Folliculitis

[Danneaux]

Hi All!

This one goes in "Non-Thorn Related, Anything cycling..." 'cos I can't believe I'm the only Forum member dealing with folliculitis on a regular basis.

So, what is it? See:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001826/
Looks a bit like this: http://www.mayoclinic.com/health/medical/IM02746

Cyclists of my acquaintance get it. A lot. Tight-fitting cycling clothing presses close against body hair and rubs back and forth with movement and vibration, causing irritation at the root. With bacterial growth fostered by sweat, the hair follicles get inflamed and finally a stubborn staph infection takes hold. It can take weeks or even months to clear and is pretty uncomfortable. Also, if your hair is a bit curly, the clothes can cause it to ingrow, adding to the problem.

My outbreaks started in the late 1970s when I started cycling long distances, and coincided with buying and using "real" cycling clothing. Back then, I used wool shorts (with a leather chamois that required a cream treatment to keep it soft after laundering) and wool jerseys and arm and leg warmers. After riding, I would get a rash of angry red pimples on my legs and in my armpits. They would get inflamed, drain, and itch like crazy for weeks. It finally reached a point where I felt kinda sick with it. Finally, a dermatologist who got tired of treating me for it suggested I shave my legs and armpits. He figured the shorter hair wouldn't be irritated so much and it would keep the bacteria count down while riding. Problem solved, till the advent of polypropylene in the early 1980s. The ad copy said it was like wool without any of the drawbacks. What they forgot to mention was it soon went sour even during wear, producing fumes noxious enough to fell a horse. It also made folliculitis worse, because unlike wool, the synthetic fibers didn't wick away the bacteria, instead leaving it trapped against the skin to make things worse. The foul odor came from the trapped sweat and bacteria going "off". Ew.

Move ahead a few years, and lycra replaced polypropylene. It was light, breathed pretty well, washed in a machine and dried quickly. Stretchy and form-fitting, it didn't flap in the wind. Slick stuff, it minimized chafing and -- along with "engineered" synthetic fabrics -- also included synthetic chamois that needed no fuss or special treatment and came with antibacterial properties. Life was good until...

...I started riding a lot longer distances at a time. For years, I rode 8,000-12,000mi/13,000-19,000km annually, but never really long daily distances. That changed when I started to consistently ride 200-400km several days a week. Riding 16-20+ hour days, a sweat-soaked lycra jersey traps the sweat against the skin for longer periods, and I'm finding even with a change to a spare jersey mid-ride, I get folliculitis. It is worst across my chest and upper shoulders. A friend from my Mississippi days put it best: "Boy, y'all look like a speckled pup!"   Yes, yes I do!  

My doctors are a doughy lot that rarely exercise and never cycle and tend to favor things like antibiotics. I've tried a number of solutions, some better than others:

1) Shaving. Legs and pits worked great, but you have to keep it up. Let the stubble return and with it comes instant folliculitis. How did it come to this? I'm a cyclist! This takes time from the bikes, man. I mow my lawn less often...

2) Hair-removal cremes. Smells, harsh on skin, but better on the chest than shaving, which caused ingrown hairs even with exfoliation. What's that? Well...

3) Exfoliation. I didn't know what the word meant till I started dealing with follicuitis. It mostly means using a really rough sponge to scrape off the pimples and dead skin so the bacteria are exposed to air. Helps a bit.

4) Regular bathing/showering, immediately after a ride. Put-the-bike-away-jump-in-the-shower has become my routine. Trouble is, I break out during long rides.

5) Benzoyl peroxide. Typically used as an acne treatment, this sometimes has helped clear the rash a bit sooner.

6) Bikini Zone creme: http://bikinizone.com/ Helps to bring along on a long ride and apply at a rest break. The active ingredient is lidocaine, a topical anesthetic. I have no idea what helps the pimply spots, but it makes a positive difference.

7) Band-Aids (adhesive plasters) help over my nips, as that area frequently gets irritated from the jersey rubbing on rough roads after so many hours.

8 ) A lady who worked in the same office had once been a stripper, and she said an old trick used in that field was to rub a smooth-on or roll-on deodorant on the skin, especially after shaving. The aluminum chlorhydrate that prevented body odor also served as an antibacterial. It worked for me, but not as well as Bikini Zone. According to some studies, I'll be halfway to Alzheimer's if I keep this up. See: http://en.wikipedia.org/wiki/Aluminium_chlorohydrate

9) Not all jerseys are created equal, even if made of the same basic stuff. The weave makes a big difference, and my favorite jerseys have a sort of perforated, fine meshlike inner surface. Others that look like that are harsh and make the problem worse, so it pays to feel them in the store and get the softer ones.

10) Alcohol gel-based anti-bacterial hand cleaner. This works, but smells sour afterwards and really dries out skin.

11) Riding without a shirt in sunshine for brief periods. Helps, but I have to watch for sunburn. I'm one of those who can burn under a light bulb and go up like a match in summer sun. What really helps is letting the jersey dry in the sun and wind. That's where carrying a spare on long day rides helps, changing at about the 200km mark.

12) Various lotions and skin moisturizers. The theory is these make a barrier between the bacteria and the hair follicles. Kinda works but the results are still inconclusive for me. Mostly, they make me feel...greasy.

13) Vinegar. Yes, it is an old folk remedy for sunburn (does make it feel better. Cold tea water is another). I think it might actually help, but the smell is such that I feel like a pickle after riding for awhile and I just can't take a trial long enough to see if it is really effective. If I keep it up, I'll never eat another pickle. People do give you funny looks as you approach, and back away as you get closer. It also draws flies. Scratch vinegar off the list.

All this is coming to the fore once again as I plan another long tour. I'll be out for roughly 4-6 weeks, much of that in the desert where I'll get hot and sweaty and can't bathe regularly. The only part I am not looking forward to is more folliculitis. I've got a bad case of it now only on my chest, but it should be something else again by the time I return.

If anyone else has a favorite treatment or solution, I'd surely welcome it. In the meantime, maybe something in the above will help if you're also subject to folliculitis. Anyone else on the Forum run into this, and if so, what do you do about it?

Many thanks in advance!

Best,

Dan.

[Pavel]

I had no idea of this.  Man, you are tougher that I am Dan - in your shoes (clothes, I mean) I'd probably take up driving a motorcycle for exercise instead.

No advice however, sorry!

[kickingcones]

My solution? Just stop wearing that cycling specific clothing and return to the looser clothing, particularly merino wool, of the early days. I've cycled thousands of kilometers, especially in the unbearable humidity and heat of Japan, with never any of the problems you mention. I can't stand wearing skin-tight clothing, particularly because it is so tight, hot, and restrictive. I don't see how other people manage to be comfortable in them for hundreds of kilometers. When I say loose, I don't mean flapping-in-the-wind loose, but just loose enough that there is a generous space between the skin's surface and the fabric. I find this both warmer and cooler both when I hike and when I cycle. It eliminates any rubbing against the skin. For the crotch and saddle I wear a separate chamois undergarment under the shorts while my nethers are still tender and the saddle leather still stiff, but once the saddle is broken in the shorts with a simple liner are good enough as is. Sometimes getting too technical is what causes the problem.

[Danneaux]

Thanks, Pavel. I keep telling myself it builds character, but I'm not so sure. It would be great to finally get a handle on this recurring problem. It seems to bother a lot of riders I know, but people never really talk about it. I hoped my list might help someone, but I'm looking for the magic solution myself.

My solution? Just stop wearing that cycling specific clothing and return to the looser clothing

Good point Miguel. I think a major part of the problem is the friction caused by the relatively tighter fit of racing-oriented clothing. I never get the problem from my street clothes.

particularly merino wool, of the early days

An excellent observation. My problem started with wool cycling clothes, but remained manageable so long as I kept my legs and 'pits shaved. Polypropylene tipped the scales and lycra has been surprisingly good...until I did the really extended-duration rides. Talked with a dermatologist about this a few weeks ago, and he figures it is the usual vibration-friction-sweat problem exacerbated by the time factor. It is just that much longer for bacteria to remain in contact with the hair shafts and roots (follicles).

Sometimes getting too technical is what causes the problem.

Wise words indeed, Miguel, and something for me to take to heart. Thanks!

Best,

Dan. (who is tired of being a "speckled pup")

[triaesthete]

Hi Dan
I've never heard of a problem like this before. Have you thought about it from the angle of what goes into your body, after all you are what you eat and so is your sweat. At the other side of the equation so to speak are external contaminants. Have you tried different laundry detergents and methods? They may be a common factor in all this.
Best wishes
Ian

[energyman]

Now you tell me and I've just invested in two pairs of tight padded cycling pants (English description) So I guess its back to good old M&S (Marks & Spencer) underwear.  Never had a problem with them.  I guess the maxim "hang loose" still rules.

[Danneaux]

You know, Ian...that's an excellent suggestion! You're absolutely right, what we eat really does have an effect on our bodies, and is bound to affect the composition of our sweat, etc. There may very well be a common component there, and is well worth looking into.

I have been looking for a correlation over the years, and pretty well stopped when there seemed to be a 1.0 relationship between the clothing and the rash, but what if it is something more...or synergystic, in combination with the clothing and the act of being on the bike, soaked in sweat for a long time?

The more I think about it, the more I'm wondering if you've really touched on something, and it may indeed be environmental as well. I live about 1.2km south (downstream) of the municipal wastewater-treatment plant. Being that close, we tend to get higher, less-diluted doses of the treatment chemicals. Horrible as it sounds, they have been recycling our wastewater into drinking water (and clothes-washing water) for the last many decades. The water is also purified in part through heavy, heavy chlorination. On rainy days when the rivers swell, extra chlorine is added and residents are advised to let bathwater sit awhile before climbing in (doesn't work for showers). You can *smell* the chlorine and it really makes skin dry and eyes burn. A friend from the NL came for a visit and could taste it in the ice cubes we put in his fruit drinks (in Rotterdam, they purify the water using ultraviolet light, sort of a giant version of a SteriPen, so it is odorless and taste-free).

  The penny drops...

What I have looks identical (dermatologist agrees) to the "hot tub rash/folliculitis" shown in the Mayo Clinic link above, which says it comes from a swimsuit holding contaminated water close against the skin. Well, hot tubs also use chlorinated water. And, that's what I wash my clothes in; there's nothing else.

As a kid, I had to give up on swimming lessons because I developed a sensitivity to chlorine used in the municipal pool. I'd go in fine and come out looking red as a strawberry, covered in rash. Y'don't suppose it's the chlorine in the water remaining in the wash somehow? After all, the rinse-water is chlorinated, also. I'd think the chlorine would outgas, but perhaps there's something chemical remaining. I do remember swimming friends saying chlorinated pool water really changed the color of their lycra swimwear (one woman is blonde, and her hair turns a greenish hue if she swims frequently). Well, bike clothing is made of lycra, and the folliculitis gets worse when I wear sweaty lycra for long periods of time. What if the sweat somehow reacts with or activates any remaining water products? I have noticed that fresh laundry begins to develop a...musty?...odor after it has been washed on a day when the water smells of heavy chlorine. Scented sprays marketed as "laundry fresheners" have hit the store shelves in ever-greater numbers in recent years. Maybe other people in the area are getting musty-smelling laundry as well?

It is surely a thought worth pursuing, though I'm not sure how I would address the problem if this proves to be the cause. I can't do my laundry in bottled Evian, but I could surely switch to other materials. I still have some of my wool and wool-blend cycling clothing, stored in zip-lock bags in my gear lockers. It's in good shape, but retired because the lycra stuff was less trouble and, well, I didn't want to advertise "Retro-Grouch" any more loudly. The eyeglass-mounted rearview mirror pretty well does that. I wonder if I could also find something to kill-off bacteria mid-ride. The Bikini Zone product helps greatly. If I could figure out what they put in it, I'd be halfway home.

Thanks, Ian, for giving me an avenue to pursue; really sharp-thinking there, and very much appreciated!

Now you tell me and I've just invested...

Hold tight, Chris; you may be fine unless you live immediately downstream from the nuclear power er, wastewater treatment plant. Or don't live too many hours in the clothing without changing it.  As for my nether regions, on shorter rides, I always wore cycling shorts alone, putting them promptly in the wash upon my return (riding on an underwear seam once caused me a saddle-sore/boil bad enough to crater. Ever after, it was "Go-Commando, Danneaux"). The exception is when I am on-tour and cannot wash my cycling shorts regularly due to a lack of fresh water (much of the water where I go is contaminated with alkali-/dissolved-lye). For those occasions, I use an unpadded, open-mesh synthetic underwear that washes and dries quickly. My brand (cyclists' SpinSkins) is apparently no longer made, but it is essentially the same concept as this one but with lots of breathable mesh and no padding: http://www.andiamounderwear.com/mens/briefs.php Washable under a water bottle and dryable in about 45 minutes outdoors, they've really helped when laundry facilities are unavailable or when I don't have time for a pair of lycra shorts with synthetic padded chamois to dry.

Best,

Dan.

[triaesthete]

I'm glad you liked that Dan. I find it helps to look at a problem like this in a broader context. You describe your doctors as reliant on antibiotics  and they are because they are taught to treat a symptom or fault in isolation rather than view it as an imbalance in a system. Many things you say you have tried seem similarly targeted on a fix for a simple cause/effect fault.
Have you considered the onset timing of the 1.0 relationship may mark the point you developed an allergy as opposed to previous sensitivity?
Do you use regular (harsh)soaps and overclean your skin? The chemical industry want you to but this strips the skin of all natural fauna, good and bad.
Biological washing powders don't work well with many synthetic fabrics and can leave residue in clothes, do you use non bio and does your machine rinse well?
Ian

[Danneaux]

Ian, you've offered some more very good points to ponder, and I appreciate them greatly. It always helps to have a fresh set of eyes to look at a problem, and is exactly what I was hoping for with my post. I'll go through the ingredients on my washing soaps this evening and see what I can learn. I have taken plains to use so-called "clear" detergents that have no added perfumes and minimal additives, but I have sometimes been fooled. "Green" is a great marketing tool, and sometimes the manufacturers don't play fairly.

The one thing that encourages me is I don't develop folliculitis in street clothing, so Miguel may be onto something in terms of suggesting a non-restrictive fit. Or, it may be the duration of exposure and the conditions (i.e. heavy perspiration trapped while riding the extra-long distances making for the equivalent of hot-tub-acquired folliculitis). Too, some jerseys washed identically (and with seemingly identical fabric content) are definitely worse than others, so I need to investigate that as well.

You're absolutely right, a holistic approach of looking a the bigger picture is bound to be helpful, as this is a persistent problem seemingly triggered by a specific set of circumstances. Focusing only on those might cause me to miss another contributor or trigger. You've some really good ideas!

Best,

Dan.

[triaesthete]

Maybe the street/sports clothing distinction is less clearcut if you never sweat a lot in street clothes. I'm hypothesising along lines of no/less  sweat in street clothes therefore no/less reaction from wetted detergent/chlorine residue?

[jags]

I'm sticking to my lycra bibs nothing has fallen off thus far

[Danneaux]

nothing has fallen off thus far

Snorkk!  Drinking tea at the time I read this! Hahahaha! You got me going with that one, jags!  

Sort of a belt-and-suspenders approach, leaving nothing to chance, eh?

I have one set of bibs (my 3/4 pants or "knee-tights" as the Dutch call them), but they require me to disrobe when I hear nature's call. Off comes the jacket and jersey so I can slide off the bib-straps. At some times of year, that gets a bit cold and turns a quick process into a bit of a hassle. Is there a secret to it? Maybe wearing the bib straps over the jersey?

Best (and still chuckling),

Dan.

[il padrone]

Always olive oil with the vinegar for that mediterranean touch. A benefit that you can just drizzle over the salad at lunchtime  

[Danneaux]

Always olive oil with the vinegar...

Made my evening, Pete!

Every tourist's goal is at least two uses for every product carried. Spot-treatment and dressing; well done! 

Still chuckling, 

Dan.

[Fred A-M]

Would suggest turmeric pills - helps cleanse the blood decreasing vulnerability to skin infections.  Whether this is scientifically proven, I'm not sure, but I've tried it and it seems to have helped when I've suffered from said condition!  Worth a try I reckon given it hardly costs anything and has other health benefits.