Patients should also be asked about their use of fragrances, which are the most common allergens in cosmetics, soaps, shampoos, and laundry products. Patients who have cases that are difficult to treat or frequently recurrent should be patch tested. Besides being subject to the same food and food-additive allergies that beset the general population, athletes tend to use vitamins, food supplements, and other reputed performance enhancers that are potential allergens. Airborne allergens also complicate the picture. Difficult cases may require allergy testing.
Treatment starts with nonsedating antihistamines.
Several of the newer products, like fexofenadine and loratidine, minimize drug interactions. While most infections tend to be painful, superficial infections in athletes may be itchy. Most cases are gram-positive infections with staphylococci or streptococci. Other bacterial infections that itch in their early stages include impetigo, often an infection with both Streptococcus and Staphylococcus organisms. If imidazoles cannot be used or application does not resolve the infection, a culture is advisable.