Athletic, healthy - and sitting ducks

April 1, 2007

Folliculitis occurs from wrestlers' and others' close contact and could occur from contaminated mats.

The most common skin findings from sports are superficial infections, folliculitis and viral infections, according to Joel E. Holloway, M.D., a dermatologist practicing in Norman, Okla.

Wrestlers and others in contact sports are among the athletes particularly vulnerable to folliculitis and herpes simplex.

Folliculitis occurs from wrestlers' and others' close contact and could occur from contaminated mats. One way to avoid the problem, the dermatologist says, is to keep mats clean.

"Folliculitis comes with nasal carriage of Staphylococcus. That means that in the anterior nares, people might carry community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) and they breathe it out on themselves and on others," Dr. Holloway tells Dermatology Times. "There have been several random studies of football teams and people in dorms, army barracks, etc., where there tends to be a fairly high carriage. Around 4 percent to 5 percent of the people will have carriage of that Staphylococcus."

Beating it to the punch

Dr. Holloway often treats the problem prophylactically.

With wrestlers, for example, he recommends that team members and coaches treat their noses with a mupirocin ointment twice a day for two weeks to eliminate the potential for folliculitis.

For those that already have the condition, he prescribes the same antibiotic ointment, which athletes can use perianally if needed. He might treat folliculitis with a sulfa drug or ciprofloxacin, if patients are not allergic.

As medical director for the U.S. Judo Association and a seventh-degree black belt in judo, Dr. Holloway says people in the martial arts get similar skin problems, sometimes resulting from secondary infections from mat burns.

Football players and other athletes who wear gear often find that they get folliculitis or acne under their athletic pads and on their foreheads from the pressure of their equipment. Dr. Holloway treats the pressure-induced acne as he would any other acne.

"It can be pretty refractory until they get off-season," he says.

Treating what's afoot

Athletes who stop and start quickly in their sports might present with talon noir, bleeding under the skin found on the foot.

The shearing forces of the foot sliding against the shoe when the foot stops fast tears the capillaries, causing black dots under the skin.

"Talon noir will go away on its own," he says. "But dermatologists should be able to recognize it, because some people think it is a melanoma."

Athletes commonly experience intertrigo, or inflammation in the folds of the skin between the legs and, sometimes, under the arms. They also can have fungal or yeast infections, as well as bacterial overgrowth, in those areas.

Those who are active in water sports and do not change out of their wet bathing suits or take showers and dry properly after sweating are most at risk for the fungal infections.

Dermatologists should counsel patients to get out of their wet clothes and bathe and dry themselves thoroughly as a first-line treatment and/or prevention. Then, Dr. Holloway treats according to the problem, using either anti-inflammatory lotions, or, if the problem is a fungus, antifungals.

On occasion, the dermatologist might see impetigo among athletic patients.

"Usually, it's a mixture of staphylococcal and streptococcal germs, and it is treated with topical and oral antibiotics," he says. "If somebody has impetigo all over his face, that person would not be able to wrestle for three or four days into antibiotic treatment."

There are generally no special considerations when treating athletes, other than they might have to stop competing for a few days if they have something that is contagious. Otherwise, these tend to be relatively healthy patients, according to Dr. Holloway.

Disclosure: Dr. Holloway reports no disclosures.