Abstract
Tinea corporis, or ringworm, has become a common nuisance in competitive wrestling. Although it is a fairly benign infectious skin disease, it has significant effects on the ability of a wrestler to compete because of infection control issues. Very little has been published in the medical literature describing this problem. The majority of the literature has described outbreaks in an isolated group of wrestlers. One must examine ringworm infections in wrestlers as an entity distinct from tinea corporis infections typically seen in the paediatric population, thus the term ‘tinea gladiatorum’.
Tinea gladiatorum outbreaks have been caused by the dermatophyte, Trichophyton tonsurans. The epidemiology and microbiology point to person-to-person contact as the main source of transmission in wrestlers. The clinical features of tinea gladiatorum may or may not be consistent with those found in the general population. Ancillary tests, including potassium hydroxide preparations and fungal cultures may have to be done to confirm the diagnosis. Treatment guidelines for tinea corporis have failed to produce the desired goals in this particular population. More research studying different treatment regimens in the wrestling environment is needed to define the optimal treatment to return wrestlers to competition quickly without putting other wrestlers at risk for infection.
Intuitive hygiene practices have been suggested to prevent spread of the infection, but they have not been substantiated. Anecdotal reports suggest that hygiene practices fall short of producing adequate primary or secondary prevention. Pharmaceutical prophylaxis has been effective, but universal drug prophylaxis carries risks including drug adverse effects and potential drug resistance. The role of potential asymptomatic carriers of dermatophytes has yet to be elucidated in the origin and/or perpetuation of tinea gladiatorum outbreaks.
There are many unanswered questions about tinea gladiatorum. Sports medicine professionals must work to define this entity more completely before making recommendations about treatment, prevention and infection control. The ultimate goal is the eradication of tinea infections from the wrestling world. Energy should be focused on primary and secondary prevention, as well as treatment. Without a thorough knowledge of tinea gladiatorum as a distinct disease entity, wrestling has been losing its battle with this formidable opponent.
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References
Cohen BA, Schmidt C. Tinea gladiatorum [letter]. N Engl J Med 1992; 327: 820
Beller M, Gessner BD. An outbreak of tinea corporis gladiatorum on a high school wrestling team. J Am Acad Dermatol 1994; 31 (2 Pt 1): 197–201
Stiller MJ, Klein WP, Dorman RI, et al. Tinea corporis gladiatorum: an epidemic of Trichophyton tonsurans in student wrestlers. J Am Acad Dermatol 1992; 27 (4): 632–3
Werninghaus K. Tinea corporis in wrestlers [letter]. J Am Acad Dermatol 1993; 28: 1022–3
Kohl TD, Martin D, Berger MS. Comparison of topical and oral treatment for tinea gladiatorum. Clin J Sport Med 1999; 9 (3): 161–6
Hradil E, Hersle K, Nordin P, et al. An epidemic of tinea corporis caused by Trichophyton tonsurans among wrestlers in Sweden. Acta Derm Venereol 1995; 75: 305–6
Hazen PG, Weil ML. Itraconazole in the prevention and management of dermatophytosis in competitive wrestlers. J Am Acad Dermatol 1997; 36 (3 Pt 1): 481–2
Dienst WL, Dightman L, Dworkin MS, et al. Pinning down skin infections. Physician Sports Med 1997; 25 (12): 45–56
Odom R. Pathophysiology of dermatophyte infections. J Am Acad Dermatol 1993; 28 (5): S2–7
Frisk A, Heilborn H, Melon B. An epidemic of tinea corporis caused by Trichophyton tonsurans among wrestlers in Sweden. Acta Derm Venereol 1966; 46: 453–6
Kern ME, Blevins KS. Medical mycology: a self-instructional text. Philadelphia (PA): F.A. Davis Company, 1997
Kemna ME, Elewski BE. A U.S. survey of superficial fungal diseases. J Am Acad Dermatol 1996; 35 (4): 539–42
Hay RJ. Dermatophytosis and other superficial mycoses. In: Mandell GL, Douglas RG, Bennet JE, editors. Principles and practice of infectious diseases. 3rd ed. New York (NY): Churchill Livingstone, 1990: 2017–27
Knudsen EA. Experimental dermatophyte infection: the extent of fungal invasion. Acta Derm Venereol 1989; 69: 247–9
Hebert AA, Head ES, MacDonald EM. Tinea capitis caused by Trichophyton tonsurans. Pediatr Dermatol 1985; 2: 219–23
Cohn MS. Superficial fungal infections: topical and oral treatment of common types. Postgrad Med 1992; 91 (2): 239–44
Bergus GR, Johnson JS. Superficial tinea infections. Am Fam Physician 1993; 48 (2): 259–68
Haldane DJ, Robart E. A comparison of calcofluor white, potassium hydroxide, and culture in the laboratory diagnosis of superficial fungal infections. Diagn Microbiol Infect Dis 1990; 13: 337–9
Drake LA, et al. Guidelines of care for superficial mycotic infections of the skin: tinea corporis, tinea faciei, tinea manuum, and tinea pedis. J Am Acad Dermatol 1996; 34: 282–6
Fromtling RA. Overview of medically important antifungal azole derivatives. Clin Microbiol Rev 1988; 1: 187–217
Smith EB. Topical antifungal drugs in the treatment of tinea pedis,tinea cruris, and tinea corporis. J Am Acad Dermatol 1993; 28: S24–8
Gupta AK, Sander DN, Shear NH. Antifungal agents: an overview. Part II. J Am Acad Dermatol 1994; 30: 911–33
Friedlander SF. The evolving role of itraconazole, fluconazole, and terbenifine in the treatment of tinea capitis. Pediatr Infect Dis J 1999; 18 (2): 205–10
Cauwenbergh G, Degreef H, Heykants J, et al. Pharmacokinetic profile of orally administered itraconazole in human skin. J Am Acad Dermatol 1988; 18: 263–8
Willemsen M, DeDonecker P, Willems J, et al. Posttreatment itraconazole levels in the nail. J Am Acad Dermatol 1992; 26: 731–5
Faergemann J, Laufen H. Levels of fluconazole in serum, stratum corneum, epidermis-dermis (without stratum corneum) and eccrine sweat. Clin Exp Dermatol 1993; 18 (2): 102–6
Haneke E. Fluconazole levels in human epidermis and blister fluid. Br J Dermatol 1990: 123: 273–7
Faergemann J, Zehender H, Jones T, et al. Terbenifine levels in serum,stratum corneum, dermis-epidermis (without stratum corneum) and eccrine sweat. Acta Derm Venereol 1991; 71 (4): 322–6
Bourland A, Lachapelle JM, Aussems J, et al. Double-blind comparison of itraconazole and griseofulvin in the treatment of tinea corporis and tinea cruris. Int J Dermatol 1989; 28: 410–2
Hernanz ADP, Gomez SL, Lastra FG, et al. A comparative double-blind study of terbenifine and griseofulvin in tinea corporis and tinea cruris. Clin Exp Dermatol 1990; 15: 210–6
Roberts WO. Specific problems and pearls in wrestling. American College of Sports Medicine Team Physician II Course; 1999 Feb 24–28; San Antonio, 14
Goodman RA, Thacker SB, Solomon SL, et al. Infectious disease in competitive sports. JAMA 1994; 271 (11): 862–7
Sevier TL. Infectious diseases in athletes. Med Clin North Am 1993; 78 (2): 389–412
Scheinberg RS. Stopping skin assailants: fungi, yeasts, and viruses. Physician Sports Med 1994; 22: 33–9
Disclaimer: The material presented in this review article is the work of the authors based upon their study and review of the literature. It in no way represents the views or ideas of the United States Air Force or the Department of Defense.
Dr Kohl would like to thank colleagues David Martin, MD and Richard Nemeth, MD who have helped him to uncover information about tinea gladiatorum. Special gratitude is extended to Dan Giesen, ATC, John Moyer, ATC, Todd Bartley MS, ATC, Glenn Thompson, MEd, ATC, Terry Ventresca, ATC, Jennifer Ganter, MEd, ATC, Jennifer Motze, ATC and Matthew Blimline, ATC for their assistance in developing and implementing research in this area. A final thank you to D. Michael Baxter, MD and Marc S. Berger, MD for their support of the research and study needed to produce this paper.
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Kohl, T.D., Lisney, M. Tinea Gladiatorum. Sports Med 29, 439–447 (2000). https://doi.org/10.2165/00007256-200029060-00006
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DOI: https://doi.org/10.2165/00007256-200029060-00006