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Making a salt water soak
With skin conditions you’ll often see the advice to ‘soak in salty water’ to help prevent and treat infections. There’s some evidence that plain old water will do just as well, but if you want to try salt water (saline) then it’s good to know how to make it yourself. Strong concentrations of salt might aggravate the skin and weak ones will be ineffective. Here’s my advice for making a saline soak:
• Use 500 millilitres of warm tap water. If you plan to use this in your nose or eyes, then you should boil it for at least one minute to sterilise it.
• Add one teaspoon of salt. This can be table salt or fine sea salt (non-iodised).
• Stir until the salt has dissolved.
• Fill a bowl with the salty water and soak the affected area for ten to twenty minutes, twice a day. If this isn’t practical, then apply a compress by wetting a clean flannel and pressing it against the inflamed or infected skin.
• Let the area air dry and apply a clean dressing if needed.
• If you want to keep unused solution to use later, then store it in the fridge in a sealed jar that’s been washed in hot soapy water. It’s best to use it within 24 hours.
Q Any tips for dealing with a verruca? I’ve got an annoying one on my heel that’s a bit sore when I run.
A While running itself doesn’t put you at high risk of verrucas, your cross training might. They’re usually picked up at swimming pools and in communal showers. They are incredibly common and nothing to worry about, but they can occasionally be a bit uncomfortable in your running shoe. Verrucas are basically viral warts on the soles of your feet that grow inwards rather than outwards, due to the fact that you constantly tread on them. You don’t actually need to treat them as they will eventually go away on their own, but that can take two years so you need to be patient! There’s a strong argument that leaving them to clear is the best option, because it makes you less likely to get another one – your body will have produced the antibodies needed to prevent them. If one is causing you bother and you want to get rid of it, then there are plenty of things you can buy over the counter. Applying salicylic acid to the verruca (avoiding the surrounding skin) and filing away the dead skin the next day is one option. This is very effective, but does take weeks. A quicker option would be to use a home freezing spray. They’re expensive and don’t work as well as liquid nitrogen, but this is no longer widely available in GP clinics for the treatment of verrucas.
Alternatively, if you want to avoid using chemicals, try duct tape. Stick a piece of tape over the verruca. Take it off every week and soak your foot in warm water for a few minutes. File away the dead skin with an emery board and then reapply the tape. Keep doing this for four weeks. Another natural treatment is to apply a piece of banana skin (soft side down) over the verucca and secure it with a plaster. Do this overnight for two weeks washing the area every morning. The evidence for these methods is variable, but they won’t cause any harm and might just do the trick.
Did you know?
When you have diabetes (type 1 or 2), the sensation from the nerves in your feet becomes reduced, so it’s easy to get skin sores and blisters and not even know it. If you have diabetes, you should check your feet carefully after each run. Any lesions should be treated promptly because skin healing can be impaired and infections are more likely in diabetics.
Skin rashes
Q After I run I get a red, warm, itchy rash on my chest and back. I think it’s just heat rash. Can I stop it happening?
A Heat rash is very common, especially if you sweat a lot. Sweat clogs up the pores causing little red spots, which can itch and feel a bit prickly. The best way to prevent it is to keep your skin cool, which is hard if you’re a runner. Don’t over dress and wear fabrics which wick moisture away from the skin. Keep well hydrated with cold fluids too. It can take a few days to settle and if it’s bothering you try applying a cold flannel or ice pack to the skin. Calamine lotion can be soothing, but avoid any perfumed skin creams or washes in case they irritate it. Particularly troublesome heat rash might improve with hydrocortisone cream or antihistamine tablets, but it’s best to speak to your pharmacist before you try these and always get confirmation of the diagnosis if things aren’t improving.
Q I get these weird blotchy, itchy spots on my skin sometimes, usually after a run or after a post-run shower. They go away the same day, but what are they?
A This sounds like urticaria, the medical term for nettle rash, hives or wheals. The spots are usually pink or white and raised from the skin. They appear in response to a trigger and the number of things that can cause them is huge. Exercise, heat and water appear on this list, all of which may apply to runners! Other causes include stress, certain foods and viral infections. The trigger causes the release of histamine from mast cells in the skin which leads to the rash appearing. If they’re mild and disappear within a few hours, then there’s no need to treat them. If they’re persistent, causing discomfort or continue to spread, then antihistamines will help. If you keep getting urticaria then see your GP to discuss possible causes and treatments. Although rare, if rapidly developing urticaria is associated with lip and tongue swelling or difficulty breathing, then this may indicate a life threatening allergic reaction, called anaphylaxis, and you should dial 999 for an emergency ambulance.
Toenails
Q I ran my first marathon a few days ago and three of my toenails have turned black. Do I need to worry?
A There’s no need to panic. Black toenails are well known to long distance runners and, while they can look pretty gruesome, they’re usually harmless. The black colour is blood from the delicate nail bed that has become trapped under the nail. It’s essentially a bruise. The medical term is a subungual haematoma from ‘unguis’, the Latin word for nail and haematoma, meaning a collection of blood. Don’t be alarmed if the nail falls off. This is often inevitable. However, let it stay in place as long as possible so it can protect the nail bed, and don’t pull it off. A new nail will gradually grow up from the base, but it may take six to nine months before it’s fully grown. Make sure there’s enough room for your toes in your running shoes so your nails aren’t repeatedly bashing against the end of the shoe, particularly when you run downhill. You might need to go up a full size. Socks which are too small won’t help either. Try using the heel lock for lacing your shoes (see here) to stop your feet slipping forwards.
Q My big toenail has really thickened up. My GP says it’s caused by trauma to the nail, but could it be a fungal infection?
A Both fungal infections and nail trauma can cause a nail to thicken, discolour (usually yellow) and become flaky. It can be hard to tell the difference, but if there is uncertainty scrapings can be taken from the nail and sent to the laboratory for microscopic examination and culture. Even then, the result can be misleading. Fungal infections don’t actually need to be treated. There are no serious consequences, but they can spread to other nails. Cosmetically they are unpleasant and the nail can become a bit tender, which makes running hard. If treatment is required, then sadly, there’s no quick fix. Although it tends to be the same fungus as athlete’s foot that causes nail infections, anti-fungal creams can’t penetrate the nail. Either nail lacquers with repeated nail filing or oral antifungal tablets are needed, and these can take six to nine months to work. It’s a long process and you should discuss the possible side-effects of anti-fungal tablets, including the risk of liver damage, with your GP. Traumatised nails are more likely to get infected, so make sure your trainers are big enough and practise good foot hygiene to prevent athlete’s foot.
Q I keep getting a really sore area on the edge of my big toe, where it meets the nail. Sometimes it weeps and bleeds, and when it’s bad I can’t run because it’s so sore. What can I do?
A This condition is called paronychia, from the Greek ‘para’ (around) and ‘onyx’ (nail). It’s due to an infection which nestles itself b
etween the skin and the nail. This is more likely to occur if the area has been damaged, which can happen to toenails with the repetitive impact of running, as well as by ingrown nails. When it happens suddenly, it’s usually caused by bacteria – staphylococcus aureus is the usual culprit. Redness and swelling develop in the skin alongside the nail and there’s often a collection of pus under the skin. This type of paronychia can be treated at home by applying warm, wet compresses or soaking feet in warm salty water several times a day, and using antiseptic creams or sprays. Sometimes, however, it requires antibiotics or drainage of the pus, so it’s important to see your doctor if it isn’t getting better, particularly if the pus isn’t draining, the redness is tracking up your toe, or you feel unwell with it.
Slower growing and longer-term paronychia infections are often caused by fungi, so they’re an extension of athlete’s foot problems. The treatment is foot hygiene, antifungal creams and possibly tablets if these aren’t helping. You can help to prevent paronychia occurring by keeping your feet as clean and dry as possible, wearing the right size running shoes and treating any athlete’s foot early. If your paronychia is caused by ingrown nails, it’s important to learn how best to trim your nails.
Did you know?
Paronychia is three times more common in women than it is in men. This may be due to its link with artificial nails, manicures and pedicures.
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Preventing ingrown toenails
Looking after your feet is important if you want to run many miles comfortably. A toenail which grows into the soft skin around it rather than growing straight upwards can be very uncomfortable. It can also make the area more likely to get infected. Toenails do need trimming, but it’s important to do it correctly. Here are some simple tips to stop nails growing into the toe:
• Don’t cut your toenails too short.
• Cut the nail straight across rather than curving it round at the side of the nail.
• Make sure your running shoes have a wide enough toe box for your feet (some women may need a men’s shoe to allow this).
• Don’t wear socks that are too tight.
• See your GP if ingrown nails are a recurrent problem for you. Surgical options, including removing the edge of the nail, are available.
Long-term skin conditions
Q Will running get rid of my cellulite?
A There is no guarantee that any type of exercise will help reduce cellulite. Cellulite is the term used for the fatty deposits of skin around the hips and thighs. It’s often lumpy in texture because of the way the underlying connective tissue, the scaffolding of skin, is stretched and pulled by the fat. Whether or not you have cellulite is largely determined by your genetics rather than your weight. Skinny people get cellulite too. Don’t be fooled by expensive creams, massages and procedures promising to get rid of cellulite. They may temporarily improve skin appearance, but the best bet in the long term is to eat a healthy diet, maintain a normal body weight, and do both cardio and strength training exercise to lower body fat levels and tone the muscles underlying the fat. Many of us have cellulite. We may not like it, but it’s normal and nothing to be ashamed of.
Q I have adult acne. I don’t want to stop running, but I’m worried that all the sweating is making it worse.
A Sebaceous glands make sebum to keep skin and hair moist and supple. Acne occurs when the glands over-produce and the hair follicles become blocked with sebum and dead skin cells. A black-head or pustule is the result. The bacteria that naturally live on our skin then have the opportunity to infect the blocked follicles. The face is the area most likely to be affected, but the chest and back can be problematic too. Sweating heavily while running may potentially make your acne worse, because it makes the pores more likely to clog, but there are some steps you can take to minimise this risk. Always remove any make-up before you run. It’s best to use a mild face wash to do this rather than just wipe it over with make-up remover. Spots often form where the skin is covered up, so tie your hair back and avoid headbands on your forehead if you’re getting spots underneath them. Running packs and vest or bra straps can obstruct the skin too, but it’s not so easy to avoid these. Keep your body and skin as cool as possible to minimise sweating. When you get back from your run, shower and wash your face and body thoroughly, as soon as you can, using a mild anti-bacterial wash. Always use a clean towel to dry yourself to prevent spreading bacteria. It can be a fine balance, but hopefully the benefits of running for you will outweigh any skin flare-ups. Chat to your pharmacist about which products might be best for your acne and if they aren’t helping then see your GP. We often underestimate the effect that acne can have on those who suffer from it.
Real-life runners
I’ve had flare-ups of severe acne and rosacea, and running helped to take my mind off it. When I was running I didn’t care what my skin looked like, I just enjoyed the run.
Sarah Wood, runner, writer and mum
Q Running seems to make my eczema worse. Do you have any tips for helping me to look after my skin?
A Running can both help and hinder eczema. There are lots of different types of eczema, but generally we’re talking about atopic eczema, an inflammatory skin condition that usually starts in childhood. Skin gets dry, cracked, red and may weep. It’s usually very itchy and can sometimes get sore and infected. If eczema flare-ups are linked to stress then you may find that running improves your skin by helping you relax. However, running can also aggravate eczema, because outdoor exercise exposes you to the elements, and wind and sun can dry out skin, making eczema worse. On top of this, skin can be irritated by sweat and further aggravated by any clothes that rub.
The key is to moisturise as frequently as you can, with a moisturiser (emollient) designed for eczema, at least three times a day. A layer of emollient before you run will help to stop skin drying out, and act as protection from sweat and chafing clothes. Shower after your run using a soap substitute, which won’t dry out your skin so much, and then reapply the emollient. Experiment with which fabrics keep you coolest and rub the least – seam free clothes are good. Use a non-biological washing powder to wash your kit and consider using an extra-rinse cycle if your clothes still seem to be irritating you. There are lots of treatments available for eczema so don’t suffer in silence. It’s best to treat flare-ups early so seek help. It can be hard work to keep on top of eczema. Sometimes you need a trial-and-error approach, but in my experience it’s very rare for eczema to prevent people running.
Did you know?
Your face turns red when you run because your body is trying to cool itself down. By dilating (expanding) the blood vessels in the skin, more blood can flow near the surface and lose its heat to the surrounding cooler air. Red faces during exercise are more common in women and more obvious in fair skinned people.
Q I have a very red face. I thought it was just from being out in all weathers but someone said I might have rosacea. Could running have caused it?
A Rosacea is a very common skin condition, but we still don’t fully understand it. It affects the face and is characterised by a redness of the skin. This can come and go, but it can also stay for long periods of time or even become permanent. There may be spots, dry skin, skin thickening and broken blood vessels. It usually affects people between the ages of 40 and 60, and it can be pretty miserable for those who have it because of the way it can look. There’s no cure and there are many theories as to what the cause is, including genetics, abnormalities of the blood vessels and a reaction to skin mites. Hope is not lost, though, because there do seem to be certain things which set it off, including some which are particularly relevant to runners. Strenuous exercise, strong winds, and hot and cold weather, for example, can all potentially activate rosacea, as can sun exposure and hot baths. Others on the list are stress, spicy foods, alcohol, caffeine and dairy products. If you suffer from rosacea, over time you’ll probably work out what your triggers are and can avoid them w
here possible. Runners can shade their face from the sun with a cap or visor and wear sunscreen. In cold or windy weather a light scarf and hat might be useful. Avoiding perfumed products and looking for dietary causes can be beneficial too.
Treatment focuses on avoiding triggers, using creams to minimise redness and tablet antibiotics to reduce inflammation. If these don’t help, then referral to a dermatologist is needed to explore other treatment options.
Did you know?
Sweat doesn’t actually smell. It’s effectively 99 per cent water with a bit of salt. The odour develops when the bacteria that live on your skin start to break the sweat down.
Q I seem to sweat much more than other runners I know. Why is this and what can I do about it?
A It’s estimated that while running an endurance event in the heat, you can lose up to 10 litres of sweat in a day. How much we sweat depends on how many sweat glands we have in our skin. The average is thought to be around 3 million, but it could be as many as 5 million! The number is largely determined by our genetics – we’re all made differently. There are two types of sweat gland: eccrine and apocrine. Eccrine glands are found in the dermis of the skin (see here) and empty their watery, salty sweat onto the skin surface. Apocrine glands are associated with hair follicles and discharge their thicker, oilier sweat into the hair follicles once puberty has commenced. This is the type of sweat you’ll find in hairy areas such as your armpits or groin and this produces body odour when it meets skin bacteria.
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