herpes simplex,
so the athlete must stay out of contact drills until the crusted
lesions have healed.
The contagious skin conditions listed above are very common in
wrestling. For many years they have been considered nothing more
than "an occupational hazard" due to the fact that most wrestlers
have contracted a skin lesion of some form. This way of thinking
should be re-examined because if skin lesions are not recognized
and proper action is not taken, they can quickly spread until an
entire team or an entire program is ineligible for competition.
Listed below are some tips for athletes, parents, and coaches on
how to prevent contracting these skin conditions.
PREVENTION IS THE GREATEST TREATMENT.
1) Wrestling mats should be cleaned
daily prior to and following practice/competition with an agent
that is antibacterial, antifungal, and antiviral. The antiviral
agent should specify that it is anti HIV. Ken Clean is a popular
product for cleaning wrestling mats.
2) Locker rooms and showers, and any other place where sweaty
athletes congregate should be cleaned with bleach water at least
once every 7 days.
3) Preventative lotions or creams that are antifungal, antiviral,
and antibacterial are good to apply to all areas of exposed skin
prior to practice or competition. Ken Shield is a popular product
for this purpose.
4) Do not allow people with street shoes to walk on the mats. You
never know what can be tracked onto the mats.
5) Cover all wounds to prevent exposure to bacteria or fungi.
6) Encourage good hygiene. Encourage the athletes to shower with
soap and hot water immediately following practice or competition.
The faster they shower, the less likely they will develop a skin
lesion.
7) Discourage the sharing of towels, razors, roll on deodorant, and
other personal products.
8) Encourage the wrestlers to report suspect lesions to coaches and
the sports medicine staff.
9) Over the counter antifungal medications can be applied to
suspected ringworm lesions until it can be examined by a
physician.
10) If the lesions do not improve, follow up with a physician for a
wound culture. A culture will determine which antibiotic will be
effective against the infection.
11) Last but not least, my personal guideline for determining when
to send and athlete for follow up with a physician is "if it looks
threatening, it probably is".
The above information is intended to present athletes, parents,
and coaches useful information regarding contagious skin lesions in
wrestling. These lesions can be prevented if the above tips are
observed. If you have any questionable skin lesions, you should
follow up with your physician for further care.
For further information, please visit the Centers for Disease
Control and Prevention website at www.cdc.gov.