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Center for Clinical Studies, Webster, TX 77598, United StatesUniversity of Texas Health Science Center at Houston, Department of Dermatology, Houston, TX 77030, United States
Center for Clinical Studies, Webster, TX 77598, United StatesUniversity of Texas Health Science Center at Houston, Department of Dermatology, Houston, TX 77030, United States
A previously healthy 16-year-old female wrestler presented with a 2-week history of a tender and pruritic rash involving the right anterior upper arm. She had not experienced fevers, chills, or malaise. She reported no history of similar oral or genital symptoms. Physical examination revealed several grouped vesicles on an erythematous base, along with crusted erosions, involving the right antecubital fossa (Fig. 1). The rash was not found elsewhere, and there was no associated lymphadenopathy. Prior to presentation, she went to another clinic, where was clinically diagnosed with staphylococcal skin infection and was started on oral and topical antibiotics. Her symptoms failed to respond after three days of therapy. Vesicular fluid was collected and sent for further analysis. What is the Diagnosis?
Fig. 1Grouped vesicles on an erythematous base, along with crusted erosions, involving the right antecubital fossa.
Herpes gladiatorum; a herpes simplex virus type 1 (HSV-1) infection found in athletes in contact sports.
2. Discussion
Athletes involved in sports with skin-to-skin contact have increased likelihood for introduction of HSV into areas of skin abrasion and excoriation. Cutaneous infection with HSV in wrestlers is termed herpetic gladiatorum (HG) [
Typically, the clinician has little difficulty in diagnosing classic intact vesicular HSV lesions (grouped vesicles). Yet athletes with HG are frequently misdiagnosed as the vesicles are often grazed or scraped during training and can appear as various types of dermatoses. As these sheared herpetic lesions appear similar to impetigo or folliculitis, athletes are often mistakenly prescribed antibiotics [
]. Thus, when examining a rash with erosions in a contact sport athlete, we advise clinicians to have a low threshold for obtaining a viral culture to rule out HSV. Athletes with HG should be separated from other participants and started on oral valacyclovir [
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