What is it?
Saddle sores include a range of skin conditions seen in the pelvic/genital region of cyclists. They occur as a result of moisture, pressure and friction where athletes sit on the bike seat (saddle). 

Saddle sores are thought to develop over time, starting with simple chafing of the skin over the buttocks, genital region and inner thigh. If ignored, the areas can become open sores, which are a more severe form of injury due to damage to the top layers of skin. Inflammation can also occur around the hair follicles (“folliculitis”) and result in painful bumps on the skin. The most severe sores involve the development of an abscess or deep skin infection that may be filled with, or drain, pus. 

Causes:

• Excess friction and pressure
• Poorly fitting bike or saddle
• Poorly padded shorts
• Long bike rides without proper training

Sports Medicine Evaluation and Treatment
Chafing and minor sores do not typically require evaluation by a physician and can be treated with time off from riding, or making changes to the bike, saddle or clothing. More severe sores or infections, especially those that are painful, red or draining pus require medical attention. A sports medicine physician will perform a history and physical exam to determine the severity. 

The physician may prescribe skin creams treatment such as cortisone, anti-fungal or anti-bacterial preparations.  If an abscess or nodule has developed, the wound may need to be drained and oral antibiotics may be necessary.

Injury Prevention
Tips to prevent development of skin issues in cyclists include wearing proper bike shorts that help keep the area dry, and reducing repetitive forces and friction between the skin and saddle surface.  Shaving the area should be avoided as this irritates the hair follicles and can introduce skin bacteria into the follicles. Various synthetic pads within bike shorts, called chamois, can help reduce injury. Athletes should properly wash shorts between rides. Lubricants such as chamois cream (carried by most biking stores) or petroleum jelly products can also be used to help reduce friction. It is important to adequately clean the skin using soap and water after rides.  A “bike fit” should be performed with focus on changing the type of saddle, adjusting the seat height and tilt, and proper handlebar position to help with reducing pressure in areas of concern. Sometimes seats with cutouts or modified noses can help.

Return to Play
Returning to cycling with saddle sores is dependent on symptoms. If the athlete has an active bacterial skin infection, especially if it is making him/her feel poorly, the physician may limit his/her cycling. Tips for returning without worsening sores are to shorten rides, allow a day between rides, use moisture barriers and/or chamois creams as needed, ensure use of clean, breathable biking shorts, use of a seat with good fit, and washing with a good antibacterial soap after rides. If sores worsen despite riding, the athlete may need to cross train off the bike for a few weeks.

AMSSM Member Authors: BJ Deimel, MD and Chris Madden, MD