Dermatology for Wrestlers

Wrestlers and Skin Issues

Of all athletes, skin issues plague wrestlers most. We commonly see several dermatologic conditions in wrestlers due to the extensive amount of skin to skin exposure in this sport. Some skin conditions have even been renamed for the subtype seen in wrestlers as “gladiatorum” variants.

Common skin conditions in wrestlers include herpes simplex virus, bacterial infections, molluscum contagiosum, warts, fungus (aka ringworm) and athlete’s foot. Although I am not a wrestler (what a goofy smile comes to my face at the thought…), I have patients, friends and friends’ kids who have wrestled. I have heard the stories. Pre-meet skin examinations to look for skin infections are some of the most appalling stories I have heard from patients. The goal, of course, is to maintain public health and prevent an infected wrestler from infecting others.

Common Skin Conditions in Wrestlers and Treatments

In this post, we will discuss the most common conditions and preventative measures wrestlers can take to ensure they won’t be kept from competition due to skin disorders. There are published guidelines on both the local, high school and collegiate levels. There is a summary of some of these guidelines at the end of this article.

Herpes Gladiatorum 

Herpes viral infections include a group of viral infections that encompasses cold sores (HSV1), genital herpes (HSV2), shingles (VZV) and chicken pox (VZV). While there is a vaccination to prevent VZV skin infections for both chicken pox and shingles, there is no vaccination for Herpes simplex (HSV). Herpes viral infections are most effectively treated with oral antivirals including acyclovir, famciclovir, and valacyclovir. These oral medications can be prescribed to have on hand at the first sign activation of the virus. Often, there is a change in sensation to the area prior to lesions appearing on the skin. One common regimen is to take THREE famciclovir all at once at the first sensation even prior to lesions appearing on the skin. Taking this dose at the first sensation often will prevent lesions from breaking out on the skin. *Three pills is the adult dose and may need to be altered by the pediatrician based on the patient’s weight and other medical conditions.

For more on shingles, specifically,

Bacterial Infections

Bacterial infections can vary from impetigo to more serious cellulitis. One of my recent soapbox items is antibacterial soaps. I am, or should I say was a fan of antibacterial soaps for athletes especially post-practice and meets to reduce contracting bacterial infections. . Unless you have some stockpiled, you are out of luck. My suggestion is to purchase

In my experience, active infections are most effectively treated topically with prescription mupirocin ointment at the first sign and with oral antibiotics if they are severe or advanced. More severe infections may need to be cultured to more effectively determine the causative bacteria and most effective antibiotic for treating them.

Read more on the FDA’s ban on antibacterial soaps by

Fungus-tinea Gladiatorum

Fungal infections include what is commonly known as ringworm or athlete’s foot. Any suspected fungal rash should be promptly treated with topical Lamisil cream as directed on the labeling. Lamisil is one of the most fungicidal of the available topical antifungal medications. Fungicidal means it kills the fungus. Most other antifungal agents are classified and fungistatic, meaning they slow the growth, but do not kill the fungus. One reminder is to NEVER use a topical steroid on suspected fungal rashes. Topical steroids make fungus grow deeper in the skin causing topical antifungal agents to be ineffective. Treat topically at the first sign of infection.

Molluscum Gladiatorum

Molluscum contagiosum virus causes small umbilicated flesh-colored bumps on the skin. These can easily spread and multiply, so it is important to obtain control as quickly as possible. I was shocked to learn from one patient that at wrestling meets he had to pay $25 per lesion to have these manually scraped off by a doctor prior to wrestling. Personally, I find this ludicrous, though this practice is listed in the . Molluscum lesions have a core that has thousands of active viral particles. So curetting lesions prior to skin exposure increases the risk of spreading by releasing those viral particles. Curetting lesions also opens an area of the skin for increased further risk of infection with everything on this list. Personally, I think covering active lesions with an occlusive dressing is more effective at both preventing transmission and further infection.

Warts

Warts are also caused by a group of viruses called Human Papilloma Viruses. There are over 100 strains of this virus, with different strains causing different types of viruses in different locations. Curetting is also listed in the for warts and my opposition to this practice is the same. Treatment of warts varies on the location on the body and the size of the wart. Warts can require weeks to months to resolve. Similarly, I think covering active lesions with an occlusive dressing is more effective at both preventing transmission and further infection.

Bio-Occlusive Dressings

Guidelines vary on this. For some conditions, complete coverage of an area with a bio-occlusive dressing is sufficient per guidelines. There are a variety of these dressing available. is probably the most common and is available on Amazon and at retail pharmacies.

My Top 5 Tips For Wrestlers

1. Wash with Hibiclens before and after practice and meets. Effects last 24 hours.
2. Apply mupirocin ointment to any suspected bacterial infection.
3. Apply Lamisil cream to any suspected fungal infection.
4. Take a handful of bio-occlusive dressings with you to any meet.
5. BE PROACTIVE. that govern your particular meet or organization. Take them with you to the meet. If visiting a doctor prior to a meet for clearance, bring your governing guidelines to the doctor with you. Don’t try to wait and track these down at the last minute.

Articles from Sports Health are provided here courtesy of SAGE Publications

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