While hiking can be an exhilarating experience for anyone, it may come with unpleasant ramifications like painful rashes on the calves. So, what is a hikers rash?

As a hiker, you must have, at one point or another, noticed inflamed lesions, known as the hiker's rash, above your ankles post-hiking, especially in summers.

A hiker's rash is a dermatological condition, medically known as exercise-induced vasculitis (EIV), in which small blood vessels in the legs swell, leaking blood into the outer skin. This results in reddish/purplish blotches on the lower legs, often accompanied by itching or burning.  

Going on a hike is certainly something outdoor enthusiasts look forward to, but once you experience the discomfort caused by the hiker's rash, you start to wonder if you want to go through it again.

As a passionate hiker and someone who has dealt with EIV more than once, I have had the same thought many times before heading for a hike. But after reading up on the condition, I found myself better prepared to manage it while trudging on rocky trails.

What Is Hikers Rash?

Hiker's rash, golfer's rash, Disney rash, flip flop rash, runner's rash, or golfer's vasculitis is the name given to a skin reaction on the lower legs which occurs due to prolonged exertion on the muscles.

When a person is out gallivanting in the outdoors, scaling mountains, their legs are constantly moving. This causes extreme pressure on the muscles, resulting in capillary bleeding into the dermis.

Simply put, our muscles require oxygen in order to function, which is provided by the capillaries. But when our muscles are in overdrive as they are during hikes, our blood vessels struggle to meet the excessive demand for oxygen.

Consequently, the capillaries inflame and start dripping blood into the surrounding tissues. Hence the name, vasculitis since vasc means blood vessels and itis means inflammation.

This vasculitis translates into reddish or purplish (medically known as purpuric) lesions on the skin in the lower legs.

Another more straightforward explanation of the pooling of blood in a trekker's lower extremity is their motion against gravity. That is since a person is generally going up while on a hike, the blood in their lower legs accumulates and doesn't return to the heart as readily as required.

As a result, an erythematous rash- characterized by bumpy red patches that form due to the accumulation of blood in the outer skin, appears on the skin.

Sometimes a hiker's rash can be tremendously painful, in which case a person may feel a burning, stinging sensation at the wound site.

There may also be instances when a hiker's rash begins to itch nonstop. Typically, in such a scenario, people who haven't experienced EIV before end up scratching their wound, agitating the skin further.

What Causes Hiker's Rash?

As I have already discussed the physiological etiology above, here I will focus on the environmental factors that lead to the hiker's rash.

Although the flip flop rash is called exercise-induced vasculitis, it primarily happens to people during hikes in warm weather. That said, you can get it from working out aggressively in any form under the sun.

Whether you run, golf, or build muscle, if you do any of that for an extended period of time in the scorching summer heat, you will most likely develop EIV.

As a general rule of thumb, remember that whenever there is too much heat and humidity in the atmosphere, you are at risk of getting a hiker's rash if you engage in any strenuous activity.

And that holds even if the weather is windy.

Another external contributor to EIV is a hiker's attire during a trek. If you wear something that exposes your lower legs, your chances of contracting the common excursion malady will be high.

Furthermore, you may notice that your ankles and feet remain rash-free even when you have had socks on the entire time during your outdoor adventure. This happens because a hiker's rash doesn't form below the sock line as it is covered for the better part of one's journey.

In a nutshell, prolonged exposure to the sun, strenuous physical movement, and high atmospheric temperature can greatly increase your odds of developing a hiker's rash.

Who Is More at Risk of Getting Hiker's Rash?

While pretty much everyone who goes out into the open and exposes themselves to the sun while exercising (in any form) can get EIV, there are two categories of people who are more prone to it.

Women above the age of 50 and people not used to working out are more susceptible to exercise-induced vasculitis.

Why that is the case requires more research. However, it is believed that people whose bodies are not used to physical exertion need more oxygen initially when they start going on hikes or indulging in any kind of outdoorsy adventure/sport.

Resultantly, the blood in their lower legs pools, causing skin lesions.

What Are the Symptoms of Hiker's Rash

As the title implies, a hiker's rash is a dermatological condition characterized by red, bumpy patches in a person's lower extremity. However, there can be variations in its appearance.

Some people may have prominently red spots all over their calves and shins, while others may develop reddish and purplish blotches.

On top of the pigmentation on the affected areas, someone with a hiker's rash can feel immense discomfort, burning, tingling, or stinging in their wound. However, that may not happen to everyone.

Some people only develop large patches on their skin without any sensation whatsoever.

Lastly, in some cases, the damaged skin may swell.

The hiker's rash is not contagious and doesn't bring about a fever, diarrhea, or nausea. If you start to experience the symptoms of any of these conditions, you should consult an expert.

Diagnosis And Treatment of Hiker's Rash

There is no blood test to diagnose the hiker's rash; it's generally confirmed clinically. That is, a patient's physical examination is used to determine whether they have EIV or not.

Although dealing with EIV can be difficult, it is easily treatable and not contagious.

Icing or Dabbing the Wound with a Cool Cloth

One of the easiest and most effective solutions to a hiker's rash is exposing it to something chilled, like an ice pack or cool washcloth.

Since EIV is caused due to intense heat, bringing down the body's temperature can help calm the agitated skin. This can be done using the items mentioned above.

Applying an Over-The-Counter Ointment

Rashes of any kind are often treated with over-the-counter creams, and a hiker's rash is no different.

If you develop a golfer's vasculitis, apply an anti-itch cream. Such ointments fall under the category of antihistamines or topical corticosteroids, which are formulations used to provide relief from itching.

Using a Witch Hazel Wipe

Witch hazel is a plant with tannins and oils known to control inflammation and to bleed in the skin.

Moreover, it pulls swollen blood vessels together, stopping the blood from leaking into the surrounding tissues.

Witch hazel-infused wipes or towelettes are readily available in drugstores, so you can carry a pack with you when you go on hikes.

Drinking Plenty of Water

Besides icing, another way to bring down the body's temperature is drinking lots of water. So, if you start experiencing the symptoms of a hiker's rash, keep yourself hydrated.

Elevating Your Feet

Since EIV happens when the blood in your lower legs pools, you can prevent it by elevating your feet to get the blood moving.

If you are on a long hike, you must put your feet up on a rock every so often to ensure that your blood vessels carry the blood toward the heart.

Submerging Your Legs in a Cool Bath

Once you notice the purpuric rash on your calves, fill up a bucket with cold water and soak your legs, at least up to your knees. Doing so will provide much-needed relief to your affected skin.

Hiker's Rash Prevention

Like many skin conditions, hiker's rash can be prevented. However, sometimes precautionary measures may not work. Nonetheless, they are worth a shot.

Wear Breathable Clothing

Hiker's rash forms when the skin is exposed to the sun, which causes excessive sweating that irritates the dermis (of course, there are other factors as well, but sun exposure is a significant one).

Considering that, wearing light clothing to cover up your legs is advisable. But when the humidity levels are high, you should put on stockings or pants that do not retain moisture.

While sweating or moisture retention may not directly cause EIV, it can aggravate and irritate the skin even more. Therefore, covering yourself up with moisture-wicking clothing is essential when hiking.

Wear Sun Protection

Protecting your legs from direct heat is another preventative solution people use to avoid getting EIV. To do that, you can either put on light pants or pull up stockings.

Some hikers say that applying sunscreen is also effective in concealing the skin from the sun. However, more research is needed on the topic.

Put On Compression Stockings

Compression stockings are excellent at improving blood flow in the legs. They are used in many different scenarios where blood circulation in a person's lower body is impaired, for example, post-surgery.

Post-op patients have to lay in bed during recovery, which compromises the blood flow in the legs. But with compression stockings, the issue of constricted capillaries can be prevented as they squeeze the tissue, forcing the blood to gush upwards.

Similarly, when someone is on a hike and their blood begins to pool, wearing compression stockings stops that from happening.

Take Intervals

Since EIV occurs due to excessive exertion on one's legs, taking breaks during physical activity can lower the chances of that.

If you continuously move your body (and that too against gravity), the capillaries in your calves will inflame. As a result, you will develop a golfer's vasculitis.

So, try taking breaks while hiking, even if that slows you down a bit.

Stay Hydrated

Drink a lot of water throughout your hike to stay hydrated and keep your body temperature under control.

Massage Your Legs

Although massaging your lower legs may not drastically improve the blood flow, it can certainly help as it drains the fluid buildup in your calf tissues.

Out of all the preventative measures, the ones that have helped me the most are wearing compression socks, taking breaks, and drinking plenty of water. However, that doesn't mean these will work for you too. You will have to figure that out with trial and error!