Diagnosis and Management of Vesicular Circular Rash in Athletes

Diagnostic Approach

The American Academy of Pediatrics recommends considering herpes gladiatorum (HSV) or tinea pedis with vesiculopustular features in athletes with vesicular circular rash, in addition to tinea corporis (ringworm) 3, 4
Tinea corporis characteristics include circular, scaly lesions with central clearing and raised borders, and may have vesiculopustular features at the active edge 2
Herpes gladiatorum characteristics include vesicular or ulcerative lesions in clusters, often on exposed areas, and may be painful with prodromal symptoms 3, 4

The American College of Sports Medicine recommends topical terbinafine 1% cream applied twice daily for 1 week as first-line treatment for localized tinea corporis 1
For extensive tinea corporis, terbinafine 250 mg daily for 1-2 weeks is superior for T. tonsurans infections 1, 2, 5
For herpes gladiatorum, valacyclovir 500 mg once or twice daily for 7 days shortens HSV PCR clearance time by 21% when given within 24 hours of symptom onset 3, 4, 6

The National Federation of State High School Associations recommends a minimum of 72 hours of topical or systemic antifungal therapy before return to competition for tinea corporis 1
For herpes gladiatorum, athletes should be excluded from competition for 3 to 8 days, or until all lesions are fully crusted or a physician provides written statement that the condition is noninfectious 3, 4, 6

The Centers for Disease Control and Prevention recommends avoiding skin-to-skin contact with infected individuals, not sharing towels or personal items, and daily changing of clothing to prevent tinea corporis outbreaks 1, 2
For herpes gladiatorum outbreaks, pre-competition examination for vesicular or ulcerative lesions, cleaning wrestling mats with bleach solution, and considering suppressive valacyclovir therapy for athletes with history of recurrent herpes are recommended 3, 4, 6