Contagious Skin Infection In Football Linemen - Page #4
 

Working Diagnosis:
Bullous Impetigo

Treatment:
1) Cephalexin 1 gm by mouth two times a day for 14 days
2) Mupirocin 2% topical cream three times a day
3) Chlorhexadine wash twice a day during shower

Outcome:
Bullous Impetigo was diagnosed clinically based on expert opinion and supported by successful resolution with appropriate antibiotics. Three days after initiating treatment all lesions were dry and no new lesions were observed on four of the six football players. The remaining two athletes were examined after five days with similar resolution.

Author's Comments:
Bullous Impetigo is highly contagious and can be spread by skin-to-skin contact in football linemen. Physicians caring for contact athletes should consider bullous impetigo and be aware that most lesions present after rupture of the bullous. Early lesions may appear similar to herpetic eruptions and when macerated by sports contact the lesion may develop a raised ring boarder similar to ring worm.

Impetigo is a highly contagious infection of the epidermis.

Most commonly non-bollus impetigo presents as a honey crusted lesion on the face and is caused by Streptococcus pyogenes (GABHS).

Bullous Impetigo is usually caused by methicillin-susceptible Staphylococcus aureus that produces an exfoliating toxin.

Editor's Comments:
This case scenario illustrates the difficulty that often arises in diagnosing skin lesions in athletes. Taping, macerated lesions and skin abrasions all can make the diagnosis challenging. This underscores the importance of covering lesions and holding athletes out of competition (if appropriate) when the diagnosis is unclear or the lesions are still present. Obtaining a dermatology consultation early on, if there is a suspicion of an infectious lesion, can help pinpoint the diagnosis, initiate the correct therapy and minimize the likelihood of spread to other athletes.

References:
SHI D. J Clin Microbiol. 2011 May;49(5):1972-4. Epub 2011 Mar 23.

Case Photo #1. Early vesicles
Case Photo #2. Collarette
Case Photo #3. Collarette
Case Photo #4. Late raised ring
Case Photo #5. Late raised ring

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