A Puzzling Facial Rash on a 17-Year-Old Boy

Faisal M. Mawri, MD; Nida Yousef, MD; Ammar Alhmood, MD; Walid Abuhammour, MD, FAAP, FIDSA


July 09, 2018


Herpes gladiatorum is an infection caused by the Herpes simplex virus (HSV) type 1. Herpes gladiatorum most commonly occurs among wrestlers and other athletes who participate in close skin contact sports such as wrestling (herpes gladiatorum) and rugby (herpes rugbiaforum). Herpes gladiatorum is also known as “mat herpes” among wrestlers. Herpes gladiatorum is spread by direct skin-to-skin contact. The lesions appear within 7 to 14 days after exposure on an infected person; however, in some cases the lesions take longer to appear.

The patient in this case presented with a primary herpes gladiatorum (PHG) infection, which is usually more severe than the recurrent infections. His lesions presented with disseminated vesicles, punched-out erosions, and central crusting on the forehead and right cheek. The patient was at an increased risk of contracting PHG because of his participation in wrestling. Herpes simplex virus DNA was detected with a polymerase chain reaction (PCR) examination.[1,2]

Outbreaks of herpes gladiatorum are common, particularly among wrestlers. Health care providers, athletic trainers, coaches, and athletes must recognize the threat of herpes gladiatorum skin infection to minimize the risk of outbreaks. Vigilant surveillance and appropriate antiviral treatment help curtail the transmission of herpes gladiatorum among wrestlers.[3] Lack of proper understanding of PHG disease can lead to misdiagnosis and frequent outbreaks.[4]


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