Treatment of cutaneous infections in athletes can be problematic

Bacterial, viral and fungal cutaneous infections are all common among athletes, and the optimized treatment and prevention of these infections is important to ensure minimal disruption to the sports careers of the athletes, according to Dr. Brian Adams.

“Intense skin-to-skin exposure transmits the organisms between athletes,” said Dr. Adams, who is a sports dermatology specialist and chair of the Department of Dermatology at the University of Cincinnati.

“Most sports require the use of equipment and this occlusion creates a perfect environment for micro-organism growth,” he said during a presentation at the annual meeting of the American Academy of Dermatology in Washington, D.C.

“Athletes experience profuse sweating, which macerates and impairs the stratum corneum. In addition, in many sports [the athletes] experience skin trauma and that further facilitates the entry of the micro-organisms into their skin.”

MRSA present at athletic facilities

In the case of methicillin-resistant Staphylococcus aureus (MRSA), it can potentially be transmitted through contact with surfaces at athletic facilities, according to Dr. Adams, who referenced a study that was published in the Journal of Environmental Health (Jan.-Feb. 2010; 72:8–11).

For the purpose of this investigation, the researchers cultured various surface areas for the prevalence of MRSA in 10 rural high school athletic training settings with no known epidemics.

Data showed that 90% of facilities had two or more positive MRSA surfaces, while one school had no recoverable MRSA colonies. Of all surfaces tested (n=90), 46.7% produced a positive result, the authors wrote.

“Interestingly, 90 per cent of the mats and 78 per cent of the benches were found to be MRSA positive,” explained Dr. Adams. “Probably the most shocking finding was that 20 per cent of the door knobs to the training rooms at the schools were MRSA positive.”

Dr. Adams noted that community-associated MRSA might also be able to survive on artificial turf, according to results of a laboratory study published in Medicine and Science in Sports and Exercise (May 2011; 43(5):779–784).

The results suggest that community-associated MRSA could survive on artificial turf in significant numbers for one week, and, in lower numbers, for at least one month if supplied with appropriate nutrients, the authors wrote.

Outside of a lab setting and during the summer months, said Dr. Adams, artificial turf reaches hot temperatures, which is not conducive to MRSA growth, he explained.

MRSA and MSSA treatment

When a patient has a cutaneous bacterial infection that is staphylococcal in nature, it is important to culture the lesion to determine whether it is methicillin susceptible staphylococcus aureus (MSSA) or MRSA because “you cannot tell the difference just on clinical examination,” said Dr. Adams.

For the treatment of MSSA, Dr. Adams recommended the following:

•Oral antibiotics: dicloxacillin and cephalexin.

•Topical antibiotics: mupirocin

When treating MRSA, Dr. Adams suggests systemic agents such as sulfamethoxazole/ trimethoprim and tetracycline. He also recommend mupirocin as a topical antibiotic for MRSA.

Molluscum in athletes

Recognizing the presence of molluscum contagiosum can be difficult because, among athletes, the lesions often lack the characteristic umbilication, he said.

“Typical destructive treatment methods such as curettement and liquid nitrogen work well for molluscum contagiosum,” Dr. Adams said. He added that in extensive cases he may utilize off-label treatments such as retinoids, imiquimod, and 5-fluorouracil. “There is a lot of controversy over [the use of] imiquimod [in these cases], but I will tell you that sometimes it works and other times it doesn’t.”


Moisture is an associated risk factor for verruca and sharing equipment plays a major role in the spread of verruca among athletes, Dr. Adams explained.

Verruca can be tricky to treat in athletes, he said, because the treatment may require that they take some time away from their sport. If using destructive treatment methods, it is better to do so in the off-season if possible so that the patient has time to heal, he said.

Often times, Dr. Adams said that he will treat an athlete’s verruca using salicylic acid or imiquimod. “These [treatment] methods are often preferred in an effort to minimize loss of training [time].”

Pitted keratolysis

The treatments of choice for pitted keratolysis include topical antibotics such as erythromycin or clindamycin, Dr. Adams noted during his presentation.

“I also like benzoyl peroxide gel for pitted keratolysis. It is not only anti-bacterial, but it is also antiinflammatory. The downside with using benzoyl peroxide gel, however, is if there are a lot of erosions then it can be quite irritating to the athlete,” he said.

Tinea corporis gladiatorum

When treating wrestlers who have tinea corporis gladiatorum, Dr. Adams explained that he takes a twopronged approach and uses both topical agents (terbinafine and ciclopirox) and oral antifungals (terbinafine and azoles).

#dermatology #DrBrianAdams #AmericanAcademyofDermatology


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