July 23, 2005
Dr. Jane Fore
Idaho State Athletic Trainers Conference
A Brief Overview of
Skin injuries and conditions are
the most common athletic injury
Dermatology and Athletes
• The most common injuries afflicting
the athlete affects the skin.
• These include infections,
inflammatory conditions, traumatic,
environmental encounters and
• Teaching good principles of skin and
wound care to the athlete is a great
• Fungal- Tinea corporis, Tinea Pedis
• Viral- Herpes simplex, Warts
• Bacterial- impetigo, furunculosis,
pitted keratolysis, hot tub folliculitus
• Atypical mycobacterial- swimming
• Parasitic- cutaneous larva migrans
Caused by Corynebacterium or Micrococcus
Other common conditions
• Allergic and contact dermatitis
• Urticaria- hives
• Nail dystrophies, calluses and blisters,
• Warts, jogger’s nipples, intraepidermal
bleeding leading to Talon Noire and
• Nodules on the skin due to recurrent
• Something in chronically ill,
hospitalized, institutionalized people.
• Rarely diagnosed- first recognized in
1961, with initial outbreaks in the
• Rarely seen in outpatient clinics and
usual staph and strep skin and soft
tissue (SSTI) infections were covered
by the usual, commonly prescribed
• A Staphylococcus aureus variant with
unique virulence features.
• Can be the cause of aggressive SSTI in
• Requires a culture of the wound to be
• Responds to a limited number of
• Something that anyone in this room can
have and will be encountered by you.
• Accounts for 40-70% of the ICU Staph
Types of MRSA
• Hospital-acquired infection (nosocomial)-
likely to be a form that is more resistant to
• Community-acquired MRSA (CA-MRSA) –
no health care association.
• CA- MRSA with health care association.
• There are several strains and the source
makes certain strains more or less likely
and influences their virulence and their
response to antibiotics.
• The MRSA produces an altered Penicillin Binding
Protein 2a that renders antibiotic resistance to
• The most common CA-MRSA is type IV with the
Panton-Valentine leudocidin, or the Leukocyte-
killing/ perforating toxin.
• Able to colonize for long periods of time without
clinical infection. Colonizes skin and nasal
passages but also urine, stool and lungs.
• Majority of cases are non-healthcare associated
• Colonization is a significant risk factor for future
infection with MRSA.
• 1-2% of people in the community will have
colonization of the skin or nose.
• In LA county emergency depts, the incidence of
MRSA in SSTI rose from 29% (2001) to 64%
• In one survey, 40% of children with SSTI had
Staph aureus and 45% of the Staph was MRSA.
• About 30% of the hospital MRSA is community
• A pediatric survey of healthy children found 0.8%
colonization (2001) verses 9.2% (2004) on nasal
Presentations of Disease
• Skin boils, cellulitus and abscesses, furuncles
located on the trunk, buttock and axilla are most
common. “spider bite”
• Due to the P-V leucocidin necrotic or very inflamed
aggressive infections may result.
• The CA-MRSA is usually not associated with
invasive disease, but reports of MRSA and rapidly
progressive necrotizing lung infections are a new
entity emerging as a new MRSA infection process.
• Other possibilities include impetigo, osteomyelitis,
scalded skin syndrome, toxic shock, septic shock
• Significant pain with a robust inflammatory
reaction associated with fever and chills is a
Risk Factors for CA-MRSA
• Many with disease have no risk factors
• Antibiotics within the last three months
• A hospital stay within 12 months
• HIV or Drug abuser
• Colonization history with MRSA
• Exposure to someone associated with the
health-related industry or around someone
who has been in the hospital or has had
Risk Factors and Athletics
• Direct skin contact, especially on
injured skin i.e., wrestling, tackling
• Shared equipment such as towels,
soap, balms, lotions, towels, clothing,
• Prolonged coverage of wounds,
maceration of skin, cosmetic shaving,
turf burns all injure the skin increasing
• Shared dorm rooms and bathrooms
• Avoid contact with infected individuals
• Infected people to cover wounds
• Good hygiene
• Do not share clothing (Including towel)
• Scheduled cleaning of equipment
• Players to report skin problems and coaches inspect players
• Risk of cosmetic shaving
• Prevention of turf burns
• Whirlpool disinfection
• Prevention and treatment of skin injuries in an
• Clearing MRSA infections in players once diagnosed
• Teaching players about the principles of skin and wound
• Awareness of skin infection symptoms
• Culturing the drainage
• Following symptoms once treatment is
initiated is important
• Unresolving/ worsening despite treatment
is a red flag
• Learn to evaluate skin rashes common to
athletics to recognize early the need for
• Antibiotics, tailored towards treatment of MRSA, is
necessary when suspected. Commonly used
medications for CA-MRSA include Bactrim DS,
Minocycline, Zyvox, Rifampin, Cleocin, but running
a sensitivity is necessary. Intravenous therapy
may include daptomycin, synercid and
• Nasal mupiricone may be prescribed to eradicate
nasal colonization since antibiotics do not
penetrate the area well.
• Topical cleaning with chlorhexidine,
hexachlorphene, or povodine-iodine soap, even
after clinical clearance of the infection
• Incising and drainage of any abcess.
• Use of antimicrobial wound sprays, alcohol-based
antimicrobial soaps and gels for prevention is also
Risk Factors for Colonization with Methicillin-Resistant
Staphylococcus aureus in Patients Admitted to an Urban Hospital:
Emergence of Community-Associated MRSA Nasal Carriage,
Hidron Alicia et al, Clin Inf Dis 2005;41:159-66.
Cutaneous Community-acquired Methicillin=resistant
Staphylococcus aureus Infection in Participants of Athletic
Activities, Cohen PR, Southern Med J 2005;98:6.
A High-morbidity Outbreak of Methicillin-resistant Staphylococcus
aureus among players on a college football team, facilitated by
cosmetic body shaving and turf burns. Clin Infect Dis.2004;39:10,
Community-acquired Meticillin-resistant Staphylococcus aureus: an
emerging threat. Zetola N, et al, Lancet Infect Dis 2005;5:275-86.
Methicillin-resistant Staphylococcus aureus: clinical manifestations
and antimicrobial therapy. Cunha BA, Clin Microbiol Infect
Dermatologic Disorders of the athlete, Adams BB, Sports Med
Thank you for your attention
The real voyage of
not in seeking new
landscapes but in
having new eyes.
Tri-State Wound Care and
Cell phone 1-208-305-0000