Sports Related Skin Conditions

Athletes are under the spotlight by viewers around the world. The teams competing have trained together for countless hours. Along with this closeness, physical contact, and sharing of equipment comes the risk for common and potentially devastating skin infections. Vast outbreaks of skin infections with fungi, viruses, and bacteria can occur amongst teammates at all levels of competition, from junior high school to the Olympics.   In fact, some skin conditions can even prevent athletes from competing.^[1] It is important for coaches, doctors, and the athletes themselves to know about some of the most common skin conditions amongst sports teams so that they can be prevented and treated.   

Bacterial Infections

Physical contact in sports leads to skin break down and scrapes, which together with moisture can foster an environment that makes athletes susceptible to skin infections with the bacteria staphylococcus and streptococci. Impetigo is a common bacterial infection amongst athletes with skin-to-skin contact, which has a yellow colored crust, along with redness and irritation. Impetigo is highly transmissible and common amongst wrestlers, football players, and rugby players.^[2]  

Methicillin Resistant Staphylococcus Aureus (MRSA) outbreaks are a more serious form of bacterial infections because they are caused by a strain of staphylococcus that is resistant to many common antibiotics. MRSA infections may appear as an inflamed and swollen skin lesion, with oozing fluid or pus and may be found anywhere on the body, including the toenail.^[3]  

Athletes can even acquire a bacterial infection of the hair follicles, commonly called ‘hot tub folliculitis,’ resulting from soaking in hot tubs for rehabilitation.^[4] Due to their easy spreadability and potentially serious complications, bacterial infections must be promptly recognized and are commonly treated with topical or oral antibiotics.

Fungal Infections

Most people have heard of ringworm (also called Tinea corporis), an itchy rash appearing as large red, round lesions. Tinea corporis notoriously occurs in outbreaks within wrestling teams and often interrupts practice and competitions.  In fact, it is so common that it is called Tinea corporis gladiatorum in wrestlers.^[5] Lesions often occur on the head, neck, and upper arms and may appear as round, red lesions. Note: these are not to be confused with the perfectly circular bright red spots that result from cupping, an increasingly popular tool used in Traditional Chinese Medicine to promote recovery.^[6]  

Fungal infections can also infect athletes’ feet and is common in athletes who wear full coverage footwear. Like bacterial infections, fungal infections are also highly transmissible and many organizations will not allow athletes to compete if they are infected.^[7] 

Viral Infections

Infection with Herpes Simplex Virus (HSV) has been reported in epidemics within rugby and wrestling teams.^[8,9] Just as other infections spread in teams, HSV also spreads through skin contact with the infection.  Clusters of raised bumps on red bases characterize this infection, but there may be no signs of infection at all.^[10] Warts caused by human papilloma virus (HPV) can also be transmitted to team members, especially when they are on the hands and feet.^[11] 

Non-infectious Skin Conditions

The rigorous nature of intense training also puts athletes at risk for non-infectious skin conditions and exacerbation of pre-existing conditions. Runners and other endurance athletes often get calluses, irritation, fissures, and even skin breakdown in areas with constant friction or pressure. Athlete’s nodules can occur in areas with chronic trauma, such as over the anklebone or top of the foot in long distance runners. In many cases, surgical removal of the nodule has been warranted.^[12,13]

Athletes can also develop allergic contact dermatitis when they become allergic to equipment or other substances in the environment after repeated exposure, such as contact with rubber.^[14] These rashes may appear red, itchy, and scaly. Another important skin condition to recognize, especially in outdoor sports, is skin cancer.  Studies have documented that athletes are especially vulnerable to damage from sun exposure.  Studies have demonstrated the particular risk for skin cancer in bikers,^[15] skiers,^[16] and water sport athletes.^[17]

Prevention

At a meeting of the American Academy of Dermatology, dermatologist Brian B. Adams, MD, MPH, FAAD advocated that athletes must protect themselves from infection by immediately showering following training, wearing sandals in the locker room, and only wearing non-cotton moisture-wicking socks.^[3] Infections can become rampant amongst athletes, and teams can be disrupted and prohibited from participation. Non-infectious skin conditions can lead to harm and injury, and athletes need to speak up and get proper treatment. Athletes, coaches, and physicians need to be educated about both common and uncommon skin conditions to ensure adequate surveillance and appropriate diagnosis and treatment.