Play it safe

Dr Vikas Sharma

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Team sports have a long history of fostering cooperation, camaraderie and a healthy competitive spirit among athletes. But the closeness that brings athletes together also can create an environment for a host of contagious skin infections. It is important for teammates and coaches to be aware of the skin conditions resulting from skin-to-skin contact among athletes and how to prevent outbreaks in teams. 

Outbreaks of ringworm, herpes, and methicillin-resistant staphylococcus aureus (MRSA) have occurred in various team sports. These skin conditions are highly contagious and can spread through teams quite quickly, especially if these are not immediately diagnosed and contained. That is why athletes need to be aware of these risks and how to spot the warning signs of a skin infection.

Touch me not

In skin-to-skin contact sports like wrestling, participants are particularly at risk for developing contagious skin problems. These can include diseases like impetigo, a highly bacterial infection of the skin characterised by honey-coloured, crusted, red areas which may be itchy. Occasionally, blisters may occur. 

Methicillin-resistant staphylococcus aureus (MRSA) is a bacterium, a type of staph that causes infections that are resistant to common antibiotics such as methicillin, penicillin, amoxicillin and oxacillin. It may sometimes be responsible for impetigo. MRSA outbreak also may appear as a pimple, boil or abscess, sometimes with draining fluid or pus. These lesions may be red, swollen, warm and tender to touch. 

Physical contact, shared facilities and equipment, and poor hygiene all contribute to its incidence.  Football players experience a variety of factors predisposing them to MRSA infections. These include skin injuries that can occur on the playing field, turf burns from artificial turf that can worsen skin trauma. Even an athlete’s ingrown toenail can lead to a MRSA infection. Some athletes are even carriers of the bacteria in their noses.

One common virus that is easily transmitted in athletes is the herpes simplex virus. This contagious virus causes blisters and sores around the mouth, nose, genitals and buttocks, but these can occur almost anywhere on the skin, especially in athletes. Early in the course of the disease, the lesions appear as non-specific red lesions but then acquire the characteristic grouped blisters on a red base. The sores may be painful and unsightly. The infection must be detected and treated quickly to prevent the spread of the virus among team members. 

Herpes simplex is quitecommon among wrestlers, where skin-to-skin contact is unavoidable. The condition is termed herpes gladiatorum. Treatment includes oral antiviral medications and the athlete can return to practice and competition after four to five days of treatment. Wrestlers, who spar with an infected partner, have a one in three chance of contracting this skin infection, so it is crucial that the virus is treated and athletes avoid participating in competition during the period of infection.

Ringworm is a fungal infection that develops on the top layer of the skin and is characterised by an itchy, red circular rash with clear skin in the middle. Ringworm outbreaks can occur in wrestling teams, often disrupting practices and competitions. Any athlete in any sport with skin-to-skin contact could develop ringworm but the intensity of close contact and exposed skin makes wrestling the highest risk sport for this particular fungal infection. Early detection and treatment are essential in containing the spread of infection.

Be cautious of the tight fit

Athlete’s nodules is a general term for reactive nodules occurring in individuals who plays sports like football and canoeing. Chronic rubbing on the ankle from tight-fitting shoes may cause athlete’s nodules in football players. Well-defined, skin-coloured nodules appeared on the dorsal aspect of the feet (football) and knees (canoeists). 

Hockey players, surfers and boxers can also develop athlete’s nodules. Boxers traumatise their hands during boxing and develop well-defined, hyperpigmented plaques over their knuckles.

Other problems

Almost all sports enthusiasts are at risk of developing traumatic entities such as nail dystrophies, calluses and blisters. Other more unusual traumatic skin conditions, such as talon noire, jogger’s nipples and mogul’s palm, occur in specific sports. 

Several techniques and special clothing can help preventing traumatic skin conditions in athletes. Almost all athletes, to some degree, interact with the environment. Winter sport athletes may develop frostbite and swimmers in both fresh and saltwater may develop swimmer’s itch or seabather’s eruption, respectively. Swimmers with fair skin and light hair may also present with unusual green hair that result from the deposition of copper within the hair.

Tips to prevent infections

1. Keep cuts and scrapes clean and covered with a bandage until healed. A cut or scrape weakens the skin’s defence and allows germs that cause infections to enter.

2.Prevent blisters to reduce infections. Apply a pad, gel or spray to areas that routinely blister. To help prevent blisters on the feet, ankles and hands, use specialised gloves and socks or wear two pairs of socks. Athletes should also make sure that their footwear fits properly.

3.Wear moisture-wicking clothes. This helps keep the athlete’s skin dry and prevents germs from growing.

4.Wear sandals in the locker room. Wearing sandals or other shoes helps reduce infections on the feet.

5.Shower after every practice and game. In addition, athletes should use an antimicrobial soap and wash their entire body.

6.Do not share personal care items. Athletes should always use a clean towel after showering and use their own towels, soaps, razors and other personal care items.

7.Wash clothes and towels after each use. 

8.Disinfect equipment, including protective gear, daily. For proper disinfection, follow the manufacturers’ instructions.

9.Perform regular skin checks. Athletes should check their skin daily, especially those in high-risk sports, such as wrestling. Look for any changes, such as cuts, sores, redness, swelling and pus, and report any changes to an athletic trainer or doctor.

10.Never use sandpaper or bleach to pass a skin check. This will cause more damage to the skin and keep the athlete on the bench longer.

Preventive measures

Keep it dry: Athletes’ groins and underarms are warm, occluded, and macerated with sweat, conditions that make these ideal areas for microorganism growth. Athletes must wear moisture-wicking undergarments to keep the groin and other skin folds dry.

Sweaty sock syndrome: Pitted keratolysis also known as sweaty sock syndrome is common among basketball players, tennis players and especially runners. Main risk factors could be occlusive footwear and exertional hypersweating of the foot. The affected foot reveals well-defined crater like pits on the sole, particularly on the weight-bearing points and distinct foul odour. Athletes can apply aluminium chloride to their feet before exercising to decrease sweating and should wear moisture-wicking socks.

Bicyclist’s nipples: Sweat, rain and the intense wind chill (inherent with high bike speeds) combine to cause tender, erythematous nipples. This eruption reflects cold damage to the nipples.

Jogger’s nipples: Repeated friction between non-synthetic shirts and the nipple produces painful, erythematous, bleeding erosions on the areola and nipple. It can be treated by using petroleum jelly, or topical antibiotic ointment. 

Bikini bottom: Swimmers can develop this condition after prolonged exposure to wet, tight-fitting swimming suits. This problem is also common among women volleyball players who sweat profusely in tight-fitting shorts.

Callosities: Thick, well-defined, hyperkeratotic plaques are created by the skin’s reaction to repeated frictional trauma e.g. on heel called  runner’s bump.

Corns: Corns are of two types — hard corns and soft corns. Hard corns are located on the sole and tend to be painful. Soft corns are typically located in the inter-digital area between the toes.

Piezogenic pedal papules: In long distance runners, multiple, less than 5-mm, well-defined, skin-coloured, firm papules are formed on the heel.  Most are not painful (90 per cent), but these may be more apparent after prolonged exercise (e.g. during marathon training).

Tennis toes: It results from the strong force applied to the longest toes (usually the first two toes) when a player’s foot rapidly thrusts into the toe box during abrupt stops and starts. Tennis toe is characterised by nail darkening secondary to subungual haemorrhage.

Exercise-induced anaphylaxis: Athletes who develop exercise-induced anaphylaxis should  avoid food before exercise and extreme temperatures while they exercise. Exercise-Induced angioedema/anaphylaxis can occur mainly in runners due to increased histamine.

— The writer is a dermatologist, National Skin Hospital, Panchkula