Tinea gladiatorum: wrestling's emerging foe

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.