Journal Club Episode 7:  Soft tissue skin infections in Athletes

Presenter: Dr. Adam Manis – UofT Primary Care Sports Medicine Fellow
Date: March 3 , 2015

Podcast Part 1:

Podcast Part 2:

Powerpoint Presentation:

Articles Reviewed:

1.  Pedersen M1, Doyle MR, Beste A, Diekema DJ, Zimmerman MB, Herwaldt LA.  Survey of high school athletic programs in Iowa regarding infections and infection prevention policies and practices. Iowa Orthop J. 2013;33:107-13.

2.  Fritz SA, Long M, Gaebelein CJ, Martin MS, Hogan PG, Yetter J. Practices and procedures to prevent the transmission of skin and soft tissue infections in high school athletes. J Sch Nurs. 2012 Oct;28(5):389-96. Epub 2012 Apr 3.


Table 1:  Summary of Athlete Skin Infections and Treatments

Infection TypeAppearanceTreatment
HSV (herpes gladitorium, herpes rugborium, scrumpox)Groups of vesicles on erythematous base on head, face, neck, upper extremities1° infection= valcyclovir 1g po tid x 1wk2° infection = valcyclovir 500 mg po bid x 1 wk
Molluscum contagiosumUmbillicated pearly papules 1-10 mm diameterLaser therapyCryotherapy
Tinea corporisWell-defined, erythematous, scaly lesions with raised borders (more irreg with herpes gladitorium)Localized = clotrimazole 1% cream bid x 2-4 wks OR Ciclopirox 0.77% cream bid x 1 wk OR Terbinafine 1% cream bid x 2-4 wksExtensive skin involvement = consider systemitc treatment (see Tinea capitis)
Tinea cruris (jock itch) See Tinea corporis
Tinea pedis (Athlete’s foot) Clotrimazole 1% cread od x 4-6wks OR Terbinafine 250 mg po od x 4 wks
Tinea capitisGrey, scaly patches, +/- mild hair lossTerbinafine 250 mg po od x 2-4 wks OR Ketaconazole 250 mg po od x 2-4 wks
FolliculitisMultiple small erythematous papules < 5mmUsually resolve spontaneously, warm compress
Furuncle (boil)Folliculitis extending deeper (into the dermis)Usually resolve with warm compress, for large furuncles see tx of carbuncle/abscess
Carbuncle/AbscessCoalescence multiple folliculitiiI&DUse of concomitant antimicrobials controversial and should be considered on a case by case basis (if opted for and MSSA= dicloxacillin 500 mg po qid x 5-10d OR cephalexin 500 mg po qid x 5-10d, if MRSA = clindamycin 300-450 mg po tid x 5-10 d)
ImpetigoNon-bullous; thin vesicles that rupture into honey-crusted lesions. Bullous: Raised blistersMupicorin 2% ointment bid x 1wk OR Fusidic acid 2% cream bid x 1wk

* The listed therapeutic options are not extensive