Herpes gladiatorum

Herpes gladiatorum

• The name implies association with martial arts. In association with rugby it is called 'scrum pox'.
• Transmission is primarily by direct skin-to-skin contact and abrasions may facilitate a portal of entry. The majority of lesions occur on the head or face, followed by the trunk and extremities.
• A prodromal itching or burning sensation is followed by clustered vesicles on an erythematous base which heal with crusts over about one to two weeks. Less often, headache, malaise, sore throat and fever may be reported.
• Recurrent episodes may follow the initial infection.
• Because of its unusual location, herpes gladiatorum any be confused with impetigo, varicella, staphylococcal furunculosis, or allergic or irritant contact dermatitis.
• Accurate diagnosis requires viral immunofluorescence and cultures should be obtained by gently breaking an intact vesicle and firmly rubbing the swab tip across the base of the erosion.
• Treatment of herpes gladiatorum is with oral aciclovir or similar agents and is most effective if commenced at the first symptoms of an outbreak. Topical aciclovir is probably less effective. Any secondary infection should also be treated.
• The virus can survive for hours to days outside the host if conditions are appropriate. Hence, all contaminated surfaces should be cleaned with antiseptic solution. In the vesicular phase and until the crusts have separated, patients should avoid sports which could involve physical contact.
• Herpes simplex acquired in sport is often associated with constitutional symptoms.
• Prophylactic use of valacyclovir has been shown to be efficacious in lowering the incidence of outbreaks of herpes gladiatorum among adolescents at a 28-day wrestling camp
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