RX for Saddle Sores

If this post looks familiar it's because it's a massive update of an old post. I tried to update it one too many times, and it just got confusing and had become obsolete when Triclosan was banned, Lysol Laundry Sanitizer became available again, and  Dial came out with a new foaming soap I love because it is full of glycerine, which is a moisturizer that is oil, so it will never dry and works wonderfully to keep your chamois interface well maintained. So, without further adieu...

The emergence of saddle sores is often met with macho bravado, and this is a HUGE mistake. Often times, and this was certainly true in my case during MIBM, these are not sores at all, but crushing and tearing wounds that create permanent scars and injury which never fully heal. Such wounds will forever limit your saddle time, and deserve an all-out, maximum remedial effort.

There are distinctions to be made between tearing/crushing wounds, sores/boils attendant with infected pimples, or hair follicles, and chaffing or pressure soreness.You may well need the help of a really GOOD friend to address pimples and in-grown hairs (a surprisingly common problem btw, and look like pimples). Huggies wet-wipe bum wipes for babies are a great idea in general, and will help keep the area very clean and sanitized. You'll be shocked at how much you've been leaving behind after using Huggies, or any other wet bum wipe.

Impossible to find, now back in force killing COVID-19

Of course, the best injury is one that never happens, and to that end here are some good ways to prevent saddle sores.

1. Clean and Sterilize your shorts, chamois and seat. Never use bleach on your shorts, or anything else with Lycra for compression. Bleach kills Lycra! Your shorts will end up ruined. Jerseys, headsweats, etc are much more tolerant of mild bleaching, but much better to use Lysol Laundry Sanitizer.  Yes, it kills COVID-19.
   
2. Wash you bottom side with a good antibacterial soap, like Dial Complete, which contains glycerin (same stuff they put in hand sanitizers like Purell) to moisturize, or for problem areas, use  chlorhexidine gluconate soap like Hibiclens to sterilize your skin for 6-8 hours. Use this RX for road rash as a general guideline. Wallgreen's soap is cheaper and smells better than Hibiclens, but both are excellent. Yes, it too kills COVID-19. The Chinese bought a million gallons of it from Canada to combat COVID-19.
   
3. Keep skin in tear-prone areas elastic by using petroleum jelly based Neosporin, brand name or otherwise. Lotion dries out and doesn't kill bacteria.
   
4. Keep your bottom side dry and ventilated for boils or infections. Save Neosporin for time in the saddle as it will suffocate the wound and retard healing. Apply Hibiclens every 6 hours.
5. Use an alternative short with a different kind of chamois, different shaped seat, or some combination of these to change the pressure points on your bottom.
6. Try a seat with a center channel void to increase ventilation to promote drying and cooling, although at 185lbs, I find a full-contact area seat to be better. 
7. Buy better shorts, and BIB shorts with high compression so they stay put and protect you. The best I have found to date are the Pearl Izumi PRO bib shorts. I can do 2-3 metric centuries in a week with these and rides of 70-85 miles with no problems.
   

Once the sore spot develops significantly, you either need to avoid putting further stress on it, or get off the bike. For boils, use max sterilization protocols, and turn everything up louder than everything else. I caught my boil very early, and stayed off the bike for 5 days, as I also was dealing with a tearing wound.

Dial Complete antibacterial foaming soap

I have not tried talc, cornstarch, or Baby Powder, but have it on good authority that these often work better than chamois butter, lotion, or Utter Butter. I used Utter Butter, and wasn't impressed. Palmer's coco butter lotion was still there and still slick at the end of a bunch of 60 mile rides.

If boils blister, you can pierce with a sterile needle. Using a hemostat and needle, dip the needle and end of hemostat in a small tray/dish of 99% alcohol, and then light on fire with a butane lighter. Let cool and you have a very sterile instrument. Everything that comes out of the boil is infected and full of bacteria, so use Hibiclens to persistently sterilized the surrounding area, and rewash the boil and area after popping it with a sterile needle.

Personally, in a MIBM situation, where you want to minimize the time off the bike, I'd find a good doctor as soon as there is any blistering. Women should be careful not to get Hibiclens on their girl part/s as it has been known to cause numbness. Betadine is a good alternative here, but doesn't have the persistence that Hibiclens does.

Properties of various antimicrobials

 Note that the compound in Dial, and most other antibacterial soaps is now Benzalkonium Chloride, as Tricolsan is no longer legal in the US. These soaps get the big chunks off, so the Hibiclens can soak in and get the deep stuff, and keep on killing pathogens for 6+ hours.

Also note that many of these compounds are partially neutralized by organic material, including the cotton in a cotton washcloth Use a synthetic microfiber washcloth for washing. They are commonly available as microtex dish cloths in the grocery store kitchen cleaning supplies area. Mine is labeled Mr Clean. I bought it at Safeway.

These can be sterilized by washing in bleach(kills almost everything known to man), which insures your washcloth stays part of the solution, and doesn't become part of the problem. Just be very sure you rinse all the bleach out, as it will destroy the action of Hibiclens.

RX for Road Rash

Hands-off, micro-porous, spray-on liquid bandage

Sooner or later we all get to that day when our luck runs out and we limp home with a bad case of road-rash. Even Lance Armstrong has those days. I have found a very effective way of treating road-rash as a by-product of learning to care for a friend with a severely impaired immune system.



The remedy has two parts. Cleaning with Hibiclens, and then shielding with a Curad Liquid Bandage. Hibiclens has fantastic property - it soaks into your skin and continues to kill pathogens for 6-8 hours when protected by a liquid bandage.  

Hibiclens (chlorhexidine gluconate) and the Triclosan used in anti-bacterial soaps both break down into ammonia compounds, so have complimentary chemistry, and doing the initial debriding with an antibacterial soap like Dial (lasts 45 min) gives Hibiclens a near sterile environment to start from. This insures that adequate amounts of ammonia are available to kill any residual pathogens should they emerge from deeper in the skin.

DO NOT USE with a lye-based soap such as Ivory Bar Soap. The lye will react with the ammonia and release all of it immediately - destroying Hibiclens' time-released properties.

Hibiclens is an excellent, non-irritating, pre-surgical wash, safe for hands and skin. It is sold at Wallgreens stores, and except for letting it sit on the skin for a few minutes to soak in, works like any other soap. It will NOT damage skin like peroxide or alcohol, which would almost certainly cause scaring. 

Debriding can be done with a surgical scrub brush, but I find those to be overkill for typical road rash. They are made for cleaning intact skin before surgery, not shredded flesh. It's important to get the wound clean, but not cause more damage, as this will delay healing and cause scaring.

Better is a microfiber cloth, usually sold as dish cloths at the supermarket, because both Triclosan and   Chlorhexidine Gluconate are mildly degraded by organic materials - like the cotton of a cotton washcloth. You might also try using the sleeve of a heavy fleece jacket. These will often brush the sand and grit off the skin, and will create a nice lather that will lift debris from the wound surface, all while being very kind to your skin.
 
When Hibiclens was sold by Regent they had a great web page link to Connecticut General Hospital which recommended that anyone about to undergo elective surgery shower with Hibiclens the night before and morning of the surgery. It is also very effective for acne, and I personally find it very helpful for ridding my scalp of sores that seem to crop up where the straps of my helmet attach to the hard plastic thing in back. One or two applications is sufficient. It is a liquid soap. Leave it on the wound a few minutes to maximize penetration.

CAVEATS: Since it penetrates and bonds with flesh far below the surface there are a few places it should NEVER go.

1. Eyes
2. Ears
3. Girl parts (betadine is the go-to antimicrobial for this application)
4. Boy parts with lots of nerve endings (need I say more?)

The Curad bandage sprays on as an aerosol, dries in about 5 seconds, and stays on for 2-3 days. Neosporin can be used to lube the surface for chaffing, but it will suffocate the skin under it and delay healing. Neosporin has some significant risks. Use intelligently and sparingly. It is now sold in a hands-free spray-on package. I carry one in my saddle bag.

In a pinch, 99% isopropyl or 70%+ ethyl alcohol mixed 50/50 with Ceapasol (cetylpyridinium chloride) mouthwash makes a good anti-microbial. Cetylpyridinium chloride was approved by the USDA for sterilizing meat and vegetables and showed 10-log kills 30 days after application, so it's very, very persistent. I just don't like the alcohol on raw skin.

The glycerin in the mouthwash buffers the alcohol very effectively to prevent burning, although it tends to dry just a bit sticky. Anything you can put in your mouth is going to be pretty gentle on rashes. Alcohol concentrations less than 50% are ineffective, so omit entirely below these concentrations. (all mouthwashes used to have 40-50% alcohol until a few years ago when concentrations above 20% were shown to cause an increase in mouth cancer)

A bit off topic, except perhaps for compound bone breaks, but for deep penetrating wounds honey is about as good as it gets for externally applied anti-microbials. Any veterinarian that cares for horses knows this. Certain kinds of honey are preferred for this use as bees add special compounds to the high sugar content - which adds to sugar's primary mechanism of high osmotic pressure in killing pathogens.



For Century riders and Triathletes, showering with Hibiclens the morning of the event seems like a good precaution and will give you a good level of embedded protection already in place should your luck run a little thin.