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What Does Running Do To My Skin?

What Does Running Do To My Skin?


11 minute read

Running certainly provides many health benefits from your heart to your bones and especially stress relief from sitting in front of your computer for hours on end. That said, 20% of marathoners out there tend to have skin issues.  Below are the typical problems runners face with their skin, with dermatologist-approved preventing and treatment programs.

Typical Problems Runners Face With Their Skin

Blisters

Blisters come from horizontal excess friction due to a variety of reasons including not having the correct fit for your shoes, heat, wet socks and frankly lots of training.  Blisters are usually filled with a clear, colorless fluid, but sometimes there can be blood in the blister giving it a purplish or even black appearance. 

PREVENTION:  Wear proper fitting shoes, use moisture-wicking socks, wearing protective dressings or wraps to prevent friction and moisture. Products that can diminish excessive sweating are effective and readily available.  

TREATMENT:  It is important to drain the fluid from the blister. Clean the blister with an antibacterial cleanser, soap or alcohol.  Use a sterilized needle and puncture the side of the blister, leaving the roof intact to act as nature’s best bandaid. Once the blister has been drained, apply a small amount of ointment such as Aquaphor and cover with a dressing. Depending on the site, you may want to cover with a more cushioned dressing such as those made of hydrocolloid. If you are predisposed to infection (neuropathy, diabetic) you should consider using silver gel,  medi honey or polysporin and change the dressing at least daily. 

Jogger's Nipple

This is also a friction problem between the shirt and the nipples.  Cold weather and rough fabrics can increase the risk of this problem. 

PREVENTION:  Wearing patches (see hydrocolloid above or tegadermlike bandages) over the nipples prior to running.  Apply petroleum jelly or a similar thick ointment as both a treatment and for prevention. Note that if you are using the tegaderm or hydrocolloid dressings, you cannot use the emollient at the same time as the dressing will stay on.   Wear soft fabrics that diminish friction such as silk, semisynthetic and soft fiber clothing.  

TREATMENT:  Aquaphor, vaseline, or similar thick ointment application several times a day can be soothing. These ointments may soil your clothing, so some type of dressing

Runner's Toes

Each time you take a step, the longest toe or others might bump into the end of your shoe causing trauma, especially if you are running downhill. This trauma leads to bruising underneath your nail plate.  It can truly happen on any of your toes.  This looks black and can be alarming. The best prevention is to try to get a properly fitting shoe box. Some brands are known for having better options than others No treatment is necessary. However, if you have a black streak on your toes and it is not growing out like the other black spots, it is important to get it checked out.

Talon Noir

I love making this diagnosis. It is a dark blue-black, black or brown flat area on the feet, typically on the heel. This is due to damage from trauma to the fine blood vessels in the uppermost layers of the skin.  In order to make sure it is not  Usually you can give it 2-3 weeks to see if it resolves.  You can also gently and carefully shave off the skin with a callus shaver. If the spot does not come off easily, you should get the site checked by a health care provider to make certain it is not a worrisome mole,  Proper footwear, avoiding excess moisture or even wearing heel cups can be helpful.

Subungual Hematoma 

Many athletes, not just runners get this bruising underneath their toenails resulting in black, purplish nail beds.  Sometimes this can be quite painful. If there is significant pain, you can heat a paper clip or thicker safety pen to penetrate the nail plate. This will allow the blood to escape, relieving that intense painful pressure.  If the hematoma is large, you may eventually lose the nail plate. However you should be able to grow a normal nail back but it can take quite a few months, up to a year for a complete nail to cover the nail bed.  If you don’t have a good reason to have a dark area on your toenail bed, please get it checked out by a healthcare provider.

Infections

Athlete’s Foot is also known as tinea pedis or ringworm. This infection is caused by a fungus that is literally everywhere. There are effective treatments, but some people can be predisposed to getting this infection over and over. Reasons that runners are at high risk for this infection include moisture, trauma, small breaks in the skin caused by running and pre COVID, communal showers. This can present as scaling, itching, redness, tiny or larger blisters, and cracks in the skin.   

PREVENTION:  Use well-ventilated shoes and moisture-wicking socks. Wear sandals or flip-flops in communal settings. Remove wet socks immediately and use antifungal powder before exercising.  

TREATMENT: There are many effective treatments over the counter such as terbinafine, miconazole, and clotrimazole creams. If the infection is severe (see nail infection below) you may need to take oral medication.

Toenail Infections

Toenail infections are typically due to fungus or mold. Because runner’s toenails are traumatized over and over, sometimes it can break the seal that normally exists between the skin and the nail, allowing moisture and fungus or mold to enter into this space. This is especially likely if there is also fungal present on the skin (athlete’s foot).  The end of the nail is usually lifted and thickened.  While there are many causes of abnormal toenails such as psoriasis, serious runners tend to have this problem.  

PREVENTION:  Using moisture-wicking socks, well-ventilated shoes, remove wet socks immediately. Wearing flip flops or other sandals in communal areas.  

TREATMENT:   Diagnosis is important if you are going to pursue treatment.  A health care provider often will determine the best way to make the diagnosis and discuss treatment options depending on the severity of your infection. If the infection is mild, a topical nail lacquer may be recommended. However, if there is extensive involvement, systemic therapy may be the best option. There are side effects with the systemic medication and should be discussed in-depth with your healthcare provider. 

Plantar Warts 

These warts are caused by the human papillomavirus. Small breaks in the skin from trauma or excessive moisture from running can predispose runners to this infection along with again being in communal showers/locker rooms.  Some people are more predisposed to warts than others.  The location of the lesions is often what brings them to a runner’s attention. If these warts are in the wrong spot, they can be quite painful.  If you look closely you can see the clotted-off capillaries often referred to as “seeds”.   

PREVENTION: Keep the feet dry. Wear flip flops or sandals in communal areas. 

TREATMENT:  If warts don’t bother you, you don’t have to treat them. Some will go away on their own. However, if they are painful and are changing the way you are bearing weight when you run, you may be setting yourself up for knee, ankle, or even hip issues. This also means during the treatment when warts may also be tender, to be quite attentive to your form in order to avoid further issues.  There are many ways to treat warts that include over-the-counter salicylic acid, freezing at home (carbon dioxide) or in the office (liquid nitrogen), stimulating your immune system, antiviral treatments, other destructive treatments to name a few.  It is important to discuss with your provider how much you can tolerate in terms of downtime and what will be the level of impact on your running activities. This information can assist you in working with your health care provider to achieve your goals with the best treatment plan.   

If you do not have complete feeling in your feet (neuropathy) or are diabetic, you should only treat warts under the guidance of a healthcare professional.  If I can give you one piece of insight or advice, it is that you need to remember that the virus is microscopic until it infects enough of your cells to be able to detect it with your naked eye. Therefore any treatment you pursue, you need to be more stubborn than the wart and continue to treat the skin after it appears to be “gone”.  This is advice in particular for those of you treating with salicylic acid. You also have to remove the dead skin cells before re-applying the next round of acid. The wart virus causes tiny capillaries to come to the top of the skin (seeds). So when you are scraping off the dead skin it may bleed a little. You need to keep scraping as long as it is not painful  IF what you think is a wart is not resolving after 4-6 weeks or is acting unusual with bleeding and/or pain, although rare, it may be cancer presenting as a wart and get it checked by a healthcare professional.

Frostbite

 This particular may occur on the nose, cheeks, or ears when exposed to the intense cold.  The affected areas start out numb, bluish-purple followed often by swelling, pain, and after a day or two blisterings.  The overall process may take up to 2 weeks.  

PREVENTION: Wear adequate clothing. Layers of loosely fitted clothing are best. Immediate removal of any wet clothing is essential.  Application of thick heavy emollients may be helpful as well. 

 TREATMENT:  Rewarming in a water bath of 100-110 degrees Fahrenheit over 20 minutes.  Drainage of clear but not hemorrhagic blisters is recommended. Elevation, tetanus immunity confirmed, and pain management with NSAIDs (ibuprofen/ naproxen)  if there are no contraindications (blood thinners). If there is a strong demarcation or extensive areas involved, seek immediate attention by a healthcare professional.

Hives or Urticaria 

Typically this form of hives also known as urticaria occurs in runners due to a release of a chemical in our bodies in response to stress, increased temperature of our body. Usually, the hives or wheals go away within 2-30 minutes.  T 

PREVENTION/TREATMENT:  Taking a nonsedating antihistamine prior to running may be helpful.  However, If you are getting itching without a rash, in particular, if you go running right after eating, you may have a more serious form of a reaction leading to anaphylaxis, shock, and even death.

Skin Cancer

Hands-down runners are exposed to a lot of ultraviolet rays. If you are running on a treadmill, great protection, but we still recommend a daily application of SPF.  This is the best advice on how to protect skin from the sun for men who are runners.  Runners have a higher rate of skin cancer than nonrunners and marathoners had even more concerning findings in their skin.  

PREVENTION:  Using a sun-protective program is essential for runners.  The application of a broad-spectrum sunscreen with an SPF of at least 30, reapplication every 2 hours, sunglasses, wearing a hat that protects the ears and neck as well as the face, shirt with sleeves. Many runners balk at this idea, but this simple shift in equipment can reduce the risk of skin cancer by at least 40%.  Avoiding running mid-day (10-4) and looking for shady trails is also helpful to reduce the intensity of exposure but does not take the place of the above recommendations.  Remember you can get burned even on cloudy days. One more thing, you need to protect yourself year-round as your skin is getting pounded by the nonburning UVA rays, promoting skin cancer silently. Know if you have any conditions (lupus) or medications (such as doxycycline, hydrochlorothiazide) that may make you more susceptible to a severe sunburn.  

TREATMENT:  Well if you got burned anyway, as soon as you have figured it out, and there are no contraindications, you can start taking ibuprofen every 6-8 hours. Cool compresses (put wet washcloths in the freezer) and application of calamine (not caladryl) can be soothing.  If you have blisters, cleanse the area with an antibacterial cleanser, Sterilize a safety pin or similar instrument prior to releasing the blister fluid.  You can release the fluid gently from the blisters, leaving the blister roof intact as nature’s bandaid. Applying a soothing ointment and non stick bandages (telfa) may be helpful as well. If you have extensive and severe burns, (severe pain, headache, vomiting, fever, dehydration) you may go into shock and need to seek immediate care from a healthcare professional.

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