August 2015 Issue
Focus on Fitness: Exercising With Skin Conditions
By Jennifer Van Pelt, MA
Vol. 17 No. 8 P. 60
It's a challenge, but it's not impossible.
Muscle strains, shin splints, overuse injuries, asthma. These are the typical exercise-related conditions most fitness experts focus on when cautioning clients about overdoing it. Rarely are clients counseled about exercise and the health of their skin. Since August is Psoriasis Awareness Month, I'll be discussing how exercise affects clients who have psoriasis, as well as those with rosacea, another common skin condition. I'll also briefly review conditions that can be caused by exercising, including acne mechanica and athlete's foot.
Psoriasis is a chronic, noncontagious autoimmune disease that increases the growth cycle of skin cells, resulting in raised, red patches of skin (plaques) covered with silver-white build-up (scale). According to the National Psoriasis Foundation, it's the most common autoimmune disease in the United States, affecting up to 7.5 million Americans; 80% of those with psoriasis have plaque psoriasis. Approximately 25% of those with psoriasis also develop psoriatic arthritis, an inflammatory autoimmune-related arthritis that causes joint pain. While the disease can occur at any age, it most commonly emerges between the ages of 15 and 35—when clients may be most active. Psoriasis significantly impacts quality of life. Those with psoriasis have reported feeling self-conscious, embarrassed, and even helpless during flare-ups of the disease. As a result, they may avoid exercising in public if their plaques are in areas visible to others.
Exercising with psoriasis also is challenging because any damage to the skin can trigger psoriasis flare-ups; and even sweating and minor chafing around the groin, breasts, or abdomen can cause plaques to develop in those areas. Vigorous exercise can aggravate psoriatic arthritis, causing severe joint pain. The National Psoriasis Foundation recommends the following tips for exercising with psoriasis:
• Water exercise is easy on the joints for those affected by psoriatic arthritis. Plaque psoriasis shouldn't discourage clients from swimming and participating in water aerobics. Petroleum jelly or mineral oil can be used on affected areas of skin before entering the pool to minimize the drying and irritation from chlorine. Self-conscious clients can invest in Lycra swimming gear that covers the body, commonly used by surfers and competitive swimmers.
• For clients with psoriatic arthritis, performing range-of-motion exercises regularly can improve mobility and reduce pain. The Arthritis Foundation and the National Psoriasis Foundation have created the Be Joint Smart resource, available at www.psoriasis.org/events/educational/be-joint-smart.
• Wearing looser clothing to lessen friction against the skin will protect sensitive skin from plaque flare-ups. Petroleum jelly, mineral oil, and/or sweat-absorbing powder can be applied before exercising to areas prone to chafing and irritation.
• Showering immediately after exercise, with gentle washing, not rubbing or scrubbing, can help sensitive skin. If an area appears to be chafed or developing a plaque, clients can use a topical psoriasis medication prescribed by their doctor.
Despite some of these skin- and joint-related side effects, exercise should be encouraged for those with psoriasis based on results of studies demonstrating its benefits. In a March 2014 randomized controlled trial that included 303 overweight or obese patients with moderate to severe chronic plaque psoriasis, researchers compared a 20-week diet plus a physical exercise plan with information-only counseling about diet and exercise. Participants in the diet/exercise group not only lost weight but also had a 48% median reduction in psoriasis area and severity. The group receiving information only had less weight loss and a 25.5% median reduction in psoriasis area and severity.1 An analysis of data from the Nurses' Health Study II, which included a cohort of 116,430 women aged 27 to 44, found that of the subgroup of 85,655 women who answered questions about psoriasis and also completed physical activity questionnaires, vigorous physical activity was independently associated with a reduced risk of psoriasis.2
Another common skin condition that may be affected by exercise is rosacea. According to the National Rosacea Society, 16 million Americans have rosacea, a chronic and potentially life-disrupting disorder that primarily affects the facial skin and often is characterized by flare-ups and remissions. Symptoms of rosacea include facial flushing and persistent redness over the cheeks and nose, red bumps and pimples, visible blood vessels on the face, eye irritation, stinging and itching sensations on the face, raised red patches, skin thickening around the nose, and occurrence of rosacea symptoms on the neck, chest, scalp, or ears.
Vigorous exercise, especially cardiovascular activities that raise heart rate, respiration, and body temperature, can cause flare-ups of rosacea symptoms. The National Rosacea Society advises the following to minimize flare-ups related to exercise:
• Choose low-impact and low-intensity workouts, such as Pilates, yoga, and aquatic exercise, that are less likely to cause overheating.
• Try multiple shorter exercise sessions during the day, rather than longer intense workout sessions.
• Be aware of indoor and outdoor climates. Indoor heat can be irritating, so using a fan or a cool damp towel on the neck to avoid overheating may be necessary for indoor workouts. Outdoor exercise also can aggravate rosacea; hot sun and high temperatures in summer, cold winter weather, and wind all contribute to rosacea symptoms. Protective garments (eg, hats, scarves) and sunscreen should be worn for any outdoor activity.
• Environmental and lifestyle triggers for rosacea flares differ for each individual.
The National Rosacea Society has a rosacea diary to track exercise and rosacea triggers, available at www.rosacea.org/patients/materials/diary/index.php.
Other Skin Conditions
Different types of exercise can cause other skin issues. Some are contagious, such as athlete's foot and plantar warts. And others, such as acne mechanica, result from conditions that occur during exercise. If your clients play a team sport, use the locker room and public mats at a gym, or frequent indoor swimming pools, they should be made aware of athlete's foot and plantar warts. Both are contagious fungal infections that thrive in warm, moist environments. Over-the-counter antifungal products can treat mild cases; severe cases may require treatment by a physician. To prevent these fungal infections, advise clients to do the following:
• use antifungal powder in their athletic shoes daily;
• wear synthetic socks that draw moisture away from the feet;
• wear waterproof shoes or sandals in locker rooms and pools;
• use their own mats in gym classes requiring bare feet, such as yoga and Pilates; wear socks or slip-on shoes when walking off the mat; and
• ensure shoes worn during exercise and sports are dry before wearing again, or invest in a second pair to wear when the other pair isn't dry.
Acne mechanica results from wearing pore-blocking exercise gear, such as helmets and padding, though it can occur from certain types of clothing fabrics. Cyclists, football players, and those who wear wicking fabrics during exercise may develop this red, pustular, painful acnelike rash on the chin, forehead, or any skin area that presses against padding or irritative fabric. This condition can be treated with mild acne prescription medication and topical antibiotic lotions. Preventive methods include placing a breathable fabric between the skin and padding or helmet and avoiding exercise clothing with wicking fabric if acne mechanica develops.
Clients with skin conditions who pay attention and take the appropriate precautions before and during exercise can minimize skin irritations. It's also important to keep in mind that exercise is beneficial to the skin. Any activity that increases circulation contributes to healthy skin, creating that "healthy glow."
— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care research analyst/consultant in the Reading, Pennsylvania, area.
1. Naldi L, Conti A, Cazzaniga S, et al. Diet and physical exercise in psoriasis: a randomized controlled trial. Br J Dermatol. 2014;170(3):634-642.
2. Frankel HC, Han J, Li T, Qureshi AA. The association between physical activity and the risk of incident psoriasis. Arch Dermatol. 2012;148(8):918-924.