The Skin Doctor

HEAL SPLITS, GOBIES, AND WORN TIPS FASTER

In 1978, a young dermatologist made an early ascent of Mescalito on El Capitan (VI 5.9 A4), then went on to establish hard crack routes like Sphinx Crack (5.13b/c) in Colorado’s South Platte, and Tricks are for Kids (5.13) in Indian Creek. Steve Hong also made the first ascents of hard sport routes like Planet X (5.14b) and Homonculus (5.14a), both in Rifle, Colorado. Between hard sport climbing, a history of comp climbing, his experience on cracks and big walls, and a career as a dermatologist, Hong knows a thing or two about how to take care of your skin. He offers some sage advice on protecting one of your most valuable assets.

Nina Williams showsoff her split from Crimping Matters (V10) at Guanella Pass

HEALING GOBIES

Miles of sandstone or just a couple feet of hard granite offwidth can leave climbers bruised, bleeding, and covered in abrasion wounds, what climbers affectionately call gobies. Tape gloves on hand cracks, finger tape on thinner cracks, and good technique where hands don’t thrutch inside the crack can help prevent gobies. These little wounds occur from excessive scraping between the skin and the rock, but the coarseness of the rock also increases the chance of injury.

Places like Joshua Tree with its sharp crystals tend to cause gobies faster than the smoother sandstone of Indian Creek. These abrasions take time to repair, and the body’s healing method is to seal the wound initially with coagulated blood (aka a scab). Underneath this shield, the healing process can then begin. Serum containing all sorts of growth factors is secreted, stimulating a host of cells to start reproducing and heal the wound. White blood cells and antibodies go after invading organisms, fibroblasts in the dermis start producing new collagen, and epidermal cells (the outer layer) grow in from around the wound edges and from deeper hair follicles to form a scab, and slowly the epidermis (outermost layer of skin) heals back to normal. Numerous studies have shown that in conjunction with daily cleansing with soap and water, an artificial “scab,” consisting of an ointment and Band-Aid or wrap that shields the wound from air, results in quicker re-epithelialization (healing of a wound). This translates to: Clean the wound, apply ointment, and cover the wound.

According to some studies, bandaging gobies increases the healing speed by 50 to 80 percent. Refrain from using peroxide or alcohol; instead clean the wound gently with standard hand soap and water. Afterward, apply a bland ointment such as Aquaphor or Vaniply. If properly cleaned, antibiotic ointments like Neosporin are unnecessary. Keeping the wound moist prevents a thick scab from forming, which can actually delay healing. Prescription ointments that stimulate healing exist, but they are generally unnecessary. “Usually I only bother with the treatment for a couple of days, then I lose motivation and let a scab form,” Hong says.

Robin O’leary tapes up his mangled fingers at Movement Climbing and Fitness

SPLITS

A thin cut across the sensitive fingertip can be one of the most painful climbing injuries, and dry air, chalk, and excessive climbing all contribute to split tips. Ultimately dryness, trauma, and sometimes irritant contact dermatitis—a skin disorder that occurs when the skin is injured by friction or environmental factors such as cold, overexposure to water, or chemicals—are the root causes of splits. Keeping the hands moisturized can help prevent splits, and there are prescription hydrating hand creams, like hyaluronic, salicylic, or lactic acid creams that are excellent. One good over-the-counter lactic acid cream is AmLactin. Inspect thin skin and stop climbing before splitting occurs. A bit of prudence can go a long way toward preventing splits.

To treat a split, take a straight-edge razor or a scalpel, then use a magnifying glass or magnifying reading glasses and carefully shave the keratotic edges (the dead excess layer) of the fissure. This is critical because those thickened dead edges delay the epithelium (new skin) from growing over the wound, and the rough edges can catch on things, further traumatizing the fissure.

Apply a bland ointment as mentioned previously, similar to what you would use to treat a gobie, and cover the wound. Some climbers use Band-Aids while others prefer paper tape.

Noah Kaufman, an emergency room doctor and climber, suggests bandaging the split as suggested and then splinting the digit in a straight position overnight. Healing the wound in a straight position prevents the split from healing bent then tearing the next day when extended. Finger splints, popsicle sticks, or any small, straight piece of material taped to the back of the finger can be used as a splint.

Climbing on split tips is possible, but like with any injury, it can worsen the condition. Supergluing a split may allow you to continue climbing through the day, but the glue dries the wound more and delays healing. There are different taping methods, but these treatments should only be used temporarily.

WORN TIPS

A long day of climbing on El Capitan, an extra burn on the sport project, or a huge day of bouldering can all cause the skin on the fingertips to become pink and “thin.” The underlying living epidermis is not really thin; in fact, under the microscope it looks thicker in newly healed wounds. A thin epidermis actually occurs from sunlight damage and old age. However, the dead outer epidermis can get rubbed off, which results in raw, pink skin. Holding on to rock becomes more painful and much harder because the skin, though not cut, tends to weep, releasing plasma. Switching to smoother rock or a different style of handholds can keep you climbing.

Ultimately, to heal worn, pink tips after long days of climbing on sharp rock, simply take the day off. Skin, like muscle, needs time to recover. Little can be done to promote faster skin growth other than keeping the area clean and providing time to heal.

TOUGHEN SKIN

Having thick skin helps climbing significantly, as hardened skin allows climbers to hold onto rock a little longer and dig their tips in deeper without pain. A thickened epidermis, including the dead top layer (a callus), occurs in response to rubbing. Calluses form from the friction between rock and skin and are necessary protection to climb on rough stone. Smooth calluses are beneficial, but they can become rough or too thick, which makes them more susceptible to ripping off in huge chunks and turning into flappers. Maintaining useful calluses means using sandpaper or an emery board to keep the skin on your hands smooth and not too thick. Sand off excess skin until the digit becomes smooth.Some climbers use Antihydral cream on their fingertips for harder, drier skin the next day. This is gluteraldehyde, which blocks the eccrine sweat ducts and fixes dead tissue (like embalming fluid). However, using this cream requires careful application. Applying Antihydral too often can result in splits, so monitor skin condition the more you use it.

Steve Hong, a climber of 40 years, works as a dermatologist at the Boulder Medical Center in Colorado. He has been practicing dermatology and climbing longer than most climbers have been alive.

This article first appeared in Climbing Issue 344