Sports-Related Skin Infections

Skin infections are a leading cause of missed games in young athletes. About 10 percent of high school athletes’ injuries are skin infections. Most of these infections are spread through skin-to-skin contact, poor hygiene or shared items, such as towels.

Children’s Hospital provides care for sports-related skin infections, including bacterial infections, viral infections and fungal infections. Our sports team providers evaluate and provide guidance on how to prevent the spread of skin infections among athletes.

Skin-to-skin contact

Athlete A develops a skin infection, then spreads the infection to Athlete B through skin-to-skin contact. Athlete B may now be colonized and remain without symptoms, or develop an infection.

Equipment and environment

Athlete A may indirectly transfer infectious material to Athlete B. Common ways for infections to spread include clothing, equipment such as weight machines, or a shared surface such as a training table or wrestling mat.

Preventing skin infections

• Maintain clean facilities.
• Practice good hygiene, including frequent hand washing and showering after every sports activity.
• Discourage athletes from sharing towels, gear, water bottles, razors or hair clippers.
• Worn clothing should be laundered or disinfected daily.
• Encourage athletes to complete a daily skin survey and report any suspicious lesions for treatment.

Products aimed at preventing infections in athletes include:  

• Products for turf or field
• Locker room antimicrobial solutions
• Light-based germicidal products

While these products may be effective, none are proven to be more effective than standard cleaning practices. The CDC recommends:

• Routine laundry practices
• Daily cleaning of surfaces that contact bare skin, such as benches or shared equipment. Clean those surfaces with a detergent-based cleaner or EPA-registered disinfectant and allow them to dry completely.
• Equipment with damaged surfaces that interfere with cleaning should be repaired or thrown out.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria-related infection that spreads easily with skin-to-skin contact. There is no evidence that spraying or fogging rooms or surfaces with disinfectants prevent MRSA infections more effectively than the targeted approach of cleaning frequently touched surfaces.

Viruses are everywhere in the environment. They are much smaller than bacteria and require a host cell to survive. They enter the body and travel to a specific host cell where they can replicate and spread.

Common viral skin infections in athletes

Herpes simplex virus (HSV) causes blisters on the skin and cold sores. HSV2 is transmitted sexually and causes blisters on the genitals.  

Initial infection can cause fever, flu-like symptoms and mouth sores. Skin lesions begin as small fluid-filled blisters (vesicles), often in clusters with an underlying red base. Over time, blisters will rupture and scab over.

After the initial infection, the virus travels to nerve roots where it remains for the rest of the host’s life. Certain triggers, including stress, can enable the virus to travel along the nerve to the skin, causing an outbreak of cold sores and blisters. When the virus is re-activated, even before blisters form, the host is very contagious.

Herpes gladiatorum is a classic infection in athletes. Infections often appear on the face, neck and arms. The virus can quickly spread throughout a team.

Molluscum contagiosum is a highly contagious viral disease caused by poxvirus. It manifests as smooth, flesh-colored, dome-shaped bumps with depressions (umbilications) at the center. Molluscum can occur on any area of the skin, but commonly occurs on the face, eyelids, neck, chest, armpits and folds of the arms and legs.

How are these viruses spread?

Herpes is spread through contact with open blisters and saliva and, commonly through contact sports. Examples include herpes gladiatorum and herpes rugbiorum. Molluscum is typically spread through skin-to-skin contact. It can also spread on fomites, which is anything capable of absorbing and transmitting infecting organisms such as towels or sponges.  

How are these infections treated?

HSV lesions are self-limited and typically improve on their own. Anti-viral medications, such as acyclovir, may help when deemed appropriate by a healthcare provider. A doctor can remove molluscum contagiosum lesions using a specialized instrument called a curettage. A healthcare provider may prescribe a topical ointment or cream.

When can an athlete return to play?

The athlete should be past generalized symptoms such as fever, sore throat and swollen lymph nodes. All lesions must be scabbed over, with no new lesions in the preceding 48 hours.

If treated with anti-viral medications:

• During the first episode of herpes gladiatorum, athletes are not allowed to compete for a minimum of 10 days because they are highly contagious.
• For recurrent outbreaks, the amount of virus in saliva and on the skin is often less. The athlete should refrain from competition for a minimum of five days. No new lesions should appear while on antiviral medications for 48 hours.

Fungi are neither plants nor animals. They are unique life forms that grow in soil, on plants, and animals. They tend to grown in dark, moist areas. Fungi can cause a variety of infections in humans, often termed dermatophyte, when involving the skin.

Common fungal skin infections in athletes include:

• Tinea capitis is an infection of the scalp that typically presents as patchy scales with areas of hair loss (alopecia).
• Tinea corporis (ringworm) is an infection of the skin that leads to a red, raised, circular rash with central clearing. Lesions can be singular (one lesion) or multiple (often seen with prolonged skin-to-skin contact, such as in wrestlers (tinea gladiatorum).
• Tinea cruris (jock itch) is an infection of the skin in the inner thigh or groin. Tinea cruris is more common in men and is rare before puberty.
• Tinea pedis (athlete’s foot) is an infection of the skin of the feet. It is common in adolescents and adults, and relatively uncommon in children. Wearing shoes that don’t breathe can lead to fungal infection.
• Tinea versicolor usually appears as light colored (hypopigmented), flat, oval spots on the trunk, extremities, and neck.

How are fungi spread?

Skin-to-skin contact is the primary mode of transmission, but they may spread by materials, such as towels or padded gear, that absorb infecting organisms.

How are fungal infections treated?

• Topical antifungal creams are used for most cases of tinea corporis (ringworm), tinea cruris (jock itch), and tinea pedis (athlete’s foot).
• For tinea capitis, six to eight weeks of oral anti-fungal treatment is necessary. Using antifungal shampoo in addition to oral medication may be beneficial.  
• Topical antifungal creams are used for tinea versicolor. If it is widespread, shampoo or lotion containing selenium may be applied to the affected skin for 10 minutes daily over seven days.
• Athletes should avoid tight-fitting clothes and get as dry as possible after bathing (tinea cruris).

When can athletes return to play?

For skin lesions, athletes may return after 72 hours of oral/topical therapy.

Bacteria are microorganisms that live on our skin, in our gut and almost everywhere in our environment. When bacteria are living in/on our body but not causing an infection, it is called colonization. If our body’s defenses are down due to a respiratory infection or trauma to the skin, these germs may lead to skin and soft tissue infections. 

Most skin infections are due to Staphylococcus aureus, also called Staph, or Streptococcus pyogenes, also called Strep. Staph bacteria that are resistant to certain types of antibiotics are commonly known as methicillin-resistant S. aureus (MRSA). In recent years, MRSA has been a leading cause of skin infections in athletes, resulting in significant outbreaks among teams.

Common bacterial skin infections in athletes

Folliculitis: This infection of the hair follicles can happen anywhere on the skin where hair grows. It is common on the neck, thigh, buttocks, and armpits.

Furuncles/Carbuncles (Boils): Deeper infections of hair follicles can lead to the formation of an abscess (collection of pus). These can be mistaken for a spider bite.

Impetigo: These are more superficial skin infections, often caused by Strep. They can lead to blisters or bumps with “honey-colored” crusting.  

How are these infections spread?  

Bacterial skin infections are very contagious. They spread when the lesions burst open and fluid drains onto the skin. Fluid can transfer through skin-to-skin contact, wiped onto a towel, shared equipment, or the environment, such as a mat.

How are they treated?

Topical antibiotic cream can be used when there is limited skin involvement. Oral antibiotics are often necessary for deeper infections or if there are numerous lesions. Occasionally, abscesses need to be opened and drained by a health care provider because antibiotics alone may not be sufficient.

When can an athlete return to play?

All lesions must be scabbed over with no oozing or discharge. No new lesions may have occurred in the preceding 48 hours. If oral antibiotics are required, NCAA guidelines require athletes to be on antibiotics for 72 hours before returning to play.