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Skin Infection Manual
Franklin Marshall College
Skin Infection Manual Table of Contents 1. Introduction1. Herpes Simplex1. Tinea (Ringworm)1. Bacterial Infections (Impetigo, Staphylcoccus, Folliculitis)1. Molluscum Contagiosum The purpose of this manual is to educate people on the various forms of skin infectionsand their treatment. In addition, the NCAA rules and regulations for skin infections inwrestling will be explained.
Herpes Simplex: (See Figure 1)
- A virus that is transmitted by, skin to skin contact.
What are the signs/ symptoms? - Primary infection: o Headacheo Malaiseo Mylagiao Vesicles at site of inoculationo Enlarged lymph nodes (usually 1 sided) - Recurrent infection: o Tingling, itching or burning 24 hrs. prior to skin changes.
What is the treatment? - Primary infection: o , Valacyclovir (Valtrex) ß 1g twice a day for 10 days - Recurrent infection: o Valacyclovir (Valtrex,) ß 1g twice a day for 5 days - Suppressive Therapy: o Valacyclovir (Valtrex) ß < 170: 0.5 gram twice a day.
ß >= 170: 1 gram twice a day.
- Use of drying agent such as witch hazel.
What are the NCAA rules for return to wrestling? - Primary infection: 1. Wrestler must be free of systemic symptoms of viral infection.
1. Wrestler must have developed NO NEW blisters for 72 hours before the 1. Wrestler must have no moist lesions; all lesions must be dried and surmounted by a FIRM ADHERENT CRUST.
1. Wrestler must have been on the appropriate dosage of systemic antiviral therapy for at least 120 hours before and at the time of the meet ortournament.
1. Active herpetic infections shall not be covered to allow participation.
- Secondary infection: 1. Wrestler must have no moist lesions; all lesions must be dried and surmounted by a FIRM ADHERENT CRUST.
1. Wrestler must have been on the appropriate dosage of systemic antiviral therapy for at least 120 hours before and at the time of the meet ortournament.
1. Active herpetic infections shall not be covered to allow participation.
Bacterial Infections:(See Figure 2)
o Superficial infection involving epidermis.
o Infection caused by: ß Staphylococcus aureus: 20% – 40% of typical adults are nasal ß Streptococcus pyogenes: 20% of normal adults are axillae - What are the signs/ symptoms? o Arising from minor breaks in the skin.
o Severe itchingo Small vesicles/ pustuleso Erosions (Honey crusted)o Possible regional lymphademopathy - What is the treatment? o Systemic antibiotics (ex. Dicloxacellin, Cephalexin) - What are the NCAA rules for return to wrestling? 1. Wrestler must have been without any new skin lesion for 48 hours before the meet or tournament.
1. Wrestler must have completed 72 hours of antibiotic therapy and have no moist, exudative or draining lesions at meet or tournament time.
1. Gram stain of exudate from questionable lesions (if available).
1. Active bacterial infections shall not be covered to allow participation.
- What can I do to prevent it? o Monitor and cover cuts.
o Shower and wash cuts out thoroughly.
o Watch cuts for signs of infection.
o Use an anti-bacterial soap after practice for body and face.
Tinea infections: (See Figure 3)
o Dermatophyte infection (Fungus) - What are the signs/ symptoms? o Small, scaly, sharply marginated plaqueo Single or occasionally scatteredo Pink to red color - How is it treated? o Anti-fungal creams (Naftin, Lamisil)o Oral meds for scalp lesions or difficult corpis lesions - What can be done to prevent it? o Use powders containing miconazole or tolnaftate after showeringo Naftin or Lamasil cream over suspect areaso Nizarol shampoo for washing area and hair - What are the NCAA rules for Tinea lesions? o Minimum of 72 hours of topical therapy is required for skin lesions.
The cidal topic antifungals terbinafine or naftifine (Lamisil or Naftin)are suggested for treatment.
o A minimum of 2 weeks of systemic antifungal therapy is required for scalp lesions.
o Wrestlers with extensive and active lesions will be disqualified. Those with solitary, or closely clustered, localized lesions will be disqualifiedif lesions are in a body location that cannot be ‘adequately covered.'.
o The disposition of tinea cases will be decided on an individual basis as determined by the examining physician and/ or certified athletictrainer.
Molluscum Contagiosum: (See Figure 4)
o Epidermal viral infection transmitted by skin to skin contact.
- What are the signs/ symptoms? o Pearly white or skin coloredo Papules (1-2 mm)o Nodules (5-10 mm)o Can be solitary or clustered - What are the NCAA rules and the treatment options? o Need to curetted or removed prior to meeto Solitary or localized, clustered lesion can be covered.
General Prevention Tips
The following will help prevent some skin infections: 1. Remember that your skin is the first line of defense, a cut in the skin is a portal of entry for germs.
2. When cleaning the mats clean the walls, as well.
3. Always use your own wash cloth. Do not share hygiene products (ex. Towels, 4. Using ‘ringworm cream' (OTC- Lamasil/Naftin) on ‘suspicious spots'.
5. Washing thoroughly after practice with anti-bacterial soap and hot water.
(Paying attention to the creases in the body.) 6. Make sure that you keep your immune system up by maintaining a healthy diet, and getting enough rest. This is crucial for fighting infections of anykind and for preventing recurrent herpetic lesions.
7. Use shampoo with selenium sulfide in it. ( ex. Selsun Blue) - National Collegiate Athletic Association. NCAA 2003 Wrestling Rules and Interpretations, 2002 - Fitzpatrick T, Johnson RA, Wolff K, Suurmond D. Color Atlas and Synopsis of Clinical Dermatology. Boston, MA: McGraw-Hill Medical Publishing;1992.
Figure 1: Herpes Simplex Figure 2: Impetigo Figure3: Rimgworm Figure 4: Molluscum Contagiosum Wrestling is a sport in which athletes have close skin to skin contact for the majority of the event. It is
during this contact that even the most innocent skin irritation could lead to a contagious event
sometimes taking almost an entire team out of commission for an extended period of time.
Contagious skin disease can be broken into two areas infections and infestations. For the purpose of
this article three types of infections will be reviewed:
Bacterial, Viral and Fungal.
There are three infectious diseases of the skin that strike fear into any wrestling coach; they are
Impetigo, Herpes Gladiatorum, and Ringworm. The three actually represent the three different types of
infections.
Skin diseases are common in wrestling because of the increased body temperature, sweat, and friction
caused by the sport. The resulting moist and warm environment encourages growth of bacteria and
fungus. The friction creates open (imperfect) areas in the skin that allow the bacteria, virus, or fungus
to enter. When this imperfect skin comes into contact with an infectious agent from another person's
skin or on equipment, infections may occur.
1. Bacterial:
Impetigo is a skin infection caused by the bacteria Staphylococcus aureus. Impetigo is highly
contagious with a well known history of affecting many wrestlers. This is a bacterium that can spread
during skin to skin contact as well as contact with an infected surface. Impetigo contagiosa infection is
the most common, presenting with a red sore that breaks open quickly leaving an oozing sore that
classically forms a honey-yellow crust. Often the lesions appear on the head, face and neck but can
occur anywhere on the body.
Treatment depends on the extent and severity of the infection. Often for wrestlers it is a combination of
both oral and topical antibiotics. There is to be NO participation until athlete has been treated for 48
hours or until all lesions heal. A physicians note is required for return to participation but ultimately for
competition the referee has the final call.
2. Viral:
Herpes gladiatorum is a skin infection caused by the herpes simplex virus. It occurs often in wrestlers.
It causes a rash that commonly appears on the face, neck, shoulder, and arms. This virus is
transmitted by skin to skin contact. The presentation of herpes simplex is a usually a rash made up of a
cluster of blisters. These blisters may or may not be painful.
To identify or diagnose an infection, it is necessary for a health care provider to examine your skin.
They will sometimes perform a culture to test for the herpes virus. A prescription for a medicine called
Acyclovir may be given to speed your recovery. The herpes rash usually lasts from 7 to 10 days.
Reoccurrences may happen as the virus is dormant in your system. There is should be NO skin contact
with any uninfected person while there is any herpes skin rash still present.
3. Fungal:
Ringworm is a rash caused by a fungus that has infected your skin. The name gives one a
misunderstanding that it is caused by a worm or parasite, this is not true, it is a fungus. Ringworm on
the skin is called tinea corporis. When ringworm is on the feet, it is called tinea pedis or athletes foot,
and when it is on the scalp, it is called tinea capitis. The fungus can also infect the inner thighs and
groin. This type of ringworm is called jock itch or tinea cruris.
The rash caused by a ringworm infection is usually round or oval and has a raised border. It starts
small and slowly grows larger. The rash may itch and the skin may become scaly. There may be some
small, pus-filled bumps. Over time the rash spreads from one part of the body to other parts. Ringworm can causes patches of hair loss especially on the head. The treatment of ringworm depends on your health and extent of the infection. Your health care provider may scrape the skin and look at it under a microscope or use an ultraviolet (UV) light to look for ringworm on the scalp. Usually treatment is an antifungal cream for the area of the rash; sometimes an oral medication may be prescribed. It's important to keep using the medicine, as directed, for a week after you no longer see a rash to make sure it's completely gone. Unfortunately it is common to get ringworm again, sometimes becoming a long-term problem. Simple measures can be taken to lessen the likelihood of contracting a skin infection. They are mainly in the family of hygiene: clean and disinfect. Showering with soap after practice and tournaments, not sharing towels, razors, or soap, proper laundering of personal towels and clothing, and cleaning of the mats daily, more frequently on days of high use, are easy ways to cut the risk. Surfaces needing attention include head gear, wrestling mats, and any other equipment used by the team such as stationary bike, Swiss balls, etc. during cleaning. Bring attention to your coach any skin lesions. Make sure to avoid close contact with others until appropriate diagnosis and treatment occur.
(IHSAA GUIDELINES BELOW)

IHSAA GUIDELINES TO REDUCE THE INCIDENCE OF
COMMUNICABLE SKIN CONDITIONS IN WRESTLING
The following guidelines are not meant to be all inclusive of what may need
to be done to prevent communicable skin conditions from occurring in wrestling.
They provide practical suggestions that, when implemented, should help reduce the incidence of
communicable skin conditions occurring among high school wrestlers. Some of the guidelines go
above and beyond what would normally need to be done to prevent communicable skin conditions
from occurring. However, in instances where some wrestlers, or entire teams, seem to be
extremely susceptible to communicable skin conditions the more extreme guidelines may prove to
be very worthwhile. Some coaches are currently implementing most of the guidelines.
Others may be utilizing only selected ones. Whatever the case, restricting wrestlers with skin
lesions from participation and keeping a clean wrestling environment are the keys to
reducing the incidence of skin infections.
GENERAL GUIDELINES:
1) Clean wrestling mats at least once a day with a disinfectant cleaner*, preferably within one
hour of practice or competition. Allow mats to air dry before using. There is great benefit from
cleaning mats before and after practice. *(Disinfectant cleaners used should state they are
effective against viruses, fungi, and bacteria. Typically the label will state the cleaner is
bactericidal, fungicidal, & virucidal. Follow the label directions closely for the best effectiveness.

A 1:100 solution of household bleach and water (1/4 cup bleach per gallon of water) is an
excellent disinfectant cleaner, however, it may cause skin rashes. It should be mixed fresh
daily and stored in a dark colored container. 70% Isopropyl alcohol is also an excellent
disinfectant cleaner.

2) Wash wall mats with a disinfectant cleaner on a regular basis (1-2 times weekly).
3) Wipe weight room benches with a disinfectant cleaner after use and/or prior to the next day's
use.
4) Don't allow any wrestler into the practice room without clean practice gear! Launder
towels (including wash cloths), practice gear, and uniforms after each use. Use detergent
containing bleach or dry all articles in a dryer.

5) Wipe head gear, shoes and any braces with a disinfectant cleaner after each practice.
Wash/clean shoes, knee pads, head gear once a week.
6) Do not allow wrestlers to share any item of practice gear or towels!

7) Require each wrestler to shower after each practice and contest, scrubbing vigorously
with an antibacterial or deodorant soap. Consider providing liquid soap. If this is not
possible, do not allow wrestlers to share bars of soap.

8) Have each wrestler supply their own soap and shampoo, or have dispensers containing
liquid soap available.

9) Athletes with acne problems may wish to use astringent pads (ie. Stridex) to clean their
face and neck, or other affected areas, after showering.
10) Open the doors to the wrestling room each night and use fans to lower the heat and
humidity. Proper ventilation is very important to destroy disease causing organisms,
especially those causing fungal conditions, such as ringworm.

11) Do not allow athletes to use common towels for any reason, including at mat side!

12) Wrestlers should not put dirty practice clothes in the same gym bag in which they carry
clean practice clothes to school. This may contaminate the bag and, therefore, the clean
clothes.

13) Neoprene sleeves and supports should be wiped with a disinfectant cleaner after every
use and be allowed to air dry.

14) Wrestlers should keep their finger nails trimmed short to avoid scratching themselves or
someone else, as any opening in the skin increases the risk of infection.
15) Wrestlers should boost their natural immunity to all diseases by eating healthy foods
and getting adequate rest. They may also wish to take a one-a-day, multivitamin.

16) Coaches should visit with wrestlers, and their parents, about how to recognize and
prevent the most common skin diseases.

17) Wrestlers who have been susceptible to skin conditions in the past may want to visit
with their family physician regarding preventive oral medication.


GUIDELINES FOR WRESTLERS WHO HAVE A CURRENT SKIN CONDITION:
1) Wrestlers with any signs of a communicable skin condition MUST be withheld from
practice until a medical diagnosis and clearance is obtained.

2) Wrestlers having any signs or symptoms of a communicable skin condition should be
sent to a doctor IMMEDIATELY!

3) Wrestlers with a skin condition, who have current written permission from a physician to
participate, should cover affected area with an occlusive (water resistant) dressing or a
gauze pad with water resistant covering on at least one side until the lesion(s) is completely
gone!

4) Wrestlers having lesions from a communicable skin condition on their face or neck
should launder their pillow case on a daily basis.

5) Wrestlers with any signs of a communicable skin condition should wash their hands
frequently to avoid contaminating themselves, or others.

6) Wrestlers with communicable skin conditions should be made aware that contact they
have with others during the school day, outside the wrestling room, may spread the disease
to others.
COMMUNICABLE SKIN CONDITIONS
(Guidelines for Safe Return to Participation)
The following information is meant to be used as guidelines for safe return to
participation when a wrestler is being withheld from participation due to a
communicable skin condition. Each medical professional must determine a
wrestler's readiness to return to participation on an individual basis.

HERPES:
Before returning to participation, the wrestler should:
1. Be free from any systemic symptoms of viral infection (fever, malaise, etc.),
AND,
2. Have developed no new blisters for 3 days, AND,
3. Have no moist lesions. All lesions must be dry with a FIRM, ADHERENT
CRUST, AND,
4. Have been using the appropriate dosage of systemic antiviral therapy for
at least 5 days.
Note: Physicians may want to consider season-long prophylaxis with acyclovir for
wrestlers with recurrent herpes.

IMPETIGO and BOILS (other bacterial infections):
Before returning to participation, the wrestler should:
1. Have developed no new lesions in the past 48 hours, AND,
2. Have no moist, exudative or draining lesions, AND,
3. Have been using the appropriate dosage of antibiotic therapy for at least 3
days.

RINGWORM:
Before returning to participation, the wrestler should:
1. Not have extensive and active lesions, AND,
2. Have been using topical therapy for a minimum of 3 days for skin lesions.
3. For scalp lesions, a wrestler must have been using the appropriate dosage
of systemic (oral) antifungal therapy for a minimum of 2 weeks.

Source: http://www.leaguelineup.com/mtvlions/files/SkinInfectionManual.pdf