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Fluconazole PO for 14 days, return to play after 72 hours
23%
168/738
Bactrim (TMP-SMX) PO for 5 days, return to play once lesion is no longer visible
4%
27/738
Itraconazole PO for 14 days, return to play after 24 hours
2%
14/738
Ketoconazole topical for 14 days, return to play after 72 hours
52%
387/738
Fluconazole PO for 14 days, immediate return to play as long as the skin lesions are covered
18%
135/738
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This patient’s skin lesion is classic for tinea corporis (ringworm). The National College Athletic Association (NCAA) recommendation for tinea corporis treatment and return to play is greater than 72 hours of treatment with a topical antifungal cream (Answer 4).Tinea is a superficial dermatophyte infection that spreads from direct contact. The fungus can live outside the host for an indeterminate time and warm moist environments increase the pathogen’s lifespan. The specific treatment and name of this infection vary based on body location. Tinea corporis occurs anywhere on the body excluding, feet, groin, scalp, bearded face, and nails. The lesions appear as hypo or hyperpigmented oval skin patches that are typically dry or dusty. Tinea corporis is highly contagious and can cause minor epidemics if not properly managed. Patients should be treated for at least 72 hours with a topical antifungal cream and have the lesions covered before returning to play. Pujalte et al. published a review article on common dermatologic diseases in athletes. The authors cover the presentation, diagnosis, treatment, and return to play for each major disease type. The recommendations for tinea infections are seen in Illustration 1.Nowicka et al. published a review article regarding infectious diseases in contact sports. They report the rate of affected wrestlers in wrestling teams varies from 24% to 77%. The authors support the NCAA guidelines regarding the treatment of tinea. Figure A shows an annular plaque with central clearing and elevated scaly edges, classic for tinea corporis. Illustration 1 shows the tinea treatment recommendations from Pujalte et al.Incorrect Answers:Answers 1 and 5: PO Fluconazole is recommended for widespread infection, failed topical treatment, or immunocompromised patients.Answer 2: Bactrim is an antibiotic and not recommended for tinea treatment.Answer 3: PO Itraconazole is recommended for tinea capitis.
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