“So I’ve Got This Weird Rash…”

Congratulations, you’ve chosen the rashiest hobby going. If you wanted glamour you’d have opted for opera or mixology or sushi rolling or literally anything else right?

I am not a doctor (this is important to remember) and this is just a non-professional guide to attempt to be helpful in identifying what a rash might be, what could fix it, and whether its going to kill you.

Heat Rash

What kind of rash is this?

Very common and recognisible showing up as small raised bumps and spots, sometimes with mild swelling, often with itchiness. Usually seen on the upper chest and neck as well as in the armpits, groin or any place a little bit folded and moist.

Heat Rash (from the NHS)

It is caused by excessive sweating during which the pores become clogged. More common in small kids and babies due to underdeveloped sweat glands, but long distance hikers definitely like to try their own sweat glands to the limits.

What can I do about it?

Hydrocortisone cream or chamomile will help with the discomfort, as will cooling either in a shower or bath or with wet towels. It’s uncomfy, but it’ll sort itself out in a couple days.

In terms of prevention, wear appropriate clothing. This means lightweight wicking clothing in the summer, being sure to remove layers as you warm up (though not all layers please. Unless its June 21st.)

Will I die?

No.

Exercise Induced Vasculitis

What kind of rash is this?

Also known as ‘hiker’s rash’, ‘golfer’s rash’ and ‘Disney rash’, it appears on the lower legs, separated by the sock line, and is characterised by red patches, small purple spots and the occasional super sexy hive like weals.

Hiker’s Rash, as seen on yours truly

Other symptoms of EIV include swelling of the lower legs and ankle and is pretty itchy. It is an inflammatory response of your blood vessels to exercise in warm conditions, often exacerbated by a hiker’s sturdy socks and shoes creating a lovely humid bubble. Amongst the general population it is more frequently seen in those over fifty and in women, but amongst long distance hikers it is a free for all.

What can I do about it?

It will go away by itself in a few days, but to manage the itchiness and the swelling a dab here and there of hydrocortisone cream, sitting with your legs elevated and, when possible, submerging in cool water will likely help relieve the symptoms.

There is no real prevention. When it is seen amongst older people standing for a long period of time (‘golfer’s rash’/’Disney rash’) lighter clothing is suggested but getting rid of your Darn Toughs is going to lead to a hell of a lot of far worse issues, though some success is recorded with compression socks. Removing shoes and socks and elevating your feet whenever you aren’t walking will suck for any company you have, but it might prevent a worse rash occurring.

Will I die?

No.

Stinging Nettles

What kind of rash is this?

You’re going to see some raised bumps that are pale in colour and up to a centimetre in diameter, with the surrounding area usually more red.

The irritation and stinging is usually fairly instantaneous, making it easy to realise that it was likely caused by the nettles you just plodded through

Nettle rash (from Healthline)

The small, light, hollow hairlike structures on the plant act like needles and inject you with a delicious mix of stuff. The initial sting soon gives way to itchiness.

What can I do about it?

In terms of prevention, covering up when plodding though nettles is pretty much the only good one. In terms of treatment, we have the old favourites – cleaning the area, cold compresses or other cooling methods, and a dab of hydrocortisone or chamomile for the itching. As a lot of the reaction is from the injection of histimine, an anti-histimine would also be helpful.

UK old wives tales with absolutely no evidence to support them will tell you to use the juice from dock leaves for relief. Whilst, like I say, this has absolutely no scientific evidence to support it, it has enough anecdotal evidence that it can’t hurt to try. Dock leaves are the fat and oval ones with rounded tips and wavy edges and are often found in the same area as nettles.

Ultimately the sting from a nettle is gone very quickly with the discomfort disappearing within a couple hours.

Will I die?

No. You will not die. But it isn’t uncommon to be very allergic to nettles. So if you know you’ve just been stung and then start having chest tightness, struggling for breath or having sudden vomiting or diarrhoea, get the ambo on the phone. Though preferably this is something you realised at about the age of three rather than thirty and now know how to deal with.

Phytophotodermatitis

What kind of rash is this?

Starts off as a fairly typical red, blotchy, itchy rash but within 48 hours starts to blister. Badly. These blisters often hyperpigment eventually turning all shades of purple and can leave colourful scars

Phytophotodermatitis (from Wikipedia)

Phytophotodermatitis is a fancy way of saying your rash was caused by certain plants where the reaction is reliant on UV light exposure from the sun. These plants are therefore phototoxic and distinct from stinging plants such as nettles that just sting regardless. However, the reaction is somewhat more brutal.

The main plants associated with this reaction are those in the carrot family Apiceae, but don’t go thinking that as long as you don’t roll around on farmland that you’re safe; the wild carrot is far less palatable to bunnies. You might know it as Queen Anne’s Lace – the floaty white, waist high, weedy flowers. Hogweeds and cow parsnips are also part of the carrot family and it is particularly the leaves of all these plants that need avoiding.

Other plant families associated with the reaction are certain members of the citrus family Rutaceae (such as bergamot oranges) and of the mulberry family Moraceae (figs). However stumbling across either of those on our islands in the wild would be a whole challenge in itself. If you’re reading from the tropics, well, I hope you’re having fun.

What can I do about it?

In terms of prevention, unless you actually know plants maybe don’t go fondling them all and protect your legs and arms in more overgrown areas. Sunscreen can actually help, as it blocks the UV reaction from occurring. Showering and washing clothes after hiking might also minimalise any reaction, but obviously this isn’t always possible when you’re on day sixteen of the trail and have turned primal.

In terms of treatment, if you recognise that you have come into contact with an offending plant, wash the area immediately (yes, it is worth sacrificing 200ml out your platypus) and get out the sun, or cover the area, until you can wash properly.

If you do not realise before the blisters form, get to a doctor before they go down. A doctor can prescribe topical steroids or other anti-inflammatory treatments that can tackle the reaction and prevent hyperpigmented scars from forming. If you’ve waiting until the blisters have gone down, the inflammatory stage is now over and there’s not a hell of a lot left to do.

The resulting scars don’t have a great track record of being tackled by bleaching creams, and whilst they will fade somewhat over the coming months, they’re going to be a part of you now. Sorry.

Will I die?

No.

Jock Itch

What kind of rash is this?

Well, we’re mixing thing up with a fungal infection here for extra tastiness. Densely reddened areas of skin begin in your crevices, most commonly where the thigh meets the groin, but also in armpits, beneath the neck and sometimes the arsecheeks. It then spreads in a half moon shape from the point of origin. Might be flaky and scaly. Often itchy and burny.

Jock Itch on neck (Medicalnewstoday)

Called ‘Jock Itch’ because it is common in athletes that sweat a lot. It is caused by microscopic Tinea fungi. These live on your skin anyway and generally pootle about minding their own business, but give them heat, moisture and humidity and watch them thrive.

Most common in men and adolescent boys but, as I seem to have said in all these entries, long distance hiking seems to equalise many things. The good news lads is that it doesn’t (usually) affect the scrotum.

What can I do about it?

If you are susceptible (and even if you aren’t), wash far more regularly than you are, certainly in the areas more prone to infection. Us ladies tend to call this a ‘whore’s bath’ where you prioritise the pits and bits. I’m not sure what the gentleman’s alternative is. Changing clothes if the ones you’re wearing gets soaked with sweat is a good move, preferably then and there but definitely first thing when you arrive at camp.

As friction also exacerbates the risk, a squirt of talc or baby powder goes a long way to prevent chafing and keep the area dry.

As far as treatment goes, definitely keep the areas clean and dry. Wear looser, wicking clothes and use an over the counter anti-fungal treatment. Do NOT use hydrocortisone – it tends to either have no effect or make things worse.

Will I die?

No.

Lyme Disease

What kind of rash is this?

This isn’t a good one. If you’re seeing the classic bullseye rash then you’re past the prevention stage.

Lyme disease is caused by being bitten by infected ticks. By the time a rash occurs it is usually around 4 weeks to 3 months later, during which time you might have already felt fatigued, had terrible headaches, endured muscle and joint pain and swelling, found your sleep disturbed and had incredible trouble concentrating. If you haven’t had any of those yet, you likely will soon.

Bullseye rash (from the NHS)

The sooner Lyme disease is treated the better, or it can develop into a very long battle against those symptoms as you host a pathogen-induced autoimmune response. The longer you leave it to be treated, the longer you’ll suffer – for months, sometimes for years.

What can I do about it?

Your doctor will prescribe antibiotics, usually doxycycline, for a 2-4 week course. Around 20% of Lyme disease patients suffer from post-treatment Lyme disease syndrome where symptoms continue after the course of medication has completed. No one really knows why, but you likely won’t be hiking again for a while, so do check the resources and take this one seriously.

For prevention, be clued up in how to do a tick check and how to remove ticks. The ticks you need to look out for aren’t the big fat ones you find on your dog, they’re the size of poppy seeds – deer or sheep ticks in the nymph stage of life. Of course, performing tick checks if you hike and camp solo is harder, but do the best you can. An infected tick bite cannot infect you immediately – it will take the tick hanging on for 36-48 hours to transmit the disease. If you get the tick out before then, you’re extremely unlikely to be unwell.

Ticks are active in early spring to early summer, then can cease in a hot summer before becoming active again through autumn. If hiking at these times, especially in grassy, wooded areas, take extra care to be thorough. You can treat your clothing and gear with DEET based insect repellent (and yourself too). Another suggestion is to wear light coloured clothing to show the ticks better before they find your skin.

Will I die?

No. But it won’t be a pleasant recovery.

“It’s only on my genitals and…”

My friend, your trailbang just went Coyote Ugly in another direction. Were condoms too heavy for your ultralight pack? Go to a sexual health clinic as soon as possible. No you won’t die. No I absolutely do not need to see it.

*

Hey, no need to all look so mopey in your gross rashiness. The good news is that no one is dying!

Resources

DermNet NZ

Healthline

Lyme Disease Action

NHS

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