Whether you call it hiker’s rash, runner’s rash, golfer’s vasculitis or even Disney rash (Yes that is a thing) they all refer to the same condition. So what is hiker’s rash? In this article, I will go through everything you need to know: causes, treatments and prevention.

Note: I am not a medical professional and I don’t claim to be one. This article is based on personal experiences and research. Should you need medical advice, please consult your GP.

I knew it. It was the last stretch of the 23.93 miles (38.5 km) Berkhamsted Circular Walk. We were walking so fast to make it on time to the station for our train back to London. I felt it. This itching and burning sensation on the lower parts of my legs. Heat rash, I thought! Actually, not exactly. I was wrong.

It was hiker’s rash.

What exactly is hiker’s rash? Here are the responses to all the questions you never dare asked about the hiker’s rash.

What is hiker’s rash?

Why do I get itchy when I hiking? More likely because you develop what is called a hiker’s rash, a reddish bumpy patch on the lower legs right above the socks line. So what is exactly a hiker’s rash and what causes it?

What does Hiker’s rash look like?

By its scientific name exercise-induced vasculitis, hiker’s rash appears on the lower leg and can stretch from the ankle to the knee, on the part of the skin which is exposed (not covered by clothing or under the socks).

The swelling on the leg translates into reddish raised hives, sometimes purple. As the skin is upset, it is uncomfortable, but not always painful, to be walking in this condition. When aching, the symptoms are a sensation of itch, tingle or even burn. Some people don’t even know they have hiker’s rash until they take off their socks. Unfortunately, I belong to the first group, and the sensation of burn wants to make me jump into an ice bath!

The following day, the rash turns bright red and the raised welts disappear and is replaced by a flat sunburn looking stain on the skin. It can later turn into blisters.

However, hiker’s rash is purely a skin condition and is not accompanied by nausea, vomiting, fever or headache symptoms.

Hiker’s rash is not contagious, it is your problem and yours only. It is also not seen as harmful to health by doctors as it resolves in 3 to 10 days without any treatment.

What cause the hiker’s rash?

As its names indicate, exercise-induced vasculitis appears during or after a long period of activity such as:

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• Walk
• Hike
• Run
• Golf
• Step aerobic
• Body building
• Swimming

Moreover, hiker’s rash appears when exercising during hot, sunny and humid weather. Even though this might not sound like the exact definition of the weather you get here in the UK, don’t let it fool you. You can get exercise-induced vasculitis when hiking in Britain.

When exercising, your heart rate increases, sending more oxygen into the blood vessels. The oxygen reaches the muscle and converts the glucose into energy so you can keep going. However, during a prolonged period of activity, it can happen that your body cannot keep up with the delivery of oxygen to the muscle and returning the blood to the heart against gravity. Therefore, the blood stays at the extremities, creating pools in the vessels. This is when the rash occurs.

There are two categories of hikers who are particularly prone to develop hiker’s rash. The first one is new hikers as their muscles are not in the habit of working out, therefore, require more oxygen to keep up. Though, I have been hiking for 2 years and do experience the ill effects of hiker’s rash. Am I still considered a beginner? The second category is women over 50. This can be explained as ageing vessels are less efficient to send the blood back to the heart. As much as I am a woman, I unquestionably do not meet the second criteria. I guess I am the exception to the rule then …

How to treat Hiker’s rash?

Even though the rash will resolve even if untreated, there are a few ways you can use to alleviate the pain and accelerate the healing process.

Cool it

Because it burns, cools it down! There are a few things you can do to ease the sensation of burn.

• Use a cool washcloth
• Use a ice pack
• Take a cool bath

If the rash flares up when you are on a multi-day hike, here is what you can do:

• Use a wet buff or spare T-shirt and apply it against your leg
• Soak your legs in cool water (ie: a stream or a lake depending on where you are)
• Apply snow on your legs (of course that is dependant on where you are hiking)

These are natural treatments you can use for hiker’s rash. However, there are alternate approaches to treat it.

Cover it

You MUST keep the rash away from the sun! This will just exarcerbate it. Therefore, as much as this might sound like the last thing you want to do when hiking on a hot day, discard the shorts and wear long trousers. You can find light wear fabrics that are breathable so you won’t overheat. Also, avoid using black colour as it absorbs more light which then turns into heat.

Cream it

If you are prone to hiker’s rash, I cannot recommend you enough to carry with you a topical corticosteroid cream. They act as an anti-inflammatory and they work by reducing the swelling and the pain. Apply it to the affected area, this will prevent scratching open the skin and risking an infection.

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You can buy them over-the-counter in any pharmacy.

Medecine it

In addition to the topical corticosteroids cream, I also take antihistamines. It is a drug that can be bought without prescription which is usually recommended to treat hay fever. However, it can be a great help in our case. When the body is attacked, its reactions are to grow the vessels resulting in red bumps on the skin and release a substance called histamine. Antihistamine assists with halting the process and therefore decrease the swelling.

Compress it

Wearing compression stocking won’t cure the rash nonetheless, it will support the healing process. Alone, the compression stocking might not make a difference, but used in addition to a cream and other treatments described above, it will speed up the recovery.

Elevate it

Since the blood is stuck at the extremities, lying on your bed and putting your legs up will help the blood flow and return to the heart. I found that doing it additionally reduce the swelling.

Take care of yourself

Finally, one of the ways to treat the hiker’s rash is to take care of yourself. During the recovery period, drink lots of fluid. One of my tips is to drink hot water as it increases blood circulation through the veins. I carry hot water with me at work using an insulated bottle to keep it warm and prevent spillage in the handbag.

To know more about the benefits of an insulated water bottle, click here.

Take a rest. Allow some time for your body to recover. But what if I am on a multi-day hike? Change your plan. It is smarter to take a day off than continue under such unpleasant circumstances.

How do you get rid of exercise-induced vasculitis forever?

Unfortunately, you can’t. Research shows that 78% of people who developed hiker’s rash once will relapse. You can treat it but not cure it.

However, to avoid having to treat it, you can also take some measures to prevent it from happening.

How to prevent it?

Clothing

I might sound a bit redundant but keeping your skin away from the sun is the best preventive measure you can take. Wear light clothing, if possible in moisture-wicking fabric to absorb the sweat. Underneath the trouser, wear compression socks as they assist the vessels to return blood to the heart.

If you really want to go with a short, make sure you wear sunscreen on your legs.

One of the first things I did was to change socks. I traded my cheap and used pair of hiking socks for a pair of Feideer socks from Amazon. The result even after a 45 km (27.96 miles) hike? Mind-blowing! No rash on my legs at all.

I would recommend that you wear compressing socks as well. They help prevent the rash from flaring up by supporting the blood vessel sending the blood back to the heart. It gives you a funny look of a field hockey player when worn with shorts but at the end what is the most ridiculous look: compressing socks or hiker’s rash all over your lower legs?

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Additionally, following a bad fall in 2019, I now wear a knee support when going on long and challenging hikes. I have noticed that I developed hiker’s rash around the strap as well. As a preventive measure now, I wear a knee support bandage underneath so that the knee support is not in contact with the skin and no rash appears on my leg. You can buy knee support bandage in any pharmacy, I got mine at Boots.

Prevention during the hike

When you start feeling the first prickling on your leg, there are a few things you can do to avoid it flaring up:

• Take breaks. Allow your body time to rest to delay the skin from breaking up
• Cool down in the water. On the off chance that you are near a stream or a pond, immerse your legs in the water to calm the skin
• Elevate your legs during the breaks to help the blood returning to the heart
• Apply aloe vera which is an effective anti-inflammatory
• Stay hydrated. Water is your fuel when exercising and it helps to regulate the body cooling system

Other types of rashes

Hiker’s rash is not the only rash that can occur when hiking. There are other types of rashes that should not be confused with hikers rash and require different prevention methods and treatments. Here is a non-exhaustive list:

• Heat rash (also called Prickly Heat): It is characterised by itchy red dots on the skin which develop near body parts where you normally sweat such as the underarms. Like hiker’s rash, the heat rash resolves within a few days without treatment.
• Poison Ivy (also called Oak Rash): It develops due to contact with poison ivy and takes around 3 days before showing on the leg. It looks like an itchy red rash where the plant rubbed the skin. It can turn into blisters and take one to three weeks to disappear.

Final thoughts

Even though the hiker’s rash resolves after a few days if the problem persists you need to see a specialist. All of the above is just advice based on my own experience and what worked for me. Of course, you need to follow the medical advice from your doctor.

If you are or have been suffering from hiker’s rash let me know in the comment and share your experience and tips. Let’s not suffer in silence!

PS 1: We did make it on time to the train station to catch our train, but the train was cancelled

PS 2: Still wondering why it is also called Disney Rash? When people are visiting a theme park, they walk a lot under hot weather, therefore recreating the same conditions for the rash to flare up.