Sports and Skin: The NATA position statement summed up and recent updates
In an attempt to bring condensed, informative information to all individuals involved in athletics, sports medicine, or that participate or observe sport, it is my hope to discuss how to prevent and respond to dermatological injuries and illnesses that arise in sport.
In today’s post, I will:
Break down the NATA Position Statement on Skin Diseases into recommendations for prevention, education, and management.
Talk about specific, common skin infections seen in sport
Add some key elements from new research on skin disease
Let’s get to it…
Skin Disease Prevention
The NATA Position Statement on skin disease recommends 7 items of prevention, each graded in various levels of scientific evidence. The 7 points are as follows:
Limiting the spread of infectious agents starts with support from an organizational level. Institutional administrations must allocate resources (staff, funds, etc.) to prioritizing infectious control and employees must be held accountable for maintaining the standards of infectious control. This can be written out in a company’s policies and procedures for infectious control.
All athletic participatory spaces must be properly cleaned. Frequently touched surfaces are the priority for controlling infectious agents, including the sports medicine facility treatment tables, the athletic locker room benches and floors, or specific equipment of concern like wrestling mats. The type of disinfectant should be EPA registered and used in the amount, ratio of dilution, and contact time that is recommended by the disinfectant manufacturer.
Good hygiene practices are key for athletes and health care providers. Correct hand-washing technique must be followed at all times, especially if hands are visibly dirty. This involves an antimicrobial cleanser and disposable towel.
Encourage athletes to maintain good hygiene. This includes showering after every practice or game with antimicrobial soap and water, and laundering all clothing, gear, uniforms on a daily basis. Don’t forget about braces, knee sleeves, or headgear which should also be washed daily.
Discourage athletes from sharing personal items. This includes towels, razors, hair care supplies, athletic gear or braces, water bottles, etc.
No athlete with an open wound or lesion on the skin is permitted in whirlpools, common tubs, or saunas.
All skin lesions, cuts, blisters, and abrasions should be reported to a medical provider to be treated. All non-infectious skin concerns should be covered to promote healing and prevent contamination.
Educating Others
All parties involved in athletics must be aware of the risk of skin infection and informed of the infectious disease control procedures. This includes administrators, custodial or facilities staff, coaches, athletics staff, and athletes.
Let’s specifically highlight the athlete. Athletes must be empowered and informed on skin infections in order to prevent them. Often athletes learn from negative experiences instead of learning what they can do to prevent infections initially. An easy preventative measure is to conduct a daily surveillance of the skin, and report to a sports medicine professional if a skin abnormality is found. Hygienically, athletes should be informed of hand-washing, post-practice or competition showering, gear and clothing maintenance, and avoid sharing personal items.
Management
Once a skin disease is found, it is imperative to recognize an infection and know what the next steps are. Consult a medical professional when an area of the skin appears abnormal. A medical provider will be able to assess, diagnose, and provide pharmacological treatment options.
Common skin infections can be classified as fungal, viral, or bacterial. A list of specific conditions, their clinical features, and pictures provided by the NATA position statement will be included in the article's notes.
Active skin infections will result from a removal from play. Once treatment has begun, the return-to-play process will commence and should be overseen by a healthcare provider. Below are the guidelines for athlete return to play with skin disease provided in the position statement:
Fungal infections: tinea capitis, corporis, or pedis (ringworm)
Tinea corporis
Topical fungicide for a 72 hour minimum
All lesions must be covered adequately
Tinea capitis
Systemic antifungal for a minimum of 2 weeks
Viral infections: Herpes simplex, molluscum contagiosum
Herpes simplex (primary infection)
No systemic viral infection symptoms (example: fever)
No new lesion development for a 72 hour minimum
Lesions must have a firm, adherent crust. They cannot be moist or oozing.
Minimum of 120 hours (5 days) on systemic antiviral medication
Cannot participate with covered active lesions
Herpes simplex (recurrent infection)
Lesions must have a firm, adherent crust. They cannot be moist or oozing.
Minimum of 120 hours (5 days) on systemic antiviral medication
Cannot participate with covered active lesions
Molluscum contagiosum
A medical professional must remove the lesions through curretting
If lesions are localized, they must be covered appropriately to avoid contamination.
Bacterial infections: MRSA (Methicillin-resistant staphylococcus aureus), furuncles, carbuncles, folliculitis, impetigo, cellulitis
MRSA or Spider Bite?
Oftentimes MRSA infections are reported as appearing like spider bites. However, the abscess could increase in size, show signs or infection, or lead to more serious problems
Return to play for all bacterial infections
72 hour minimum on antibiotic therapy
48 hour minimum of no new lesion development
Lesions cannot be moist, exudative, or draining
Cannot participate with covered active lesions
New Research
In 2010, the NATA published the skin diseases position statement. Below are some quick hitters from two recent publications on skin diseases and sport:
A 2023 study by Pujalte et al. highlights a greater quantity of sports related skin diseases, recommendations for NCAA versus NFHS, and clinical recommendations:
Prophylactic antiviral therapy for wrestling camps was found to reduce herpes gladiatorum outbreaks by 87%
Molluscum contagiosum can resolve on its own in 1 year. Topical medications are not as successful as lesion curettage.
The roof of a blister should remain intact to minimize infection risk
To improve antibiotic absorption for impetigo treatment, frequently removing the surface layer of crust is suggested.
A 2019 study by Carr and Cropely discussed mechanically induced skin lesions, inflammatory conditions, and skin infections.
Mechanically induced disease: discusses various diseases, including friction blister, callus, corn or subungual hematoma. These occur through friction changes from various sports that have repeated motions
Inflammatory conditions: heavy sweating sports with equipment, changes in environmental conditions (wet/dry), or chemicals can induce contact dermatitis. This can occur as an allergy or from an irritant. Inflammatory conditions here are categorized by sport, and recommendations for evaluation and treatment are provided.
Skin infections: Infections often result from athlete close contact, poor hygiene, unclean environments, or untreated trauma sites. The diagnosis, presentation, treatment, and prevention strategies for various skin infections are documented in this section.
In closing, the most important piece of skin infection prevention is personal hygiene and proper infectious control in athletic spaces. Although sports cause increased trauma to the skin, it is important to understand that most skin infections are preventable with education and proper planning. If you or your athlete notices any abnormal skin lesions, it is important to get in touch with a dermatologist or sports medicine doctor.
Sources
1. Zinder SM, Basler RSW, Foley J, Scarlata C, Vasily DB. National Athletic Trainers’ Association Position Statement: Skin Diseases. Journal of Athletic Training. 2010;45(4):411-428. doi:https://doi.org/10.4085/1062-6050-45.4.411
2. Pujalte GGA, Costa LMC, Clapp AD, Presutti RJ, Sluzevich JC. More Than Skin Deep: Dermatologic Conditions in Athletes. Sports Health: A Multidisciplinary Approach. 2022;15(1):74-85. doi:https://doi.org/10.1177/19417381211065026
3. Carr P, Cropley T. Sports Dermatology | 10.1016/j.csm.2019.06.001_Science Hub. Tesble.com. Published 2019. Accessed September 29, 2024. https://www.tesble.com/10.1016/j.csm.2019.06.001
Clinical Features of Common Skin Diseases
NATA Position Statement: Skin Disease
Common Skin Disease Images
NATA Position Statement: Skin Disease
Medical Disclaimer:
The content provided on this blog and podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional before making any changes to your health regimen or if you have any questions regarding a medical condition. The information shared here is not a substitute for professional medical guidance, diagnosis, or treatment.
