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Best treated with Trimethoprim-sulfamethoxazole
9%
107/1238
Athlete may return to play 48 hours after initiation of medical therapy
6%
79/1238
Lesions should be unroofed and debrided
2%
19/1238
Treatment of choice inactivates viral DNA synthesis
77%
952/1238
Streptoccoci would be most likely isolated on culture
73/1238
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The lesion seen in Figure A represents herpes simplex virus (HSV) and is best treated with an anti-viral medication, commonly acyclovir or valacyclovir. HSV is a common skin infection in sports with close contact like wrestling. It has an incubation period of up to 14 days and presents as clusters of fluid filled blisters on an erythematous base. Athletes with close skin contact diagnosed with an HSV skin infection should be removed from competition until they have been on anti-viral medication for 5 days and with no new lesions for 72 hours. Anti-viral medication such as acyclovir or valacyclovir, acts to rid the HSV infection by inactivating DNA synthesis. Other differential diagnoses include impetigo, tinea corporis and eczema. Carr et al review various skin conditions in athletes. Causes of these dermatologic conditions ranges from abrasions/lacerations to inflammatory skin conditions and infections. They discuss diagnosis and management of each condition. Wilson et al discuss skin condition specifically in wrestlers, mentioning that cutaneous infections cause significant disruption to the athlete's ability to participate. They note the most common skin conditions are herpes simplex viruses and bacterial and dermophytic infections. They discuss management of these lesions, mentioning that prophylactic medication is indicated in wrestlers to prevent recurrence of these infections. Figure A depicts an HSV-1 skin infection with fluid filled blisters seen on an erythematous bed. Incorrect Answers: Answer 1: Trimethoprim-sulfamethoxazole (Bactrim) treats MRSA infections, but does not address viral infections such as HSV. Answer 2: As mentioned above, the athlete should not return to sport for 5 days after initiation of anti-viral medication. Answer 3: There is no indication for unroofing the HSV blisters or performing a formal debridement. Answer 5: Streptococci would not be isolated on culture, as this is a viral skin infection. Streptococcus species are responsible for causing impetigo infections.
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