Blisters, Chafing, and More: Common Skin Conditions for Runners

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Long-distance running places unique stresses on the skin, often resulting in a variety of dermatological issues. These skin conditions can stem from repetitive trauma, friction, pressure, and environmental factors.^1-2 A recent review found that awareness and preventive strategies are essential to mitigate these problems and ensure optimal performance and long-term skin health.³

Traumatic and Mechanical Skin Disorders

The review found that the repetitive motion and environmental exposure inherent to long-distance running frequently led to traumatic skin disorders. Researchers noted common conditions include blisters, chafing, runner's purpura, black heel, and nail abnormalities. These issues are often exacerbated by poor footwear, wet socks, and extended running durations.

• Friction Blisters: The most common dermatological problem among ultra-endurance runners, the review stated friction blisters result from repetitive shear deformation of the skin. Incidence rates vary widely, with some ultramarathons reporting a 76% occurrence after 4 days of running. Preventive measures include wearing padded acrylic socks, neoprene insoles, and properly fitted shoes. Researchers wrote that blisters should be treated by draining with a sterile needle while leaving the blister roof intact to protect against infection.
• Chafing: This inflammatory dermatitis occurs when skin areas repeatedly rub against each other, often exacerbated by moisture and friction. Researchers noted jogger's nipple, a specific form of chafing, can be prevented by wearing moisture-wicking clothes and applying petroleum jelly. Treatment involves cleaning the affected area and using corticosteroid cream.
• Runner’s Purpura: Exercise-induced vasculitis presents as erythematous or purpuric eruptions, typically on the lower limbs, after prolonged exertion. Though rare in young, healthy runners, the review statedit should prompt investigation into other causes if observed.
• Black Heel: Also known as calcaneal petechiae, this condition is caused by intraepidermal bleeding from shearing forces. The review noted it resolves within weeks by avoiding repetitive trauma and wearing cushioned footwear.
• Nail Abnormalities: Jogger’s toenail, involving discoloration and subungual hemorrhage, results from repetitive trauma to the nail plate. Proper footwear with an adequate toe box can prevent this condition, according to researchers.

Additional conditions such as piezogenic papules, runner’s rump, and athlete’s nodules may occur due to localized trauma and often resolve with minimal intervention.

Allergic and Irritant Contact Dermatitis

Runners frequently encounter allergens and irritants from equipment, adhesives, and environmental exposure. Irritant contact dermatitis manifests rapidly after exposure to sweat, friction, or chemicals in athletic gear. Allergic contact dermatitis arises from sensitizers like adhesives, shoe materials, or topical products. The review stated both conditions can be managed by avoiding the offending agent and using topical corticosteroids for inflammation.

Skin Infections

Conditions like tinea pedis (athlete’s foot) and pitted keratolysis were noted as common among runners due to moist environments and occlusive footwear. Preventive strategies include keeping feet dry, changing socks frequently, and using appropriate topical treatments. The review stated trail runners may also face tick bites, though the risk of Lyme borreliosis appears limited.

Aggravation of Pre-Existing Conditions

Researchers wrote that chronic skin conditions such as psoriasis, atopic dermatitis, and vitiligo may worsen with running due to trauma, sweat, and environmental exposure. Additionally, physical urticaria and herpes labialis may flare after prolonged exertion or sun exposure. The review noted that clinicians should evaluate recurrent or atypical presentations carefully.

Sun Exposure and Photoprotection

As with other outdoor sports, outdoor runners face significant risks from UV exposure, which increases the likelihood of skin cancer and photoaging. Despite awareness, researchers found many runners neglect sun protection due to discomfort or impracticality. They stated strategies like applying broad-spectrum sunscreen, wearing hats, and choosing UV-protective clothing are critical.

Impact of Dermatologic Treatments on Training and Competitiveness

Certain treatments, like isotretinoin, antihistamines, or corticosteroids, may affect physical performance or require reporting to regulatory bodies to avoid doping violations. Researchers stated clinicians should discuss these implications with patients involved in competitive sports to provide tailored guidance.

Conclusion

Long-distance runners face numerous dermatological challenges that can impact their performance and overall well-being. Researchers found that preventive measures, including proper footwear, moisture-wicking clothing, and friction-reducing strategies, are vital. The review suggested that healthcare providers, runners, and coaches should collaborate to promote awareness and proactive skin care practices, ensuring both optimal athletic performance and long-term skin health.

References

1. Adams BB. Dermatologic disorders of the athlete. Sports Med. 2002;32(5):309-321. doi:10.2165/00007256-200232050-00003
2. Emer J, Sivek R, Marciniak B. Sports dermatology: Part 1 of 2 traumatic or mechanical injuries, inflammatory conditions, and exacerbations of pre-existing conditions. J Clin Aesthet Dermatol. 2015;8(4):31-43.
3. Ahomies H, Descamps V, Leclerc-Mercier S. Skin diseases in long-distance runners. JEADVCP. 2024. doi:10.1002/jvc2.613