Editor's note: This is the first of a two-part series on skin infections in wrestling. The first installment discusses skin infections in the sport, what the infections look like and what measures are taken to keep the infections from spreading. The second installment will look at treatments and prevention.
Jamie Ramirez leaned against the wall outside the Central Crossing High School wrestling room shaking his head as he discussed the sport's "perfect storm."
In the past year, the Comets' coach has had a wrestler -- senior 126-pounder Josh Wimer -- disqualified from two events because of skin infections, although Ramirez said it was "just part of the sport."
"Josh was diagnosed with impetigo before (the Division I) state (tournament last season), but he wasn't on the right medicine and (the infection) came back at weigh-ins (before the opening round of state)," Ramirez said. "It came back again before the second day at (the) Medina (Invitational Tournament on Dec. 28), and he had to find the right medicine. He's OK now, but it's something we monitor even more closely than before.
"Unfortunately, you're always going to have skin infections because of the close contact in the sport. There's no way around it. You just have to take precautions to stop them."
If not kept in check, skin infections such as impetigo and ringworm can spread from wrestler to wrestler.
In 2007, the Minnesota State High School League suspended wrestling for eight days because of an outbreak of herpes gladiatorum from one tournament.
The Ohio wrestling community is working to avoid the same thing happening here. While the sport likely never will be free of its rash of skin infections, there seems to be a heightened focus on cleaning up this aspect of the sport.
"Last season was bad, starting from the first week," said Jim Vreeland, director of officiating development and rules interpreter for wrestling with the Ohio High School Athletic Association. "There was an explosion of impetigo, herpes and MRSA (methicillin-resistant Staphylococcus aureus) from a tournament in north-central Ohio, I won't mention which school. If it goes unchecked, it spreads all over the place from athlete to athlete, team to team."
Vreeland added that the "first line of defense" is the coaches.
"If it (skin infection) goes unchecked, it spreads. That's why we met with the coaches in October during their rules presentation and we had a slideshow to educate them on what we see as officials. ... We need to work together to clean this up."
Types of infections
Dr. Jess DeMaria, a Westerville dermatologist, has been working with OHSAA officials during wrestler inspections before the state tournament since the event moved from Fairborn to Ohio State in 1999.
DeMaria said skin infections either are bacterial, viral or fungal.
"Bacterial infections come from staph or strep and include impetigo and MRSA, and the fungal infections include ringworm," DeMaria said. "The viral infections are more severe such as herpes.
"I think there are skin conditions that make you more susceptible. If you have an abrasion or a mat burn, maybe a cut or scratch ... when you have an open wound, you have increased susceptibility. If someone has the infection and there is an abrasion, or even dry skin or eczema, the infection can be transmitted this way."
Another problem is locker rooms and weight rooms provide a perfect environment for skin infections because they "tend to be dark and musty, which are perfect for bacteria," Johnstown trainer Derek Eggers said. "I don't care how clean your locker room may look, it's still a breeding ground for bacteria.
"If someone skins their elbow on a Friday night and doesn't shower properly that night, when his or her elbow touches something in the locker room, that bacteria can spread. They can pass from dirty practice clothing. Everything has to be clean."
Be on the lookout
Early identification can solve many problems with skin infections.
Dr. Randy Wroble, the OHSAA's medical consultant for wrestling, said the quicker athletes detect a problem, the sooner they can return to action.
"Procrastination can be a problem," said Wroble, an orthopedic surgeon. "The athletes should inspect themselves at least once a day and have any questionable areas looked at by a physician so they can be given the proper treatment. After two or three days, many infections will no longer be contagious."
Watkins Memorial coach Mark Kurth said athletes are not always up front with coaches about possible infections.
"A lot of times, (athletes) will get it just above their hairline and they will think it's a zit, but they have to be attentive," Kurth said. "When something appears on their bodies that doesn't look normal, they have to let their coaches know.
"The biggest thing is not hiding it from the coaches because they want to keep wrestling. It spreads quickly. We had to pull out of (the Big Dawg Duals on Jan. 4 at Dresden) Tri-Valley because we only had six wrestlers (because of impetigo)."
Ramirez is extra cautious with his wrestlers.
"We check them twice a day, every day," he said. "(Skin infections) are a nasty part of the sport and you can't get that on your mats."
Dublin Scioto coach Aaron McKenzie has his wrestlers go through a weekly inspection by a physician.
"I have a group that is good at self-policing," he said. "We even have a doctor come in once a week to look at them and we still have a handful every year."
Wrestlers are inspected before every meet, from the multi-team tournaments to the weeknight duals. Vreeland said officials can spot what may be a problem.
"Officials look for a variety of signs, including lesions of a suspicious nature," he said. "They aren't physicians or dermatologists, but they can recognize a skin condition or problem.
"If (the area) is damp, moist, seeping or oozing, it's still contagious. If it has a raised outer ring, it's a fungal problem. If it looks similar to a poison-ivy blister, it can be impetigo or herpes."
Vreeland said inspection takes place before the wrestler steps on the scales to weigh in for the tournament. Upon detection of a possible skin infection, officials take the athlete to a physician in attendance. If no physician is available, the officials make a judgment call.
"Usually if no physician is around, the official will get a second opinion from another official, but they definitely err on the side of caution," he said. "If one wrestler passes it on during a tournament, whomever he wrestles can be infected and maybe 10 teams could leave the meet being exposed. Those teams carry it to other meets, infecting other teams and you have a big problem. It's just not worth it."
Wimer did not expect to be turned away on the second day of competition in the Medina Invitational Tournament.
"I was really surprised on that second day because (the officials) said the spot was OK on the first day," he said. "There were different officials inspecting on the second day and they said it was still contagious and I wasn't able to wrestle.
"It goes to show that hard work isn't enough. You have to stay on top of things."
Should an athlete be diagnosed with a skin disorder, the OHSAA provides a form to be completed by a physician that can be turned in during pre-meet inspection.
The form includes the following information: Mark(s) on a body diagram where the skin problem is located; the physician's diagnosis; the treatment administered for the infection; how long the athlete has been on treatment; when the infection is no longer contagious and the athlete can return to practice or competition.
"Officials are the last line of defense concerning skin infections and have to make tough decisions," Vreeland said. "They don't want to have wrestlers sit out, but sometimes that's best for everyone.
"Sometimes physicians will fill out the (OHSAA) skin form, stating the wrestler is able to participate by the day of the meet, but the athletes still have problem spots and they won't be able to compete. Sometimes an infection like impetigo is on the cheek, but spreads to the forehead or chin. That's not something a physician could foresee when he fills out the form. Or maybe the skin area is still oozing or seeping. We can't let that infect more wrestlers. It's always a tough call."
Despite the fears, Wroble said he can recall no more than four wrestlers disqualified in a single year at the state tournament during his 25 seasons helping with inspections. That's four out of 672 participants, considering 16 wrestlers in 14 weight classes in three school divisions.
"We average about three (disqualifications) per year, sometimes four, sometimes one, but usually about three," Wroble said. "That's quite a small percentage for the numbers involved."
Ramirez is not alone in believing skin infections are just an ugly part of a closely contested contact sport. It is a generally accepted opinion, much like getting a busted nose from a nasty cross-face.
"It's pretty common during wrestling season. It's certainly not uncommon," DeMaria said. "When you have skin-to-skin contact like that, you will have issues."
"Unfortunately, it's part of the sport," McKenzie said. "As coaches, we do the best we can with it and try to nip it in the bud. We definitely don't want to spread it to other teams."
Ramirez points to a "perfect storm" that keeps skin infections active.
"You have close contact, you have a rough sport where kids get scrapes and cuts, and you have kids cutting weight, which can lead to lower immunity levels," he said. "It's a perfect storm, and it's something you have to be ready to handle."