Journal Club – Dermatological conditions in Athletes

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:
DermSTSIAdamWebpart1.mp3

Podcast Part 2:
DermSTSIAdamWebpart2.mp3

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 Type Appearance Treatment
Virus
HSV (herpes gladitorium, herpes rugborium, scrumpox) Groups of vesicles on erythematous base on head, face, neck, upper extremities 1° infection= valcyclovir 1g po tid x 1wk2° infection = valcyclovir 500 mg po bid x 1 wk
Molluscum contagiosum Umbillicated pearly papules 1-10 mm diameter Laser therapyCryotherapy
Fungal
Tinea corporis Well-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 capitis Grey, scaly patches, +/- mild hair loss Terbinafine 250 mg po od x 2-4 wks OR Ketaconazole 250 mg po od x 2-4 wks
Bacterial
Folliculitis Multiple small erythematous papules < 5mm Usually 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/Abscess Coalescence multiple folliculitii I&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)
Impetigo Non-bullous; thin vesicles that rupture into honey-crusted lesions. Bullous: Raised blisters Mupicorin 2% ointment bid x 1wk OR Fusidic acid 2% cream bid x 1wk

* The listed therapeutic options are not extensive

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