Review Question - QID 219612

The skin lesion pictured is representative of herpes gladiatorum, which is caused by herpes simplex virus (HSV)-1 and is treated with acyclovir (Answer 2).

Infectious skin lesions can occur, especially in contact athletes. It is important for providers who treat athletes to be able to accurately identify and understand appropriate treatment regimens concerning medical management and return-to-play guidelines. The rash pictured in Figure A is caused by HSV and features a cluster of fluid-filled blisters, while methicillin-resistant staphylococcus aureus (MRSA) infections tend to appear more pustulated, whereas ringworm infections tend to display a scaly, red, circular patch. Management of HSV infections is highlighted by PO acyclovir and return to play when there have been no new lesions for the prior 72 hours and the athlete has been on medication for five days.

Mirfazaelian and Daneshbod published a case report of a 21-year-old male wrestler with five days of painful facial rash and vesicular lesions. The lesion was ultimately diagnosed as herpes gladiatorum, caused by HSV1, and transferred via skin-to-skin contact. They estimated that as many as 40% of wrestlers had been affected at some point.

Johnson reviewed herpes gladiatorum and other skin diseases, noting that skin infections are responsible for 10-15% of time lost in college athletics. The contagious nature of these infections has prompted sports governing bodies at different levels to develop strict return-to-play guidelines, as mentioned above. These guidelines help dictate how long the athlete should remain out of play based on the appearance of the lesions as well as the length of medical management required.

Figure A demonstrates the raised vesicular rash seen with herpes gladiatorum.

Incorrect Answers:
Answer 1: Clotrimazole is an anti-fungal cream that is used to treat infections such as tinea corporis (ringworm). Athletes are allowed to return to play after 48 hours of treatment for ringworm.
Answer 3: Mupirocin can be used to treat localized skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA).
Answer 4: Erythromycin is a macrolide antibiotic that can be used to treat impetigo infections that are usually caused by Streptococcus or Staphylococcus bacteria. Athletes may return to play when all lesions are clear of crusting.
Answer 5: Tretinoin is a retinoid derivative used to treat acne, and athletes do not need to be held from play during treatment.