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[EXERCISE ADVISER]

Skin Care for Active People

Michael L. Ramsey, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 3 - MARCH 97


Exercisers are prone to numerous skin problems caused by increased moisture or friction or damaging elements like cold, sunlight, and infection. Many skin afflictions, however, can be prevented by keeping the skin dry, clean, and protected.

Sources of Damage

Sweating is one of the most common causes of sports-related skin disorders. Wet skin promotes the proliferation of otherwise normal skin bacteria and other microscopic organisms. Foot odor, for example, is largely due to bacteria that thrive in a moist environment. These same bacteria can also cause pitted keratolysis, a foul-smelling condition in which tiny pits appear on the heels and soles.

Jock itch (tinea cruris) and athlete's foot (tinea pedis) also occur more often in moist conditions. Continued wearing of wet clothing after exercise also increases the risk of folliculitis, a bacterial infection of the hair follicles.

Friction is another common cause of skin problems. Chafing often occurs in areas where skin rubs clothing or another skin surface. Blisters typically appear in thicker, pressure-bearing areas such as the palms and soles. Friction from clothing can also cause an irritation, and even bleeding, of the nipples, often called jogger's nipples.

Infection can occur in many sports, especially those that involve direct skin contact. Wrestlers are particularly vulnerable to herpes simplex and a similar bacterial infection called impetigo. Infections like impetigo and bacterial folliculitis can also spread via surfaces like pads and handles on weight machines.

Finally, cold and sun exposure can cause skin problems or aggravate existing conditions. Common weather-related problems include frostbite, dry skin, sunburn, and fever blisters.

Moisture Concerns

Moisture-related problems can be avoided by keeping the skin dry. Foot odor, pitted keratolysis, and athlete's foot are all related to overly wet feet, and their prevention depends on drying measures.

Socks should be absorbent or made of synthetic material that "wicks" away moisture and should be changed frequently, especially after strenuous activities. "Air out" your feet by going barefoot or wearing sandals when possible. All shoes should be well ventilated and allowed to air out for at least 24 hours between uses. Feet should be washed and rinsed well every day, and then thoroughly dried. (A hair dryer may help.) In addition, benzoyl peroxide 5% or 10% gel or a spray underarm antiperspirant that contains aluminum chlorhydrate or aluminum chloride can be applied to the feet once or twice daily.

People who have repeated bouts of athlete's foot can apply over-the-counter antifungal products such as miconazole nitrate, tolnaftate, or clotrimazole to help stave off attacks of the fungus.

Preventing jock itch depends on keeping the skin of the groin as dry as possible. Loose pants and underwear allow more air to reach these areas. Exercisers should bathe and change clothes (including underwear) as soon as possible after working out. Thorough drying of the skin is also important.

Folliculitis is an inflammation of the hair follicles caused by various bacteria. Warm, moist conditions allow these organisms to thrive. To avoid this condition, bathe or shower and remove sweaty clothing as soon as possible after a workout or athletic event. When washing, pay special attention to your back, an area particularly prone to folliculitis. Antibacterial soap can also help keep the bacteria count down.

Rubbing and Chafing

Chafing happens when skin rubs against relatively rough areas like sleeve seams. It may also occur where skin rubs together, as on the inner thighs or underarms. Looser, softer, or sleeveless clothing can help if chafing is caused by fabric irritation. Longer sleeves or shorts long enough to cover opposing skin surfaces may minimize chafing caused by skin-to-skin contact. Petroleum jelly applied to areas prone to rubbing or chafing can also help—not only for chafing, but for blisters and jogger's nipples as well.

Blisters occur most commonly on the feet from rubbing between skin and footwear. Shoes should fit well and be gradually broken in before using them in athletic activities. Use the same drying measures described for athlete's foot, because moisture increases friction between skin and fabric. Wearing a thin pair of socks under thicker, more absorbent socks can also decrease friction.

Soft, light, smooth fabric should be worn to avoid jogger's nipples. Bras decrease friction, which probably explains why men have jogger's nipples more than women do. Also, adhesive bandages can be placed over nipples to reduce friction.

Skin Infections

Good hygiene and common sense help keep contagious skin infections in check. Herpes simplex—a viral condition that often causes cold sores or blisters—is common in wrestlers. Because it is contagious, it requires completely avoiding skin-to-skin contact with other people until all sores have healed. So see a doctor right away if you show signs of infection. People who have impetigo should also avoid contact with others until their doctor says they are no longer contagious.

Those prone to fever blisters should apply a sunscreen-containing lip balm before going outdoors and then reapply it frequently. Very susceptible people may wish to consult their doctor about preventive drugs like acyclovir.

Outdoor Skin

To prevent frostbite, wear layers of nonrestricting clothing in cold weather, paying special attention to the ears, cheeks, nose, fingers, and toes. Check yourself regularly for areas of extreme cold or numbness—especially if you have pain that suddenly stops.

Also, check your companions' faces and ears frequently for loss of color or other signs of freezing. Any area of suspected frostbite should be warmed as soon as possible, but do not rub or massage the skin because rubbing may worsen any damage.

In most situations, sunburn is easily avoided with the use of protective clothing and sunscreen. Hats and clothing made of tightly woven fabric provide fairly good protection against the sun's harmful ultraviolet rays. Caps protect the scalp and,
to some degree, the face. Broad-brimmed hats afford additional coverage of the ears. Waterproof sunscreens with a sun protection factor (SPF) of at least 15 should be applied to exposed skin 20 to 30 minutes before going out in the sun.

Winter dry skin can be minimized by moisturizing the skin. Bathing and showering should be brief and as cool as tolerable, since prolonged exposure to hot water depletes natural skin oils. Use mild "moisturizing" soaps. After bathing, the skin should be patted, not rubbed, with a towel. Apply moisturizing lotion or cream immediately after bathing and any time the skin feels dry, especially before going outdoors. Direct contact with wool should be avoided because it can irritate dry skin.

Total-Body Maintenance

The skin covers the machinery that allows active people to enjoy improved health, so it's important to protect it. Preventive skin maintenance can help ensure years of comfortable exercise sessions.

Remember: This information is not intended as a substitute for medical treatment. If you have health concerns, consult a physician.

Dr Ramsey is an associate in the Department of Dermatology at Geisinger Medical Center in Danville, Pennsylvania, a fellow of the American College of Dermatology, and an editorial board member of The Physician and Sportsmedicine.


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