Why is this 16-year-old repeatedly breaking out?

A 16-year-old male has broken out like this 4 times over the last year.

What is causing this condition?

A. Staphylococcal impetigo.

B. Herpes simplex.

C. Acne.

D. Contact dermatitis.

E. Factitial.

(Answer and discussion on next page)

Answer—Herpes gladiatorum 

Herpes gladiatorum is a clinical diagnosis first coined around 50 years ago. The condition is typically associated with contact sports—wrestling being one of the most common. The head and neck area has the greatest predilection due to exposure. While mucosal surfaces more readily inoculated, any skin site can acquire the herpes virus under appropriate circumstances. It is not uncommon to see multiple lesions in the same individual, which is why the clinical picture of herpes gladiatorum can be confused with impetigo. 

Impetigo is not unreasonable, however it would not return to the same area repeatedly. The same is true with the other differential diagnoses. 

The patient was treated with valcyclovir 500 mg daily.

References:

1.Anderson BJ. Prophylactic valacyclovir to prevent outbreaks of primary herpes gladiatorum at a 28-day wrestling camp. Jpn J Infect Dis. 2006;59:6-9.

2.Anderson BJ. The effectiveness of valacyclovir in preventing reactivation of herpes gladiatorum in wrestlers. Clin J Sport Med. 1999;9:86-90.