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[EXERCISE ADVISER]

Soothing Your Summer Skin Problems: From Sun Abuse to Bug Bites to Plant Plagues

Michael L. Ramsey, MD with James R. Wappes

THE PHYSICIAN AND SPORTSMEDICINE - VOL 26 - NO. 7 - JULY 98


Sometimes, exercise and outdoor activities in the summer are no picnic for your skin. Here are some of the most common summer skin ailments, and how to avoid and treat them.

Sun Damage

Prevention. Forget the "healthy tan" business. A suntan means skin damage, period. So use a sunscreen whenever you'll be outside for an extended period, even on cloudy days.

Pick a sunscreen that has a sun protection factor (SPF) of 15 or higher—closer to 30 if you have fair skin or burn easily. Shake the container well, and apply it heavily 20 to 30 minutes before going outside. An ounce is needed to cover an average adult sufficiently, but most people use much less. If you're worried that generous application costs too much, consider buying store brands. But remember that any brand of sunscreen is a lot cheaper than getting skin cancer.

Don't forget to apply sunscreen around the eyes and mouth; on the ears, neck and back; and on the head if you are bald or have thin hair. Reapply often if you're sweaty or wet—every hour while swimming. Some products have "sweatproof" ingredients. Rub some on your forehead before you exercise and see if it stays out of your eyes.

Sunscreen, though, is only part of the protection package. Wear a wide-brimmed hat to protect your head and neck, and wear a shirt with a tight-weave fabric (white T-shirts have an SPF of only 5 to 9). It's especially important to protect babies and children, who often get a lot of sun. Also, avoid exposure during peak sun intensity—between 10 am and 4 pm.

Relief. If you do get sunburned, get out of the sun quickly to prevent further damage. Applying cold compresses, taking a cool bath, or applying soothing lotions may provide some relief. If you don't have blisters, a 1% hydrocortisone cream might also help.

If you have a few small blisters, apply a cloth wetted with a solution of 1 tablespoon of vinegar mixed into 1 pint of water for relief. Apply this compress for 10 minutes two to three times a day. If you have large or many blisters, extreme tenderness or pain, pus, swelling, fever, chills, or nausea, consult a doctor.

Soggy Skin

Wet skin can lead to problems like athlete's foot, ringworm, jock itch, foot odor, and other fungus- or bacteria-related conditions. Although sweating and summer go hand in hand, you can take several steps to help keep your skin dry and healthy.

Prevention. First, change out of workout clothes quickly and step into a shower. Thorough drying is also important; wearing loose pants and underwear can help keep the groin dry. Also, antibacterial soap can help keep the bacterial count down.

Wear socks made of absorbent or "wicking" fabric, and change them often. Athletic shoes should be well ventilated and aired out for at least 24 hours between uses. Wash and rinse your feet well every day, and dry them thoroughly, especially between the toes. A blow dryer can help.

People who have sweaty feet can apply 5% or 10% benzoyl peroxide to help keep them dry. A gel or spray antiperspirant that contains aluminum chlorhydrate or aluminum chloride can also be applied to the feet once or twice a day. Also, going barefoot or wearing sandals helps air out the feet.

Bug Bites

Prevention. Bites from mosquitoes and other flying insects can cause pain and itching. To minimize bites, wear long-sleeved shirts and long pants in bug-ridden areas, and go inside at dawn and dusk when mosquitoes are most active. Use mosquito netting on baby strollers and playpens that are outdoors. And get rid of standing water around your home, such as in old tires, where mosquitoes can hatch.

You can also use insect repellents. Diethyltoluamide, or DEET, is the most effective substance against a variety of insects. A DEET concentration under 10% is best for children, while 10% to 30% is recommended for adults for "backyard" activities. For wilderness trips, a 40% to 50% concentration will repel bugs longer. DEET concentration above 50% repels only marginally longer and may pose a higher risk of side effects like skin irritation.

A combination of DEET on exposed skin and a repellent containing permethrin (such as Permanone, Coulston's, Duranon) on clothing also protects against ticks, which can transmit Lyme disease and other diseases.

Relief. If you do get bitten, applying ice for 10 to 15 minutes may help relieve the pain and itching, as can balms such as calamine lotion. Victims of many bites may benefit from over-the-counter diphenhydramine hydrochloride (Benadryl is one brand name) or a prescription hydroxyzine (Atarax, Vistaril).

Plant Poisons

Poison ivy, poison oak, and poison sumac are the most common plants to cause allergic reactions, affecting 10 to 50 million Americans a year. We'll focus on poison ivy, but the recommendations are the same for poison oak and poison sumac.

Contact with poison ivy may produce a rash with redness and swelling within 12 to 48 hours, blisters, and severe itching. In a few days, the blisters crust, scale, and often ooze (the fluid will not spread the condition). The reaction usually takes about 10 days to run its course.

The cause of this misery is a substance on the plant called urushiol (you-ROO-shee-ol). An estimated 50% to 70% of people are sensitive to urushiol. It is typically colorless and sticks to almost anything. Urushiol can contact skin directly when you brush against the plant or indirectly through a pet's fur, garden tools, or sports or camping gear.

Prevention. Obviously, prevention means avoiding the plant. Poison ivy leaves often grow in clusters of three (figure 1), but not always. Its appearance can vary, so have a park ranger show you how it looks in the area where you plan to hike or camp. Barrier creams that keep urushiol away from the skin have been developed recently for people who spend a lot of time in the woods.

[FIGURE 1]

If you know you've contacted poison ivy, wash immediately with soap and water—or water alone. Washing immediately can remove up to 100% of the urushiol, whereas washing 10 minutes later typically removes only 50%, and washing after 30 minutes removes only 10%.

Clothing and gear that may have come in contact with poison ivy should be hosed down outside before it is washed indoors. Handle it as little as possible before washing it; urushiol can remain active for months.

Relief. If you develop the rash, try to avoid scratching, which does not spread the reaction but can cause infection. Cool or hot showers and over-the-counter preparations like calamine lotion or Burow's solution can provide relief. Lukewarm baths with oatmeal or baking soda may also help relieve itching and dry up oozing blisters. Over-the-counter hydrocortisone cream will not help.

If you have severe blisters or swelling or need further relief, consult a doctor. He or she may prescribe stronger medication.

Swimmer's Itch

Swimmer's itch is a rash caused by a tiny larval worm. The all-but-invisible parasites live in snails and waterfowl. They are not parasites of people, but they burrow into human skin and die. The dead larvae often cause itching and, at times, small red spots for several days.

Prevention. Swimmers should avoid water known to be infested with the parasite, especially in the shallows where the larvae thrive. Toweling off immediately after swimming may keep the larvae from burrowing into the skin.

Relief. Soothing lotions and other anti-itch measures as discussed above may help.

Dr Ramsey is an associate in the Department of Dermatology at Penn State Geisinger Medical Center in Danville, Pennsylvania, and a fellow of the American Academy of Dermatology. James R. Wappes is a senior editor of The Physician and Sportsmedicine.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.


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