Waconia Wildcat Wrestling

Skin Infection ManualSkin Infection Manual

Table of Contents

1. Introduction2. Prevention and wrestler guidelines3. Herpes Simplex4. Tinea (Ringworm)5. Bacterial Infections (Impetigo, Staphylcoccus, Folliculitis)6. Molluscum Contagiosum

Introduction:The purpose of this manual is to educate the team and the team member’s parents on the various forms of skin infections so that they can be diligent in checking their athletes every week or two in order to prevent infection and avoid missing team or individual events. It is important that each participant and participating family is able to identify skin infections and incorporates a regular routine of good hygiene to prevent their outbreak.

General Prevention Tips & Expectations

The following will help prevent some skin infections and should be made a regular part of each wrestler’s routine:

1. Remember that your skin is the first line of defense, a cut in the skin is aportal of entry for germs.2. When cleaning the mats clean the walls, as well.3. Always use your own wash cloth. Do not share hygiene products (ex. Towels,wash clothes)!!4. Using ‘ringworm cream’ (OTC- Lamasil/Naftin) on ‘suspicious spots’.5. Washing thoroughly after practice with anti-bacterial soap and hot water.(Paying attention to the creases in the body.)6. Make sure that you keep your immune system up by maintaining a healthydiet, and getting enough rest. This is crucial for fighting infections of anykind and for preventing recurrent herpetic lesions.7. Use shampoo with selenium sulfide in it. ( ex. Selsun Blue)8. Never wear wrestling shoes outside the wrestling room doing so especially allows Ringworm to be tracked in on the shoes.9. Wrestlers should let their coaches know if they are concerned about the health of their partner or opponents skin before wrestling.

10.Trim fingernails weekly11. Parents and wrestlers remove street shoes before entering wrestling room.

Herpes Simplex: (See Figure 1)What is it?- A virus that is transmitted by, skin to skin contact.What are the signs/ symptoms?- Primary infection:o Headacheo Malaiseo Mylagiao Vesicles at site of inoculationo Enlarged lymph nodes (usually 1 sided)- Recurrent infection:o Tingling, itching or burning 24 hrs. prior to skin changes.What is the treatment?- Primary infection:o , Valacyclovir (Valtrex)1g twice a day for 10 days- Recurrent infection:o Valacyclovir (Valtrex,)1g twice a day for 5 days- Suppressive Therapy:o Valacyclovir (Valtrex)< 170: 0.5 gram twice a day.>= 170: 1 gram twice a day.- Use of drying agent such as witch hazel.

What are the NCAA and high school rules for return to wrestling?

1. Wrestler must be free of systemic symptoms of viral infection.

2. Wrestler must have developed NO NEW blisters for 72 hours before theexamination.

3. Wrestler must have no moist lesions; all lesions must be dried andsurmounted by a FIRM ADHERENT CRUST.

4. Wrestler must have been on the appropriate dosage of systemic antiviraltherapy for at least 120 hours before and at the time of the meet ortournament.

5. Active herpetic infections shall not be covered to allow participation.

- Secondary infection:

1. Wrestler must have no moist lesions; all lesions must be dried andsurmounted by a FIRM ADHERENT CRUST.

2. Wrestler must have been on the appropriate dosage of systemic antiviral

therapy for at least 120 hours before and at the time of the meet ortournament.

3. Active herpetic infections shall not be covered to allow participation.

Bacterial Infections:(See Figure 2)Impetigo- What is it?o Superficial infection involving epidermis.o Infection caused by:Staphylococcus aureus: 20% – 40% of typical adults are nasalcarriers.Streptococcus pyogenes: 20% of normal adults are axillaecarriers- What are the signs/ symptoms?o Arising from minor breaks in the skin.o Severe itchingo Small vesicles/ pustuleso Erosions (Honey crusted)o Possible regional lymphademopathy- What is the treatment?o Systemic antibiotics (ex. Dicloxacellin, Cephalexin)

What are the NCAA and high school rules for return to wrestling?

1. Wrestler must have been without any new skin lesion for 48 hoursbefore the meet or tournament.

2. Wrestler must have completed 72 hours of antibiotic therapy and haveno moist, exudative or draining lesions at meet or tournament time.

3. Active bacterial infections shall not be covered to allow participation. What can I do to prevent it?o Monitor and cover cuts.o Shower and wash cuts out thoroughly.o Watch cuts for signs of infection.o Use an anti-bacterial soap after practice for body and face.

Tinea infections = Ringworm: (See Figure 3)

- What is it?o Dermatophyte infection (Fungus)- What are the signs/ symptoms?o Small, scaly, sharply marginated plaqueo Single or occasionally scatteredo Pink to red color- How is it treated?o Anti-fungal creams (Naftin, Lamisil)o Oral meds for scalp lesions or difficult corpis lesions

What can be done to prevent it?o Use powders containing miconazole or tolnaftate after showering. Each wrestler shall be required to shower following every practice and tournament.

o Shower with antibacterial soap such as Defense soapo Use an anti bacterial wipe following practice or a match to wipe down exposed skin

o Naftin or Lamasil cream over suspect areaso Nizarol shampoo for washing area and hair

What are the NCAA and high school rules for Tinea lesions?1. Minimum of 72 hours of topical therapy is required for skin lesions.

The cidal topic antifungals terbinafine or naftifine (Lamisil or Naftin) are suggested for treatment.

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. Those with solitary, or closely clustered, localized lesions will be disqualified if lesions are in a body location that cannot be ‘adequately covered.’.

Molluscum Contagiosum: (See Figure 4)

What is it?o Epidermal viral infection transmitted by skin to skin contact.- What are the signs/ symptoms?o Pearly white or skin coloredo Papules (1-2 mm)o Nodules (5-10 mm)o Can be solitary or clustered

What are the NCAA rules and the treatment options?

1. Need to curetted or removed prior to meet2. Solitary or localized, clustered lesion can be covered.

General Prevention Tips

The following will help prevent some skin infections and should be made a regular part of each wrestlers routine:

1. Remember that your skin is the first line of defense, a cut in the skin is aportal of entry for germs.2. When cleaning the mats clean the walls, as well.3. Always use your own wash cloth. Do not share hygiene products (ex. Towels,wash clothes)!!4. Using ‘ringworm cream’ (OTC- Lamasil/Naftin) on ‘suspicious spots’.5. Washing thoroughly after practice with anti-bacterial soap and hot water.

(Paying attention to the creases in the body.)6. Make sure that you keep your immune system up by maintaining a healthydiet, and getting enough rest. This is crucial for fighting infections of anykind and for preventing recurrent herpetic lesions.7. Use shampoo with selenium sulfide in it. ( ex. Selsun Blue)8. Never wear wrestling shoes outside the wrestling room doing so especially allows Ringworm to be tracked in on the shoes.9. Wrestlers should let their coaches know if they are concerned about the health of their partner or opponents skin before wrestling.

Reference:- National Collegiate Athletic Association. NCAA Wrestling Rules andInterpretations- Fitzpatrick T, Johnson RA, Wolff K, Suurmond D. Color Atlas and Synopsisof Clinical Dermatology. Boston, MA: McGraw-Hill Medical Publishing;1992.

Figure 1: Herpes Simplex

Figure 2: Impetigo

Figure3: Ringworm

Figure 4: Molluscum Contagiosum

Wrestling is a sport in which athletes have close skin to skin contact for the majority of the event. It isduring this contact that even the most innocent skin irritation could lead to a contagious eventsometimes taking almost an entire team out of commission for an extended period of time.Contagious skin disease can be broken into two areas infections and infestations. For the purpose ofthis article three types of infections will be reviewed:

Bacterial, Viral and Fungal.There are three infectious diseases of the skin that strike fear into any wrestling coach; they areImpetigo, Herpes Gladiatorum, and Ringworm. The three actually represent the three different types ofinfections.

Skin diseases are common in wrestling because of the increased body temperature, sweat, and frictioncaused by the sport. The resulting moist and warm environment encourages growth of bacteria andfungus. The friction creates open (imperfect) areas in the skin that allow the bacteria, virus, or fungusto enter. When this imperfect skin comes into contact with an infectious agent from another person'sskin or on equipment, infections may occur.

1. Bacterial:Impetigo is a skin infection caused by the bacteria Staphylococcus aureus. Impetigo is highlycontagious with a well known history of affecting many wrestlers. This is a bacterium that can spreadduring skin to skin contact as well as contact with an infected surface. .Impetigo contagiosa infection isthe most common, presenting with a red sore that breaks open quickly leaving an oozing sore thatclassically forms a honey-yellow crust. Often the lesions appear on the head, face and neck but canoccur anywhere on the body.Treatment depends on the extent and severity of the infection. Often for wrestlers it is a combination ofboth oral and topical antibiotics. There is to be NO participation until athlete has been treated for 48hours or until all lesions heal. A physicians note is required for return to participation but ultimately for

competition the referee has the final call.

2. Viral:Herpes gladiatorum is a skin infection caused by the herpes simplex virus. It occurs often in wrestlers.It causes a rash that commonly appears on the face, neck, shoulder, and arms. This virus istransmitted by skin to skin contact. The presentation of herpes simplex is a usually a rash made up of acluster of blisters. These blisters may or may not be painful.To identify or diagnose an infection, it is necessary for a health care provider to examine your skin.They will sometimes perform a culture to test for the herpes virus. A prescription for a medicine calledAcyclovir may be given to speed your recovery. The herpes rash usually lasts from 7 to 10 days.Reoccurrences may happen as the virus is dormant in your system. There is should be NO skin contactwith any uninfected person while there is any herpes skin rash still present.

3. Fungal:Ringworm is a rash caused by a fungus that has infected your skin. The name gives one amisunderstanding that it is caused by a worm or parasite, this is not true, it is a fungus. Ringworm onthe skin is called tinea corporis. When ringworm is on the feet, it is called tinea pedis or athletes foot,and when it is on the scalp, it is called tinea capitis. The fungus can also infect the inner thighs andgroin. This type of ringworm is called jock itch or tinea cruris.The rash caused by a ringworm infection is usually round or oval and has a raised border. It startssmall and slowly grows larger. The rash may itch and the skin may become scaly. There may be somesmall, pus-filled bumps. Over time the rash spreads from one part of the body to other parts.Ringworm can causes patches of hair loss especially on the head.The treatment of ringworm depends on your health and extent of the infection. Your health careprovider may scrape the skin and look at it under a microscope or use an ultraviolet (UV) light to lookfor ringworm on the scalp. Usually treatment is an antifungal cream for the area of the rash;sometimes an oral medication may be prescribed. It's important to keep using the medicine, asdirected, for a week after you no longer see a rash to make sure it's completely gone. Unfortunately itis common to get ringworm again, sometimes becoming a long-term problem.Simple measures can be taken to lessen the likelihood of contracting a skin infection. They are mainlyin the family of hygiene: clean and disinfect. Showering with soap after practice and tournaments, notsharing towels, razors, or soap, proper laundering of personal towels and clothing, and cleaning of themats daily, more frequently on days of high use, are easy ways to cut the risk. Surfaces needingattention include head gear, wrestling mats, and any other equipment used by the team such asstationary bike, Swiss balls, etc. during cleaning.Bring attention to your coach any skin lesions. Make sure to avoid close contact with others untilappropriate diagnosis and treatment occur.

IHSAA GUIDELINES TO REDUCE THE INCIDENCE OFCOMMUNICABLE SKIN CONDITIONS IN WRESTLING

The following guidelines are not meant to be all inclusive of what may needto be done to prevent communicable skin conditions from occurring in wrestling.They provide practical suggestions that, when implemented, should help reduce the incidence ofcommunicable skin conditions occurring among high school wrestlers. Some of the guidelines goabove and beyond what would normally need to be done to prevent communicable skin conditionsfrom occurring. However, in instances where some wrestlers, or entire teams, seem to beextremely susceptible to communicable skin conditions the more extreme guidelines may prove tobe very worthwhile. Some coaches are currently implementing most of the guidelines.Others may be utilizing only selected ones. Whatever the case, restricting wrestlers with skinlesions from participation and keeping a clean wrestling environment are the keys toreducing the incidence of skin infections.

GENERAL GUIDELINES:

1) Clean wrestling mats at least once a day with a disinfectant cleaner*, preferably within onehour of practice or competition. Allow mats to air dry before using. There is great benefit fromcleaning mats before and after practice. *(Disinfectant cleaners used should state they areeffective against viruses, fungi, and bacteria. Typically the label will state the cleaner isbactericidal, fungicidal, & virucidal. Follow the label directions closely for the best effectiveness.A 1:100 solution of household bleach and water (1/4 cup bleach per gallon of water) is anexcellent disinfectant cleaner, however, it may cause skin rashes. It should be mixed freshdaily and stored in a dark colored container. 70% Isopropyl alcohol is also an excellentdisinfectant cleaner.2) Wash wall mats with a disinfectant cleaner on a regular basis (1-2 times weekly).3) Wipe weight room benches with a disinfectant cleaner after use and/or prior to the next day'suse.4) Don't allow any wrestler into the practice room without clean practice gear! Laundertowels (including wash cloths), practice gear, and uniforms after each use. Use detergentcontaining bleach or dry all articles in a dryer.5) Wipe head gear, shoes and any braces with a disinfectant cleaner after each practice.Wash/clean shoes, knee pads, head gear once a week.6) Do not allow wrestlers to share any item of practice gear or towels!7) Require each wrestler to shower after each practice and contest, scrubbing vigorouslywith an antibacterial or deodorant soap. Consider providing liquid soap. If this is notpossible, do not allow wrestlers to share bars of soap.8) Have each wrestler supply their own soap and shampoo, or have dispensers containingliquid soap available.9) Athletes with acne problems may wish to use astringent pads (ie. Stridex) to clean theirface and neck, or other affected areas, after showering.10) Open the doors to the wrestling room each night and use fans to lower the heat andhumidity. Proper ventilation is very important to destroy disease causing organisms,especially those causing fungal conditions, such as ringworm.11) Do not allow athletes to use common towels for any reason, including at mat side!12) Wrestlers should not put dirty practice clothes in the same gym bag in which they carryclean practice clothes to school. This may contaminate the bag and, therefore, the cleanclothes.13) Neoprene sleeves and supports should be wiped with a disinfectant cleaner after everyuse and be allowed to air dry.14) Wrestlers should keep their finger nails trimmed short to avoid scratching themselves orsomeone else, as any opening in the skin increases the risk of infection.15) Wrestlers should boost their natural immunity to all diseases by eating healthy foodsand getting adequate rest. They may also wish to take a one-a-day, multivitamin.16) Coaches should visit with wrestlers, and their parents, about how to recognize andprevent the most common skin diseases.17) Wrestlers who have been susceptible to skin conditions in the past may want to visitwith their family physician regarding preventive oral medication.

GUIDELINES FOR WRESTLERS WHO HAVE A CURRENT SKIN CONDITION:1) Wrestlers with any signs of a communicable skin condition MUST be withheld frompractice until a medical diagnosis and clearance is obtained.2) Wrestlers having any signs or symptoms of a communicable skin condition should besent to a doctor IMMEDIATELY!3) Wrestlers with a skin condition, who have current written permission from a physician toparticipate, should cover affected area with an occlusive (water resistant) dressing or agauze pad with water resistant covering on at least one side until the lesion(s) is completely

gone!4) Wrestlers having lesions from a communicable skin condition on their face or neckshould launder their pillow case on a daily basis.5) Wrestlers with any signs of a communicable skin condition should wash their handsfrequently to avoid contaminating themselves, or others.6) Wrestlers with communicable skin conditions should be made aware that contact theyhave with others during the school day, outside the wrestling room, may spread the diseaseto others.

COMMUNICABLE SKIN CONDITIONS(Guidelines for Safe Return to Participation)The following information is meant to be used as guidelines for safe return toparticipation when a wrestler is being withheld from participation due to acommunicable skin condition. Each medical professional must determine awrestler’s readiness to return to participation on an individual basis.HERPES:Before returning to participation, the wrestler should:1. Be free from any systemic symptoms of viral infection (fever, malaise, etc.),AND,2. Have developed no new blisters for 3 days, AND,3. Have no moist lesions. All lesions must be dry with a FIRM, ADHERENTCRUST, AND,4. Have been using the appropriate dosage of systemic antiviral therapy forat least 5 days.Note: Physicians may want to consider season-long prophylaxis with acyclovir forwrestlers with recurrent herpes.IMPETIGO and BOILS (other bacterial infections):Before returning to participation, the wrestler should:1. Have developed no new lesions in the past 48 hours, AND,2. Have no moist, exudative or draining lesions, AND,3. Have been using the appropriate dosage of antibiotic therapy for at least 3days.RINGWORM:Before returning to participation, the wrestler should:1. Not have extensive and active lesions, AND,2. Have been using topical therapy for a minimum of 3 days for skin lesions.3. For scalp lesions, a wrestler must have been using the appropriate dosageof systemic (oral) antifungal therapy for a minimum of 2 weeks.