Prevent Skin Infections and Create a New Business Niche by Reaching Out to Young Athletes
In August 2015, parents in Long Island, NY, filed a lawsuit against their local school district. They claimed that failure to sanitize wrestling equipment caused their 15-year-old son to contract MRSA, which resulted in emergency surgery and a six-day stay in the hospital. High school athletes are especially susceptible to skin infections, partly because they don’t notice or fail to report skin concerns. But they don’t carry all the blame. Poor communication between physicians, parents and coaches also contributes to the problem. Compounding pharmacists can help prevent skin infections and tap into a new group of patients by reaching out to young athletes.
Lack of Standard Reporting Hinders Awareness and Prevention
It’s no secret that athletic activities are fertile ground for fungal, bacterial and viral skin infections, but no one knows the extent of the problem due to lack of standardized reporting requirements. California has one of the most progressive policies, yet only severe cases of MRSA are tracked. Since severe cases are defined as those resulting in admission to an intensive care unit or death, the statistics don’t paint a complete picture. Studies based on regional surveys estimate that skin infections account for 8.5 percent of all injuries in high school sports. Statistics from Minnesota high school wrestling tournaments place the incidence of skin infections at 2.5 to 3.7 out of every 100 individual competitors.1
One of the biggest challenges is lack of communication, which allows infections to spread. In 2014, a survey was sent to wrestlers who had participated in a regional wrestling competition. Health officials found 37 confirmed cases of skin infection–primarily impetigo and herpes gladiatorum–plus two cases each of tinea corporis and MRSA. One wrestler diagnosed with herpes gladiatorum four days before the tournament, didn’t tell the coach and competed with uncovered arms. Another athlete diagnosed with impetigo also participated without covering his lesions. The herpes gladiatorum subsequently spread to 10 other wrestlers. Eight athletes contracted impetigo following the tournament.2
Official Skin Infection Guidelines for Coaches
The National Federation of State High School Associations (NFHS) establishes treatment and return-to-play guidelines for coaches, but they’re intended to guide coaching decisions—they don’t supersede medical treatment from a physician. Considering the practice and competition time athletes stand to miss, it’s easy to see how they might hesitate to tell the coach about a skin outbreak. Key information from the NFHS standards includes:
Herpes gladiatorum: Athletes with herpes gladiatorum can’t participate until all lesions are crusted and new lesions haven’t appeared for 48 hours. Primary outbreaks must be treated for 10 days with oral antiviral medications. Acyclovir 400 milligrams, three times daily and valacyclovir 1,000 milligrams, twice daily are recommended. Those with a history of herpes gladiatorum should receive prophylactic treatment throughout the season. Teammates who come in contact with the primary carrier are also excluded from participating for eight days.
Bacterial infections: The NFHS requires all bacterial infections to be evaluated for MRSA. When MRSA is diagnosed, lesions are drained and cultures obtained. Oral antibiotic choices include trimethoprim-sulfamethoxazole, clindamycin phosphate, tetracycline hydrochloride or doxycycline plus rifampin, depending on resistance patterns. Impetigo and cellulitis are treated with retapamulin ointment or oral beta-lactam antibiotics. Athletes can return to play when no new lesions have appeared for 48 hours.
Fungal infections: Tinea infections are the most common fungal infections in athletes. Athletes with tinea capitis must take oral antifungal medications—fluconazole 100 to 200 milligrams and itraconazole 200 to 400 milligrams—and use a ketoconazole or selenium sulfide shampoo for at least 14 days before they can resume activities. Ringworm is treated with topical or oral antifungal medications for one week. Athletes with ringworms may be able to return-to-play after 72 hours of treatment but they must wear an occlusive dressing.
Intervention from Compounding Pharmacists Makes the Difference
The NFHS issues guidelines with advice to disinfect mats, sanitize gear and teach students about personal hygiene. But maybe that’s not enough considering the responsibility falls solely to high school coaches with little to no staff and tight budgets. Compounding pharmacists can use their expertise to help coordinate medical care and foster communication.
- Reach out to coaches and offer to serve as an expert resource. Coaches may feel overwhelmed with trying to keep up with medical recommendations for diverse infections or they may feel uncomfortable telling young athletes with a history of herpes gladiatorum that they should consider prophylactic dosing of antiviral medication. 3
- Visit the school and talk to athletes about the dangers of spreading skin infections. They need to grasp their responsibility to avoid spreading an infection. Reinforce the concept with this statistic—they have a 33 percent chance of contracting a skin infection every time they come in contact with a competitor who is infected. Make sure they know that MRSA isn’t just a hospital infection and that it’s easy to mistake the lesion for a bug or spider bite. Tell them to feel free come to the pharmacy any time they have questions.
- Target patients buying medications for skin infections—talk with them and find out if there’s a teen athlete in the household. Track prescriptions being filled for topical and oral antifungal medications such as fluconazole and itraconazole, and antiviral medications for herpes gladiatorum.
- Make an appointment for medication management. Verify they’re adhering to the treatment regimen and make sure they understand how to properly cover their infection if appropriate. Use this opportunity to talk about the benefits of compounding treatments and fill their prescriptions quickly using custom compounding kits.
- Consider hosting a community back-to-school event where you provide screening and information about skin infections, as well as other adolescent health concerns. Highlight compounded options and products available at your pharmacy.
Collaborate with the Community to Prevent Infections
Skin infections in athletes must be treated within the return-to-play guidelines of the sport’s governing body, while minimizing spread of the disease and also limiting the amount of time athletes can’t participate in their sport. Yet chances are that no one at the local high school is actually coordinating medical treatment and communication between physicians, parents, athletes and coaches in order to achieve the goals. When compounding pharmacists become part of the team, they add that missing element and prevent community-acquired infections.
Pharmaceutica North America provides expertise along with quality pharmaceuticals that meet the needs of the athletes in your community. Contact us today to talk about how our custom compounding kits and bulk APIs can support your pharmacy.
- “Common Dermatologic Infections in Athletes and Return-to-Play Guidelines,” June 2011, http://jaoa.org/article.aspx?articleid=2094209 ↩
- “Notes from the Field: Outbreak of Skin Lesions Among High School Wrestlers – Arizona, 2014,” May 2015, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6420a6.htm ↩
- “Prevention Key to Reducing Skin Infections in High School Wrestling,” December 2015, https://www.nfhs.org/articles/prevention-key-to-reducing-skin-infections-in-high-school-wrestling/ ↩