This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of tinea corporis in athletes

Kafchinski, Lisa

University of Missouri: MOspace

Tinea Corporis in Athletes Page 1 of 3   11.20.08 Tinea Corporis in Athletes Background  1. General info  o Also known as Tinea gladiatorum o Wrestling mats do not play a major role in transmission o Systematic disinfection of mats does not decrease infection rates  Pathophysiology 1. Pathology of disease  o Trichophyton tonsurans (40%) o Trichophyton rubrum (40%) o Microsporum canis (14%) o Transmitted by close skin-to-skin contact 2. Incidence, prevalence  o 24-77% of wrestlers infected o 2003-2004-accounted for 22.1% of skin infections in men's NCAA wrestling  o Asymptomatic athletes act as reservoirs for infection 3. Risk factors  o Crushed and abraded skin - "mat burns" o Excessive sweating o Occlusion of skin by clothing  Diagnostics 1. History  o Pruritic, burning lesions o Redness o Scaling o May be asymptomatic 2. Physical examination  o Location: primarily on head, neck, upper extremities   Rarely affects lower extremities o Atypical presentation of tinea corporis   Well demarcated, erythematous, scaling plaques  Not ring-shaped o Athletes with severe inflammatory reaction may present with a kerion   Fluctuant abscess located on scalp  Associated with tinea capitis 3. Diagnostic testing  o Diagnosis by inspection o Laboratory evaluation   Culture lesion  Direct microscopic visualization of fungal hyphae   KOH added to scraping from lesion  Differential Diagnosis 1. Nummular eczema 2. Pityriasis rosea 3. Granuloma annulare Tinea Corporis in Athletes Page 2 of 3   11.20.08 4. Psoriasis  5. Subacute cutaneous lupus erythematosus 6. Allergic contact dermatitis 7. Atopic dermatitis  Therapeutics 1. Acute treatment  o Infection may exclude competition-wrestling o Other sports allow participation in practices if lesions are covered  o Topical antifungal for 1 week with concurrent oral antifungal medication   May then compete safely o Continue treatment for 2 weeks after lesions disappear  o Topical antifungals   Ketoconazole cream applied BID for 2-4 weeks o Oral antifungals indicated for extensive disease, immunocompromised, and topical treatment failure   Fluconazole 150 mg PO weekly x 4-6 weeks  Itraconazole 100 mg PO daily x 2 weeks  Terbinafine 250 mg PO daily x 2 weeks  Griseofulvin 500 mg PO daily (microsize) x 2-6 weeks 2. Long-term care and prevention  o Fluconazole 200 mg PO weekly o Itraconazole 300 mg PO bimonthly   Monitor liver enzymes in patients with pre-existing hepatic abnormalities  2008-2009 NCAA Sports Medicine Handbook: Tinea Infections (ringworm) 1. A minimum of 72 hours of topical therapy is required for skin lesions 2. A minimum of 2 weeks of systemic antifungal therapy is required for scalp lesions 3. Wrestlers with extensive and active lesions will be disqualified  o Activity of treated lesions can be judged either by use of KOH preparation or a review of therapeutic regimen o Wrestlers with solitary, or closely clustered, localized lesions will be disqualified if lesions are in a body location that cannot be "properly covered" 4. The disposition of tinea cases will be decided on an individual basis as determined by the examining physician and/or certified athletic trainer  Prevention  1. Early detection and treatment as relapses are common 2. Skin inspections before competitions 3. Athlete hygiene  o Shower after every practice/game o Thorough drying after showering after each practice/game o Wear sandals in showers o Launder clothing and gear o Do not share equipment, especially head gear    Tinea Corporis in Athletes Page 3 of 3   11.20.08 References 1. Adams BB. Dermatologic disorders of the athlete. Sports Med. 2002; 32(5):309-21.  2. Adams BB. Tinea corporis gladiatorum. J Am Acad Dermatol. 2002 Aug; 47(2):286-90. 3. Kohl T, Lisney M. Tinea gladiatorum: Wrestling's emerging foe. Sports Med. June 2000; 29(6):439-447. 4. Adams BB. Skin infections in athletes. Dermatol Nurs. 2008 Feb; 20(1):39-44. 5. Cordoro KM, Ganz JE. Training room management of medical conditions: sports dermatology. Clin Sports Med. 2005 Jul; 24(3):565-98, viii-ix.  6. Turbeville SD, Cowan LD, Greenfield RA. Infectious disease outbreaks in competitive sports: a review of the literature. Am J Sports Med. 2006 Nov; 34(11):1860-5. Epub 2006 Mar 27. Review. 7. Freiman A, Barankin B, Elpem DJ. Sports dermatology part 1: common dermatoses. CMAJ. 2004 Oct 12; 171(8):851-3. Review.  8. Beck CK. Infectious diseases in sports. Med Sci Sports Exerc. 2000 Jul; 32(7 Suppl):S431-8. Review. 9. Buescher SE. Infections associated with pediatric sport participation. Pediatr Clin North Am. 2002 Aug; 49(4):743-51. Review. 10. Kohl TD, Lisney M. Tinea gladiatorum: wrestling's emerging foe. Sports Med. 2000 Jun; 29(6):439-47. Review. 11. Johnson R. Herpes gladiatorum and other skin diseases. Clin Sports Med. 2004 Jul; 23(3):473-84, x. Review. 12. Klossner D, ed. 2008-2009 NCAA Sports Medicine Handbook; July 2008.   Author:  Lisa Kafchinski, RN, University of Nevada Reno FPRP  Editor:  Carol Scott, MD, University of Nevada Reno FPRP  

Tinea corporis in athletes

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University of Missouri: MOspace