SKIN PROBLEMS ON THE TRAIL
Due to the nature and demands of hiking and backpacking, the human body can sustain a range of injuries or be exposed to certain types of medical conditions. Although the possibility of injuries and medical conditions represents an ongoing risk to hikers and backpackers, this must be contrasted with the proven health benefits of physical activity, especially compared to health conditions and illnesses that are likely to occur with inactivity or sedentary behavior. These health benefits include improvement in nearly all aspects of human health, including cardiovascular, skeletal and muscular health as well as psychological and emotional wellbeing.
While the two most common types of hiking injuries are chronic and traumatic injuries, skin problems such as blisters, chafing, calluses, and burns are also very common. Most of these are related to your hiking outfit and shoes on the trail. An understanding of wound management, including methods to cleanse and bandage injuries, and prevent infection, is a must for any good hiker.
The skin is the largest organ of the human body and takes the most punishment of any part of a hiker’s anatomy. Specifically, the skin on the feet is critical to your success on the trail. Understanding the skin, its structures, and how best to care for it is one of the most important ways for an enjoyable hiking experience.
Friction, created by the application of the skin of hikers’ feet (or footwear) to the surface is among the most common reasons for skin problems on the trail. Because of this, in discussing skin care and injury, we will focus on the skin of the feet.
Some Skin Problems on the Trail
Blisters are common injuries for hikers wearing new hiking shoes or (especially) boots or covering long miles. Big blisters make walking uncomfortable or even impossible.
Blisters are one of the most common medical problems in the outdoors. While frequently seen on the feet, they can also occur on hands and often form under calluses. Blisters are usually preceded by what is commonly known as a hot spot. This is an area of inflammation of the outer layer of the epidermis that is caused by repeated sliding at a friction point. Such points are often between the skin and a sock. This region of erythema (redness, usually from irritation or infection) causes cells in the middle living layer of the epidermis to delaminate and split. With continued friction, the middle stratum of epidermis fills with fluid, thus creating the blister. This fluid is usually clear, but sometimes can be blood-tinged.
Prevention of blisters begins with identifying rubbing surfaces. Properly-fitted gear and footwear that is broken-in is the first step in prevention. Additionally, identifying hot spots and treating these will prevent the more dramatic pain associated with a blister. Some people’s feet are softer and more prone to blisters, and all shoes and boots are new at some point, so blisters happen. If you catch the injury at the hot spot stage, stop and fix the problem right away. Your best bet is to nip any blister in the bud. Today you can buy gel blister pads that pad the area and remove the friction, preventing the actual blister from forming. If you know you are prone to blisters, say on your heel, you may want to put one of these blister gel pads on the sensitive spot prophylactically. You can also use duct tape to protect painful blisters. This type of treatment is pretty effective and much cheaper than using specialist blister tape. However, you should do it on time - before a blister develops. As soon as you feel the friction, clean and dry the affected area (the so-called hot spot) and apply the duct tape as smoothly as possible. If your treatment is successful – everything will be all right. Otherwise, a blister will be formed.
Once formed, blisters can be very painful and difficult to heal. If still intact but bulging and greater than 5 mm in size, a blister should be carefully drained, ensuring that the “roof” or outer skin is left in place (Quinn 2014). An “unroofed” blister can be particularly painful. A blister should be drained with a sterilized needle or safety pin. Sterilizing a needle in the backcountry is best done by flaming the needle and allowing it to cool. Alternatively, an alcohol swab can be wiped across the pin and then on and around the blister. Often multiple holes may be needed to ensure drainage. The preferred method is to create pinholes at the lowest point on the blister close to the margin with normal skin, allowing drainage by gravity. It may be necessary to drain the blister several times over the first day after blister formation. Eventually, the outer skin flap will dry. Maintaining its integrity will promote healing and reduce pain.
There are many methods to bandage a blister. The use of paper tape, cut to overlap the edges of the drained blister, soaked with compound tincture of benzoin and covered with an adhesive bandage works well for intact blisters. Unroofed (or open) blisters are more difficult to dress properly. First, trim away all dead/loose skin from the edges of the blister. The key points to any blister dressing are to provide adequate padding and to keep the blister clean, dry, and free of debris.
Calluses are merely a thickened portion of the stratum corneum (the outer layer of the skin) and develop due to chronic friction at that location. These areas, when not properly treated, can lead to more severe conditions. Calluses protect the skin and generally do not need treatment unless a blister forms below the thickened skin.
Chafing is the result of a combination of bare skin, clothes, straps, and sweat. It’s an irritating, skin injury caused by friction.
Chafing is the mechanical friction between a portion of the body and clothing/gear or between two adjacent parts of the body. Chafing usually occurs on the upper thighs or in the underarm region where the skin is rubbing against skin. In general, you can chafe anywhere clothes or gear may rub against your skin, in particular, in areas such as feet, hips etc. The red inflamed skin at the chafing site is best cared for by applying an antibiotic ointment or petroleum jelly to reduce the friction or by substituting clothing that causes less friction. There are also a number of commercially available products specifically designed to decrease chafing or you can simply use generic zinc oxide or talcum powder. When friction occurs, smoothing the clothing under these areas or tightening the loops for a more secure fit can help. But dirty clothes may be a contributing factor. Keeping your hiking outfit and your body clean will also help you avoid chafing.
Burns are problematic in the field for a number of reasons: They are prone to infection, they can be extremely painful, and they can cause swelling, which may threaten airways if in the throat area.
The first step in treating all burns is to remove the source. Burns from wet caustic chemicals should be flushed with water for 20 minutes; dry chemicals should be brushed off the skin.
Once the source of the heat is removed, cool the burned area by pouring water over the burn. You can also use a cool, damp cloth for this purpose. Cool the area for several minutes.
Next, assess the injury. Burns are graded according to their depth and extent, with superficial burns involving only the outer skin layers being the least serious. Superficial burns do not involve blistering, but they are painful. Partial-thickness burns are more serious and cause blistering. These burns appear wet and mottled and are very painful. Full-thickness burns go all the way through your skin layers into the subcutaneous. Full-thickness burns appear gray and charred. They may be less painful than other burns because the nerves have been destroyed, but often your patient will have partial-thickness burns as well, so don’t expect him to be pain-free.
Superficial burns can be treated in the field, as can small, localized partial-thickness burns. Burns to the hands, feet, face, or genital area and burns that go all the way around a limb, as well as burns covering a large area, are more serious and should be attended to by a doctor. Cover the burned area with a moist dressing, treat for shock, and seek help.
Prevention of burns is very important. If you follow some simple basic rules, your chances to get burned in the wilderness will be drastically reduced:
- Be careful around pots full of boiling water. Make sure your stove is stable so the pot cannot fall off.
- Keep your face averted from the stove when you light it to avoid singeing your eyebrows and hair.
- You use thick gloves to move hot pans.
Skin problems are quite common on the trail. Whether caused by hiking shoes, by clothes and gear that don't fit you properly or by losing your focus for a moment while cooking, you shouldn't underestimate skin problems in the backcountry. Active prevention is a very important part of avoiding skin problems. Knowing and applying some ingenious tricks such as identifying hot spots and treating them before a blister develops will help you have safer and more enjoyable hiking trips.