Sports Medicine: Just the Facts

154 SECTION 3 • MEDICAL PROBLEMS IN THE ATHLETE

competition until all lesions have resolved (Bergfeld

and Elston, 1994).

• Less extensive lesions may respond to twice-daily
  mupirocin ointment with aluminum acetate com-
  presses (Burow’s solution) in a 1:40 dilution three
  times daily (Bergfeld and Elston, 1994).
  •A 10-day course of an oral cephalosporin or penicilli-
  nase-resistant penicillin promotes rapid healing.


• The NCAA guidelines for participation of wrestlers
  with bacterial infections are described in furunculosis
  (Bubb, 2002).

ERYTHRASMA

• Chronic, bacterial infection affecting the intertriginous
  areas.


• The causative organism is a gram-positive rod, Coryne-
  bacterium minutissimum.


• The sharply, demarcated reddish-brown plaques are
  similar in appearance to tinea cruris (Bergfeld, 1984).


• Under a wood’s lamp (black light), the lesions will
  fluoresce coral-red; while tinea cruris does not fluo-
  resce (Bergfeld and Elston, 1994).
  •Treatment options include a topical erythromycin
  cream or gel and oral erythromycin 250 mg four times
  a day for 14 days.


• The areas should be covered for athletes to participate
  in close contact drills or events.

VIRAL

VERRUCAE

• The human papilloma virus induces warts, or verrucae
  vulgaris.


• Plantar warts disrupt the normal dermatoglyphics of
  the pressure points of the feet and often coalesce to
  form a gyrate or mosaic pattern.


• Small black dots representing thrombosed capillaries
  within a hyperkeratotic plaque confirm the diagnosis
  (Adams, 2002a).


• The NCAA requires wrestlers to be able to cover mul-
  tiple digitate verrucae of the face with a mask and ver-
  rucae plana or vulgaris must be adequately covered to
  compete (Bubb, 2002).


• Salicylic acid solutions (Duofilm, Compound W) and
  40% plaster compounds (Mediplast) can be applied
  overnight with an occlusion wrap during the season
  (Bergfeld and Elston, 1994).


• Liquid nitrogen cryotherapy can be done concurrently
  or separately every 2 weeks.

MOLLUSCUMCONTAGIOSUM

• Characterized by small umbilicated, flesh-colored,
  and dome-shaped papules.
  
  
  • The poxvirus is highly contagious and spread by
    direct skin transmission from person to person,
    autoinnoculation, water transmission, and gymnastic
    equipment (Kantor and Bergfeld, 1988).
  
  
  • The papules are self-limiting and resolve over weeks
    to months.
    •To compete the lesions must be removed by sharp
    curettage or liquid nitrogen and any solitary lesions
    must be covered with a gas permeable dressing (Op-
    Site, Bioclusive) and ProWrap and tape (Bubb,
    2002).
  
  
  • Liquid nitrogen, cantharidin (0.7% in collodion), topi-
    cal tretinoin (Retin-A), electrodessication and the use
    of imiquimod 5% cream have been successful but
    may require several treatments (Buescher, 2002).
  
  
  
  

HERPESGLADIATORUM

• Herpes gladiatorum or rugbeiorum refers to a herpes
  simplex virus(HSV-1) outbreak on the face of wrestlers
  or rugby players during “lock-up” or in a scrum.


• Classic lesions appear as a cluster of painful vesicles
  on an erythematous base.


• The virus is passed by direct face-to-face transmission
  between athletes, and headgear does not decrease the
  risk of transmission (Belongia et al, 1991).
  •Famciclovir, 250 mg three times a day for 5 days and
  valaciclovir 1 gm twice a day for 5 days are recom-
  mended for initial therapy (Buescher, 2002).
  •Famciclovir and valaciclovir have not been approved
  for use in children less than 18 years of age.
  •Valacyclovir, 500 mg once daily has been prescribed
  for prophylaxis during the season (Adams, 2002a).


• In the pediatric population, 40–80 mg/kg/day in three
  or four does for 7–10 days remains the standard of
  care (Buescher, 2002).


• The NCAA will allow a wrestler to participate if free
  of systemic systems, not developed new lesions during
  the last 72 h, all lesions have a firm adherent crust and
  the wrestler had been on antiviral therapy for 120 h
  (Bubb, 2002).

FUNGAL

TINEAPEDIS

•A papulosquamous fungal infection producing a pru-

ritic, red, scaly rash on the lateral soles of the feet and

between the toes.

• The superficial dermatophytic fungal infection is caused
  by Trichophyton rubrum, Trichophyton mentagrophytes
  or Epidermophyton floccusum (Buescher, 2002).


• The majority of cases respond promptly to topical
  antifungal creams, such as miconazole, clotrimazole,
  and econazole.