Molly Senn-McNally, MD 6/6/18

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1 Molly Senn-McNally, MD 6/6/18 At the conclusion of this activity, participants will be better able to: 1. Recognize symptomatology and presentations of common SKIN infections found in athletes and understand implications for management of such infections in school 2. List four common SKIN infections found in athletes 1

2 2

20% ~ 30% risk of transmission competing against an infected

3 8.5% of high school sports-related conditions Mostly affecting the face, head, neck Prevalence Bacteria 30% Herpes 20% Fungus 20% ~ 30% risk of transmission competing against an infected athlete Direct Contact Airborne/Droplet (spray over a few feet) 3

4 Kaden is a 14 year old high school football player. He is generally healthy, but does have eczema. He comes to your office for left leg pain and a rash. When you look at his shin, you notice an area that is bright red and looks swollen. The rash has fairly clear borders, and it is warm and very tender to the touch. His mother is a CNA at a local nursing home. Kaden is a friendly young man, and you have noticed that the guys often share water bottles, equipment, and towels at practice. 4

5 Erythema Warmth Tenderness Unilateral Lower extremities (most common) 5

6 CELLULIT IS PHARYNGITIS IMPETIGO 6

7 Atopic dermatitis Skin breaks (turf burns or trauma) Skin to skin contact Sharing of equipment and towels Higher BMI Refer for diagnosis and treatment with antibiotics Typically oral, may require IV 7

8 Completion of 72 hrs of antibiotic therapy No new lesions for 48 hrs No moist/weeping/draining lesions Cover any scabbed lesions Do not cover active, purulent lesions in order to allow play Infectious Diseases Associated With Organized Sports and Outbreak Control Pediatrics, 9/2017, Davies, Jackson, and Rice Good hygiene education and practices Do not share equipment Refrain from use of common tubs Decontamination of the environment 8

It started with some tingling and burning and then developed into

9 Jayden is a 17 y/o wrestler. He comes to you with a two day history of a painful rash on his neck. It started with some tingling and burning and then developed into water blisters. The championship tournament is in three days, and he wants to know if he will be able to compete. 9

10 Grouped vesicles Head/face/neck Prodrome of itching/burning Pattern of progression 10

11 Prompt identification and treatment Examine all wrestlers for lesions on exposed areas of the body Clean mats with bleach:water (1/4 cup:1 gal) or other EPA approved cleaner at least daily (and preferably between matches) 11

12 No systemic symptoms (fever, etc) Completely crusted No new lesions for 72 hrs If started on antivirals, must treat for 5 days prior to return Do NOT cover lesions in order to allow competition Consider suppressive therapy for the rest of the season 12

13 Nina is an 8 y/o soccer player and swimmer who comes to your office because of some bumps on her skin. They are not particularly itchy. When you examine her, you see a few scattered, shiny, pink bumps with a dimple in the middle. 13

14 Benign, viral infection Usually asymptomatic Flesh colored papules with central umbilication Risk factors for outbreaks: Eczema Public pools Age <14 Sharing of fomites (towels, equipment) Rash self resolves, but can take months to years! Various treatments available For swimming: Cover all lesions with watertight bandages Don t share towels or equipment 14

15 Maeve, a 14 year old field hockey player, comes to your office because of bumps on her fingers. You also notice some small areas with black dots on her feet. 15

16 Spontaneous regression Cryotherapy Surgical therapy Immunomodulators 16

17 No sharing of equipment or towels Flip-flops in communal showers Keep them covered 17

18 Joey, a 16 year old basketball player, comes to your office with multiple complaints. He has a rash. His feet and his groin are itching, and his scalp is itchy, flaky, and he is losing hair. 18

19 Tinea Corporis (ringworm) Wrestling/judo Tinea Pedis (athlete s foot) Moist environments Skin maceration Tinea Cruris (jock itch) Obesity Diabetes Scaly border Erythematous Annular (ringlike) Central clearing At risk athletes Wrestlers judo 19

20 Topical antifungal (usually) for at least two weeks 72 hours of topical or systemic antifungal therapy Cover any remaining lesions until completely gone 20

21 Interdigital (frequently) Pruritic Erythematous erosions or scale Topical antifungals Oral antifungal if Severe Nail involvement Poor response to topical therapy 21

22 Careful/thorough drying between toes Foot powder after bathing Daily changes of socks Periodic cleaning of footwear Exclude from swimming pools Discourage from walking barefoot on locker room and shower floors until treatment has been initiated 22

23 Starts as red patch on medial thigh Spreads outward Can have partial central clearing and raised red border Treatment with antifungals (topical or oral) Exclude from swimming pools until treatment has been initiated 23

24 Put socks on before underwear Dry well Use separate clean towel to dry groin Scalp Scaly/red Hair loss Black dots 24

25 ORAL antifungal for 4-6 weeks Minimum of TWO WEEKS of oral antifungal treatment 25

26 Maria is a 13 year old basketball player. She comes to your office with an intensely itchy rash on her hands and wrists. Her little brother also has an itchy rash. 26

27 Caused by mite Sarcoptes scabiei Hypersensitivity reaction to urine, feces, and eggs of the mite Intensely pruritic Interdigital, wrists, axillae, genitalia Small, erythematous papules Linear burrows Treat with topical permethrin from head to toe overnight x 1 Return to play: after treatment 27

28 A few of the players on your softball team come to practice scratching their heads. You take a look in their hair and see something moving. You also see some little white flakes that are attached to the hair shaft. 28

29 Many effective treatments OTC: permethrin and pyrethrin/piperonyl butoxide, cetaphil Prescription: Spinosad, ivermectin (ovicidal) benzyl alcohol, malathion (suffocant) 29

30 Consider individual helmets sharing isn t always caring! Clean shared helmets Return to play ONLY after treatment Re-examine to make sure all lice and nits are gone 30

31 The basics good hygiene Minimize sharing of equipment Disinfect athletic settings, equipment, locker rooms, and players regularly 1. Recognize symptomatology and presentations of common SKIN infections found in athletes and understand implications for management of such infections in school 2. List four common SKIN infections found in athletes 31

32 Likness, L. et al. Common Dermatologic Infections in Athletes and Return-to-Play Guidelines. The Journal of the American Osteopathic Association, June 2011, Vol. 111, Davies et al. Infectious Diseases Associated With Organized Sports and Outbreak Control, Pediatrics, Volume 140, number 4, October 2017 Harris, M. Infectious Disease in Athletes, Current Sports Medicine Reports, Volume 10, number 2, March/April 2011 Luke, A et al. Prevention of Infectious Diseases in Athletes, Clinics in Sports Medicine, 26 (2007)

COMMON SKIN INFECTIONS. Sports Medicine

COMMON SKIN INFECTIONS. Sports Medicine COMMON SKIN INFECTIONS Sports Medicine IMPETIGO IS A SUPERFICIAL BACTERIAL INFECTION CAUSED BY: STREPTOCOCCI OR STAPHYLOCOCCUS AUREUS BOULOUS IMPETIGO IMPETIGO COMES IN TWO FORMS: BOULOUS OR NON- BOULOUS