A new report released from the American Academy of Pediatrics this month addresses the topic of preventing the spread of infectious disease in organized sports. This is a hot topic for pediatricians in Raleigh who do lots of sports physicals, including those of us here at Carolina Kids Pediatrics. 

The highlights of this report: Skin infections spread by direct contact with other athletes account for 10-15% of time lost from sports. At Carolina Kids Pediatrics, we see kids from around Raleigh for sports physicals on a regular basis who have acquired skin infections through direct contact with other athletes or contaminated sports equipment. A general rule we can review during sports physicals is never to share equipment, towels or clothing, and make sure that wrestling mats and protective sports equipment are cleaned regularly – a dilute bleach solution works quite well to kill many bacteria, viruses and fungi which cause skin infection. Some additional advice about common sports-related infections:

1. Strep and staph (including MRSA): Resistant, aggressive staph infections often cause skin infections and abscesses (which look like hard, red painful lumps) on skin. If a team member is infected, up to 10 to 23% of fellow athletes on football teams and wrestling teams can develop MRSA skin infections. If there is a team outbreak, athletes with eczema or skin scrapes are at higher risk for infection. Having kids take a bath in a tub of water with 1 cup of bleach twice weekly can help decrease the risk of infection, especially during a team outbreak. Infected athletes should not return until they have been treated for at least 24 hours, and sites of infection should be covered during sports.
    
2. Tinea (ringworm): Ringworm can appear in the scalp (often causing patches of flaky skin with hair loss), the body (often causing scaly, raised rings), or the feet (athlete’s foot - often causing peeling and redness that most commonly starts between toes. Prevent ringworm of the scalp by avoiding sharing of hats, combs and brushes among athletes, and using an antifungal dandruff shampoo (like Nizoral) once or twice a week. Prevent spreading ringworm on the body by avoiding shared towels and cleaning equipment regularly as described above. Studies have shown that use of foot powder after bathing can decrease risk of athlete’s foot by 75%.  Ringworm on the body or athlete’s foot can be treated with over the counter creams and sprays, including terbinafine (Lamisil) and clotrimazole (Lotrimin) twice daily for 3-4 weeks – but ringworm on the scalp requires oral prescription medications.
    
3. Herpes: This refers not just to genital herpes, but also to the herpes virus which causes fever blisters. This can cause painful, blistering skin infections (called herpes gladiatorum), sometimes with fevers, in contact sports. Up to 34% of wrestling team contacts can be infected during a team outbreak. Athletes with active skin blisters should be excluded from contact sports for about a week, and the blisters should be covered until healed. Herpes skin infections are treatable with acyclovir and other prescription medications – and earlier treatment, within a day or two of symptom onset, works better. Athletes with frequent outbreaks can be treated with preventative medication during the sports season.
    
4. Molluscum & warts: Kids who come in for a sports physical often have these. Both are viral skin infections, which cause single or clustered skin bumps. Bumps from molluscum are usually smooth with a dot in the middle, while warts are usually rougher and scalier. Both molluscum and warts can be spread by direct contact in sports, and covering them is the best way to prevent spread. Plantar warts (warts on the bottom of the feet) are easily spread in communal showers – in fact up to 25% of athletes who use communal showers are affected, so it might be worth coming in to treat plantar warts if your athlete uses a communal shower in sports (or wear pool shoes in the shower if they don’t want to treat their warts). We can treat both molluscum and warts in the office with treatments such as liquid nitrogen and cantharidin extract, but treatment is not always necessary for bumps which can be easily covered in sports.

Every organized sports team, whether school-based or not, requires that children be cleared by their Raleigh pediatrician through a sports physical. When your child gets their sports physical at Carolina Kids Pediatrics, please talk to us not only about injury and concussion prevention, but also the prevention of infectious disease from sports participation.
For more information on these guidelines on preventing infections in sports, check out this article before you come in for this year’s sports physical:

https://www.nytimes.com/2017/09/25/well/family/when-athletes-share-infections.html
 
Christian Nechyba, MD
Carolina Kids Pediatrics
Your Pediatrician in Raleigh, North Carolina