Fluconazole for the prevention and treatment of tinea gladiatorum

Background. Tinea gladiatorum is a common problem in competitive wrestling. It impacts on a wrestler's ability to compete. Several methods have been a dvocated to prevent these infections; however, no well-designed study of ph armacologic prophylaxis has been conducted. Methods. In a double blind placebo-controlled trial during the 1998 to 1999 regular wrestling season, wrestlers were randomized to receive 100 mg of f luconazole once weekly or placebo once weekly. Those not involved in the st udy were treated as a second control group. The effects of prophylaxis were also examined by assessing treatment of clinical infections with fluconazo le 200 mg weekly for 4 weeks. Results. There was a significantly smaller incidence of infection in those given fluconazole (6%) than in those receiving placebo (22%) and those not involved in the prophylaxis phase (18%) (P < 0.05). There was also a signif icant reduction in the total number of infections in the fluconazole group (P < 0.05). Prophylaxis with fluconazole did not impact on the severity of disease, if contracted, when compared with the placebo prophylaxis particip ants who contracted tinea corporis. Of 21 wrestlers with tinea infections a nd positive cultures, 14 were able to have their isolates identified as Tri chophyton tonsurans. Conclusions. Fluconazole is effective and safe for primary prevention of ti nea gladiatorum. We must now define when and in what population prophylaxis would be warranted.