Wrestlers more prone to skin conditions

With the end of fall sports, it will not be long until local high school and collegiate gymnasiums will be filled with fans celebrating the beginning of wrestling season. Philadelphia has a long tradition of wrestling and has already been celebrated as a wrestling city with the NCWA All-Star Classic held at the Palestra at the University of Pennsylvania last weekend. As a physician who takes care of wrestlers, I am very aware of the importance of accurate diagnosis, treatment and surveillance of skin diseases in wrestling. The NCAA Injury Surveillance System indicates that on average 15% of all practice time loss in wrestling is due to skin conditions.

There are several skin conditions that are common in wrestling. The most concerning is MRSA, or Methicillin Resistant Staphylococcus Aureus. This is a bacterial infection that is resistant to many antibiotics, but is still susceptible to common oral medications such as Bactrim or Doxycycline, or IV antibiotics, if the infection is more severe. This bacterium is transmitted from skin to skin or skin to objects to skin.

It begins as a small pimple-like lesion that progresses to a red, hot inflamed lesion. As this is often confused with cellulitis, which is susceptible to many more antibiotics, any suspicion of MRSA infection should be immediately seen by a health care provider for culturing and immediate treatment while waiting for bacterial cultures to be processed. Occasionally, these lesions need to have surgical intervention. Athletes can return to wrestling once the proper antibiotic course has been completed and current lesions have scabbed over with no new lesions developing for 48 hours. Particular attention should be placed in looking at the whole team when MRSA is present as people often can be carriers of the MRSA bacteria.

Another common bacterial infection is Impetigo, which also spreads skin to skin or from skin to objects to skin. It is identified by small red blisters on a reddish base that break to form a honey-colored scab that often itches. As this appearance often is enough to diagnose the condition, bacterial cultures are rarely necessary and usually used only if there is confusion concerning the diagnosis. Small areas can be treated with topical antibiotics, while bigger lesions should be treated with oral antibiotics. Return to wrestling is often after 3 days of antibiotics with no new lesions for 48 hours and complete crusting of the existing lesions.

Viruses are also common in wrestling. The most common are herpetic lesions (Simplex, cold sores, Zoster and Gladiatorum). On average, 2.6% of high school wrestlers and 7.6% of college wrestlers demonstrate infection during a single season. These viruses are spread from skin to skin or skin to objects to skin. Those affected often have flu-like symptoms for 2-24 hours before a rash starts which begins as a tingling sensation on the skin then develops into small blisters on a red base.  Often the blisters break, and then form yellow-brown scabs.  The diagnosis is often made just based on the appearance of the rash, but there can also be lab examination to confirm the diagnosis. Oral antivirals, such as Valtrex, should be started as soon as symptoms are present to decrease the course and severity of the infection. Wrestlers can return once they have been treated for 5 days with oral anti-virals, there have been no new blisters for 72 hours, no systemic symptoms, and all lesions must be crusted over. Wrestlers may need anti-viral prophylaxis for repeated infections.

The final most common infection that is seen is Ringworm, or more properly, Tinea Corporis. Despite its name, this is not caused by a worm at all but by a fungus. Spread from skin to skin, skin to object to skin, or by pets, ringworm starts with a lesion that is a scaly, flatspot in the shape of a brown circle. This spot then grows into a larger circle with a scaly border with bumps or blisters on the edge. As the lesion grows, the center fades to a light brown or red color. The presence of the lesion is usually enough to make the diagnosis, but fungal cultures can be done if necessary. Mild cases are treated with topical anti-fungals while more severe cases are treated with oral anti-fungals. Wrestlers may return when treated orally or topically for 3 days. Often, it can take up to six months for the area where the lesion was present to completely disappear.

The key with treating skin lesions in wrestling is preventing them from occurring in the first place. It should be noted that every wrestler is checked for suspicious lesions before the beginning of all competitions at weigh-in. In order to not have a problem at "skin check," wrestlers should have their skin and hair consistently checked for breaks and lesions. Body shaving has been an increasing problem as razors often breach the skin barrier allowing for infection. All wounds should immediately be cleaned and covered for all practices, matches and tournaments. Showering should be performed immediately after practice or competition. Wrestlers should also never wear abrasive uniforms or gear that can irritate the skin and should never share these items. Uniforms and practice gear should be cleaned after every practice. Wearing practice gear with sleeves and pant legs will also help decrease transmission of disease. Nails should be kept trimmed and neat, and there should also be no sharing of grooming equipment.

If a skin condition is present, it should be dried last after showering and the towel then immediately laundered. Finally, all competitive surfaces should be cleaned and disinfected according to club/league rules, and any lesion discovered, should be reported to the hosting and traveling institution. Healthcare providers should be immediately notified of any suspicious lesions to contain the spread of any infection.

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