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Treatment Guidelines

Treatment / Prophylaxis

Tinea Corporis Gladiatorum, a.k.a. Ringworm

Single skin lesion

Topical agents (creams):

Treatment
Apply agent twice a day until gone, then 1 more week.

Terbinafine 1%, Butenafine 1%, Ketoconazole 2%

Multiple skin lesions or scalp involvement

Oral agents:


Treatment

  • Terbinafine 250mg once a day for 2 weeks
  • Itraconazole 200-400 mg daily for 1 week
  • Fluconazole 200mg once weekly for 1 month

Note

Scalp lesion(s) may require several weeks of treatment.

If kerion present, will require daily treatment up to 6 weeks.

Herpes Gladiatorum

Primary outbreak

Treatment
May require 10-14 days of treatment:

  • Valacyclovira  1GM twice daily
  • Acyclovir 200mg 5 times a day

Recurrent Herpes Gladiatorum

Treatment
Requires 7 days of treatment:

    • Valacyclovira 500mg twice a day
    • Acyclovir 200mg 5 times a day

Prophylaxis to reduce Recurrent Outbreaks

If history of HG <2 yrs:

      • Valacyclovira  1GM once daily for whole season

If history of HG >2 yrs:

      • Valacyclovira 500mg once daily for whole season

afor adolescents < 12 years of age, dosing parameters may differ. Contact your Primary Care Provider for guidance

Impetigo/Folliculitis

Treatment

Treat for 7 days:
  • Clindamycin 300mg 4 times a day
  • Cephalexin 500mg 4 times a day
Treat for 5 days:
  • Azithromycin 250mg
Impetigo
CA-MRSA

Treatment

For 7-10 days:

  • Trimethoprim-Sulfamethoxazole 800mg/160mg twice a day
  • Minocycline 100mg twice a day
  • Clindamycin 300mg 4 times a day (check local resistance pattern)
  • Linezolide 400mg twice a day

For 6 days:

  • Tedizolide 200mg daily
 

Prevention

Tinea Corporis Gladiatorum, a.k.a. Ringworm

Prevention

For 7-10 days:
  • Terbinafine 250mg once a week*
  • Fluconazole 100mg daily for 3 days at start of season and repeat at 6 weeks
  • Itraconazole 200mg twice a day  for 1 day every other week
*Anecdotal preventative without clinical studies to verify efficacy

Herpes Gladiatorum

Prevention

  • Valacyclovira 1 GM a day-to be started 5 days before tournament or camp starts
  • Note: 10-year study shows that Valacyclovir 1 gm daily may prevent contraction of the virus.May be considered for all wrestlers leading into end of season tournament competitions or attending a camp. 
    Anderson BJ, et al.Prophylactic Valacyclovir to Prevent Outbreaks of Primary Herpes Gladiatorum at a 28-day Camp: A 10-Year Review. Clin J Sports Med. 2016.26:4;272-8 (Click for reprint of article). 

    afor adolescents < 12 years of age, dosing parameters may differ. Contact your Primary Care Provider for guidance

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Medical Disclaimer

The material presented here does not necessarily reflect the views of the University of Minnesota, Boynton Health Service, MN/USA Wrestling, USA Wrestling or Augsburg University. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. Decisions about following these recommendations of drug treatment or for aiding in the diagnosis of a skin condition should be at the discretion of a qualified health care professional. Readers should verify all information presented here before using it in making decisions on evaluating these skin conditions. Skin infections are a common problem that plagues the sport of wrestling. The Mat Doc, LLC and Dr. Anderson assume no responsibility due to wrongly identifying a skin condition and the consequences of these conditions even if properly identified. Information on this program should not be used to replace the relationship that exists between a patient and his/her physician.

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