Infectious skin diseases in athletes, with particular reference to contact and combat sports: a narrative review of epidemiology, prevention and treatment

Abstract

Introduction and purpose. The skin is the body's largest organ and its principal barrier against the external environment. In athletes—especially those in contact and combat sports—continuous mechanical, thermal and microbial stress predisposes to cutaneous infection and to team-wide transmission. This review synthesises current evidence on the epidemiology, clinical features, diagnosis, prevention and treatment of infectious skin diseases in athletes, with emphasis on wrestling, judo, boxing and mixed martial arts.

Material and methods. A narrative review of peer-reviewed reviews, epidemiological and microbiological studies, outbreak investigations and case reports addressing bacterial, viral, fungal and parasitic skin infections in athletes.

Results. Bacterial infections—chiefly Staphylococcus aureus, including community-associated methicillin-resistant strains, and Streptococcus pyogenes—together with herpes gladiatorum (herpes simplex virus type 1) and dermatophytoses (tinea gladiatorum, predominantly Trichophyton tonsurans) dominate the clinical picture. Transmission occurs mainly through direct skin-to-skin contact, with fomites playing a secondary role. Diagnosis is largely clinical but is strengthened by potassium hydroxide microscopy, culture and polymerase chain reaction. Management combines targeted antimicrobial therapy, incision and drainage of purulent lesions, isolation and, for herpes gladiatorum and tinea gladiatorum, chemoprophylaxis; return to competition is governed by defined criteria.

Conclusions. Early recognition, accurate diagnosis, prompt treatment and isolation, rigorous hygiene, environmental disinfection and evidence-based prophylaxis are the cornerstones of minimising morbidity and interrupting transmission of skin infections in athletes.