MRSA bacteria has blossomed, although not in a good way, over the past 15 years to be the single most prevalent cause of skin-related abscesses (boils). Primarily affecting youth and young adults, it is often thought to be a ‘spider bite’ that progresses to a simple boil. Treatment with incision and drainage (lancing) is usually adequate, but occasionally antibiotics are necessary. The problem lies in a reoccurrence of the infection. Once an individual has an outbreak, there is a 50% chance of reoccurrence over the next year. Simple hygienic principles like washing with soap and water or using cleansing agents can reduce this risk of repeated MRSA infection.

Ringworm, the other common skin infection, is caused by a dermatophyte, T. tonsurans, and can affect up to 70% of high school wrestlers each season. This fungal infection spreads by direct contact with the skin of an infected individual or contaminated surface. Ringworm is extremely contagious and can spread easily and rapidly throughout a wrestling team. The fungal infection is superficial but can be a nuisance for athletes like wrestlers who must pass skin inspections on a near-daily basis to practice and compete. Treatment with topical antifungal creams is generally effective, but occasionally oral medications are required. The treatment may take up to 6 weeks to fully eradicate the fungus. Ringworm is a huge issue for wrestlers it often takes daily skin checks, along with meticulous skin hygiene to reduce and control this skin condition.

Antibacterial soaps, washes, and wipes contain a wide array of substances purported to reduce bacterial/fungal counts and reduce skin infections in the athletic setting. Triclosan and triclocarban are two agents that have been used extensively in consumer antibacterial products like soaps, toothpaste, mouthwash, and deodorants. Other less known ingredients have also been used, such as tea tree oil, isopropyl alcohol, and triethanolamine. While these agents have been in use for decades and have been heavily promoted as beneficial, most of the literature on their effectiveness is based on anecdote and not scientific evidence. Although some are useful as antimicrobials in the hospital setting, the efficacy in out-of-hospital settings is not proven. Although laboratory data showing reduced bacterial/fungal growth on a petri dish is reproducible, the extrapolation to reducing microbial growth on the athletes’ skin is implied, but not proven.

In September 2016, the FDA released a new ruling on the Safety and Effectiveness of Consumer Antiseptic topical products – soaps, washes, and wipes. isopropyl alcohol hand sanitizers were excluded since their use for hand sanitation has been proven, but the body wipes which are unproven were included in the ruling. The FDA could find little data showing the effectiveness of any of these products compared to the use of soap and water in reducing the risk of skin infections and have required that manufacturers of these products withdraw any statements of product effectiveness until efficacy studies have been performed to confirm effectiveness. The products must be more effective than simple soap and water in reducing skin infections in users for manufacturers to make claims about anti-microbial effectiveness. With the vast number of these products available to the public and annual public expenditure into the millions of dollars, showing product efficacy with scientific studies seems a reasonable requirement as most of these products are extremely expensive compared to soap and water.

In 2010, a study comparing an isopropyl alcohol body wipe to a soap and water wipe in wrestlers throughout one high school season was performed in Minnesota. The results showed the soap and water wipes were slightly better and statistically just as efficacious. With the cost of the isopropyl alcohol wipes at 10-15 times that of the soap and water wipe, it makes financial sense to use the soap and water wipe.

Another issue is the environmental and personal safety impact of repeatedly using these chemicals on the body and disposing of the waste. Recent studies focusing on the use of triclosan and triclocarban have found cumulative absorption into the body, and these chemicals may have effects on hormone regulation and receptors. Also, recent studies have found these chemicals do not break down and accumulate in our waterways and sewage, which contributes to bacterial resistance and potential problems for antibiotic development. In response to these research findings, the State of Minnesota banned these agents from consumer hygienic products in 2014. The annual expenditure on our athletes to reduce skin infection with unproven products is huge. Until the manufacturers can show effectiveness in these antibacterial soaps, washes, and wipes it appears we should be using plain soap and water immediately after practice to keep our athlete’s infection-free.