Cleared for Competition: A Dermatology Provider’s Game Plan for Tackling Fall Sports Dermatoses

Are you ready for some…Fall Sports Dermatoses??

Fall sports season is here, and for dermatology providers caring for student-athletes, that
means it is time to gear up for a familiar opponent: sports-related dermatoses. From bullous
impetigo to Herpes Gladiatorum, skin infections can quickly bench athletes and spread across
teams if not properly recognized and managed. With years of hands-on experience in the
athletic community—from assisting with pre-season sports physicals to managing wrestlers' skin
outbreaks—I have seen firsthand how vital it is for dermatology PAs and NPs to be prepared.
Beyond diagnosis and treatment, it is just as important to understand the return-to-play rules
set by athletic associations like the NCAA, NAIA, or your state’s high school sports authority.

This post will help you stay ahead of the game and keep your athlete-patients safe, treated, and
back in action.

Let’s review some common communicable skin conditions that would prevent an athlete from
competing. 

Bacterial Skin Infections in Athletes: Impetigo, Abscess/Cellulitis,  Folliculitis, Hot Tub/Spa Folliculitis

To return to competition, athletes must have completed 72 hours of antibiotic therapy
and must be without any new skin lesions for 48 hours before the meet or tournament.  The athlete must have no moist, exudative, or draining lesions.

Fungal Skin Infections in Athletes: Tinea Corporis, Tinea Capitis

Fungal skin infections are incredibly common in athletes who participate in skin-to-skin contact,
especially wrestlers! For Tinea Corporis, the athlete must be on an oral or topical antifungal
treatment for 72 hours prior to returning to practice or games. If the fungal infection includes
hair-bearing areas like the scalp (Tinea Capitis), the athlete must be on 14 days of systemic
antifungal therapy prior to returning to play.

Viral Skin Infections in Athletes: 
HSV/Herpes Gladiatorum- Skin lesions must be surmounted by a firm, adherent crust at
competition time, and have no evidence of secondary bacterial infection. The athlete must have
developed no new blisters for 72 hours before the examination, and be free of systemic
symptoms of viral infections (such as fever, malaise, etc). The athlete must also have been on an 
appropriate dosage of systemic antiviral therapy for at least 120 hours before the time of
competition. Active herpetic infections shall not be covered to allow participation.
Molluscum Contagiosum- all lesions must be curetted or removed via cantharidin before the
meet or tournament and “adequately covered”

Verrucae- Warts in skin-to-skin contact areas must not be bleeding or seeping, and be
adequately treated or “adequately covered” 

Infestations in Athletes:  Pediculosis, Scabies

The athlete must be treated with appropriate pediculicide and re-examined for
completeness of response before returning to practice or tournaments. 
The athlete must be adequately treated and have a negative scabies prep at the meet or
tournament time. “Adequately covered” is defined as ‘the lesion is covered by a gas impermeable dressing, pre-
wrap, and stretch tape that is appropriately anchored and cannot be dislodged throughout the
sport activity.'

It may be necessary for a dermatology provider to come to an athlete’s defense when skin
lesions are NOT communicable. We do not want our student athlete patients to be excluded
from skin-to-skin contact sports because of psoriasis, eczema, pityriasis rosea, vitiligo, lichen
planus, or other non-communicable skin conditions. So be your patient’s champion and
advocate for them by filling out the appropriate forms so they are allowed to participate and are
not excluded from their athletic endeavors. 

I want to encourage all dermatology providers to reach out to local high schools, college
programs, semiprofessional, or professional sports organizations in your area. You can contact a
school’s Athletic Director or Certified Athletic Trainer, and let them know you would like to help
their athletes.  ALL Dermatology providers can make a difference, because ALL athletes need
our help.