The first national survey of skin infections among high school athletes has found that wrestlers have the highest number of infections, with football players coming in a distant second, according to researchers at the University of Colorado Anschutz Medical Campus.
The study, published in the February edition of the Journal of the American Academy of Dermatology, examined data from a large national sample of U.S. high schools over five years and found that 73.6 percent of skin infections occurred during wrestling followed by football with 17.9 percent. The head and neck were the most frequent site of infection.
“Given the nature of the sport, it’s not surprising that wrestlers suffer the most skin infections,” said senior author Robert Dellavalle, MD, associate professor of dermatology at the University of Colorado School of Medicine. “Most of the infections were bacterial and fungal.”
Most athletes were able to return to play within three to six days but some of the infections were more serious.
“While most skin infections require a week recovery on average, others may have more serious eye and neurological involvement from a primary Herpes Simplex Virus,” said study co-first author Kurt Ashak, a fourth year medical student at Michigan State University who helped conduct the research during a recent dermatology rotation at CU Anschutz.
The study used data from the National High School Sports-Related Injury Surveillance System, High School RIO (Reporting Information Online), directed by Dawn Comstock, PhD, associate professor of epidemiology at the Program for Injury Prevention, Education and Research (PIPER) at the Colorado School of Public Health.
They looked at 22 high school sports and found 474 skin infections reported during 20,858,781 ‘athlete exposures’ (AE) or one athlete participating in one practice, competition, or performance. The rate of skin infections in wrestling was 28.56 per 100,000 AE while football rates were 2.32 per 100,000. Other sports had rates of skin infections less than 1.00 per 100,000 AE with eight reporting none at all.
Some 60.6 percent of skin infections were bacterial followed by tinea (ringworm) at 28.4 percent. The study showed herpetic lesions like cold sores and fever blisters represented 5.2 percent of infections while 3.2 percent were miscellaneous infections.
“A number of best practices are available to prevent sports-related skin infections,” said study co-first author Kyle Burton, a fourth-year medical student at the University of Central Florida, who also did the research during a dermatology research rotation at CU Anschutz. “For example, the Centers for Disease Control and Prevention currently recommends that athletes take showers directly after each competition.”
Burton said if showering directly after each competition and practice is not possible, studies have shown that skin infections also drop dramatically when athletes use soap and water skin wipes. A recommendation from the National Federation of State High School Athletic Associations calls for referees to perform skin checks before each wrestling match in an attempt to prevent athletes from spreading infections.
Dr. Dellavalle noted that most schools wipe down wrestling mats before and after competitions but given that most infections occur on the head and face, they should be more vigilant about headgear.
“Wrestlers are not rubbing their heads and faces on the mats,” he said. “The problem may be not keeping headgear properly cleaned before each match.”
The study co-authors include Dawn Comstock, PhD and Dustin Currie, MPH, both of the Colorado School of Public Health at CU Anschutz. Teresa R. Johnson, MS, PhD, of the University of Central Florida College of Medicine in Orlando is also co-author.
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