Skin and Soft Tissue Infections in the Athlete

Abstract

Skin and soft tissue infections (SSTIs) are a very common problems in athletes. Whether caused by bacteria, viruses, or fungi, many of these skin infections may be contagious, lead to team outbreaks, and have an impact on the athlete’s eligibility to compete. Although the skin functions as a protective barrier, frequent skin trauma along with the athlete’s contact with equipment and other players predisposes them to the development of skin infections. While most of these skin conditions are relatively easy to treat, more recently the emergence of methicillin-resistant Staphylococcus aureus (MRSA) has become a recurrent and potentially serious problem among athletes. This review focuses on the recognition, management, and return to play guidelines for the skin infections that most commonly afflict athletes. Cutaneous Bacterial Infections Methicillin-Resistant Staphylococcus aureus. Historically, clinicians could be confident that a healthy patient presenting with a skin or soft tissue infection was likely infected with either methicillin-susceptible S. aureus (MSSA) or Streptococcus pyogenes (beta-hemolytic Group A streptococcus). Unfortunately, that is no longer the case and community-associated MRSA must now be considered a potential pathogen. MRSA, once considered a health care associated organism, has evolved into an important cause of community-associated SSTIs, currently accounting for more than half of all SSTI-related S. aureus infections in the outpatient setting. 1-3 While many patients with community-associated MRSA have no risk factors, the established risk factors include poor hygiene, overcrowded living conditions, skin-skin contact between individuals, sharing contaminated personal items, and trauma, all of which play a large role in disseminating the organism. 3,4 Outbreaks have occurred in athletes engaged in contact sports, including wrestlers, football players, rugby players, and fencers. 5-7 Specifically, among competitive sports, the following risk factors have