Author: Jason Crookham, DO
Co Author #1: Daniel Hendrickson MD
Co Author #2: Timothy M Johnson MD
Editor: Michael Henehan, DO
Football linemen with upper extremity rash.
Over a 14-day period six college football linemen presented with similar skin lesions on their extremities. The primary case presented early with a non-dermatomal vesicular rash on the anterior aspect of the upper arm. Valacyclovir was initiated for suspected Herpes Gladiatorum. Soon after that a second player presented with a puritic five-day-old lesion on the posterior elbow. Rash was 25mm in diameter with a raised circular boarder on an erythematous base but somewhat macerated from taping and excoriation. Topical Fluconazole was prescribed for suspected Tinea Corpois. Athletic Trainers followed both student-athletes closely and despite treatment more lesions were soon noted on exposed skin of the upper extremities. Most lesions were initially 5 to 25 mm in diameter, flaccid blisters with an erythematous rim. After football practice many lesions would be macerated leaving an erythematous base with a crusted ring or superficial undermined sloughing border. None of the athletes had fever or systemic symptoms. Over the course of two weeks four more players presented with similar lesions on exposed surfaces of upper extremities.
All athletes had multiple lesions on exposed skin of upper extremities at different stages of healing. Many were macerated from traumatic contact. Early lesions were noted to be discreet pustules with surrounding erythema. After one to two days they expanded to flaccid blisters and ruptured leaving an erythematous base surrounded by a scaled collarette at the periphery of the lesion. New lesions continued to appear usually grouped and on extensor surfaces of the arms.
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