Saddle Sores: Tips from an actual cycling dermatologist, and comments from Grant

A warm, humid crotch and lots of pedaling can lead to skin problems, including the classic saddle sore, in all its throbbing, raging glory. Cycling dermatologist and Rivendell member, Bernie Burton tells us why they happen, how to avoid them, and if you don't pay attention, how to get rid of them. 

by Bernie Burton, M.D.

The saddle sore develops in three stages.

Stage 1: Hot Spot or Abrasion

This is caused by rubbing your thighs and skin under the ischial tuberosities (ishi al toober aw cities, but from now on, just "sit bones") against the saddle. Pedaling or just riding over bumps can cause this.

Since abrasion is the cause, decrease or eliminate it. Here's how:

1. Set your saddle to the proper height. If your saddle is too high, your sit bones will rock over the saddle as you pedal, causing friction.

2. Get a good saddle. It should be wide enough to support the sit bones; smooth, so it doesn't cause friction; and it shouldn't be filled with shiftable mushy gel, which can move around, increasing friction. Leather is a good start. It's smooth, doesn't shift, and depending on the model, supports the sit bones properly. I personally ride a Brooks B.17, but I've been a leather saddle fan longer than Rivendell has existed. Any sort of suspension -- ranging from higher volume tires at lower pressure to Allsop Beams, may reduce friction, too.

3. Wear seamless-chamois cycling shorts (if you're getting sores in the areas of seam-to-skin contact). Some chamois has a baseball-style seam; some have a single seam up the middle; and some have none at all. Figure out what works for you. Seams in cycling short chamois tend to be flat, and most cause no problem, but if you find yourself irritated by them, get shorts with a seamless chamois.

4. Coat your skin and/or chamois cycling shorts with Vaseline Petroleum jelly. Cover under your sit bones, and any place that might rub, or has been a problem in the past.

One concern some riders have with Vaseline is that it might plug their sweat ducts. This is more likely to be a problem on faces, where the ducts are smaller. I've never seen clogged crotch ducts. Vaseline is pure, and nobody is allergic to it. If you ride a lot, by all means, get some.

What If I Still Get a Saddle Sore?

Treat the first symptom (the hot spot) with Bag Balm®. This old fashion medication, designed for a milk cow's sore and irritated teats (from too much frictional rubbing) is available at many pharmacies and animal supply stores. Lot of Bag Balm® applied to irritated areas immediately after your shower will usually result in recovery overnight. This will help heal the superficial wound and prevent its worsening while you're off the bike.

If using a goop originally developed for cow teats makes you uneasy, get a prescription for a strength topical steroid ointment such as Temovate®. There are side effects and dangers with frequent usage, and it costs ten to forty times as much as Bag Balm®.

Whether you use Bag Balm® or prescription steroid ointments, apply it in the evening, and cover it with Vaseline the follow morning. If, after riding several hours, this area of irritation again appears, smear on more Vaseline. 

Stage 2: Folliculitis

This looks like acne -- small red bumps with puss-filled heads. These are found in hair follicles, and there's often a hair sprouting right out of the puss-filled bump. If this sounds like something you'd like to prevent, just ride with freshly-laundered cycling shorts each day, and/or use lots of Vaseline. Topical antibiotic gel or oral antibiotics may help, too.

Note: If you start your rides with a clean crotch and a clean, Vaseline-covered chamois, and you reapply Vaseline daily, you can go a week or two without laundering your shorts. That's how good Vaseline is.

Stage 3: Abscess

This is an infected, red, hot, swollen, tender bump that varies in diameter between a third of an inch to two inches. These frequently scar over and may form sinus tracks with extensions going in multiple directions from the original lesion. In addition, cysts may form that totally surround the abscess after it has been resolved, or may develop directly from the folliculitis stage without abscess development. 

If an abscess occurs, quit riding until they're healed. Go to your doctor (whom you should have seen before now), who then may prescribe oral antibiotics.

Soap Tips For Folks With Problem Crotch Skin 

Cetaphil®, Dove® or Purpose® soap. Wash gently and moisturize with simple emollients like Eucerin Creme®, Aquaphor®, Moisturel®, Curel® or Bag Balm®. You may actively reverse irritant dermatitis by using over-the-counter 1% Hydrocortisone Ointment, or prescription hydrocortisone ointments.

A little TLC to the groin to prevent irritation and lots of Vaseline will keep you riding long and pain-free.

I would like to graciously thank Harry Hurley, M.D., a superb academic and general dermatologist. -B.B.


Grant would love to add: If you're getting saddle sores, you're riding too much, too many hours at a time. Back off some.