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Gracia Walker of Kiehl’s poses with just some of the fine skin care products given to all Badwater entrants and staff in 2005.

An interesting thought struck me while lecturing to a group of hard-core triathletes recently. Yes, they are fit, yes they are intense, and yes, they are amazingly motivated people, I thought. But gosh, the ones who have been doing this for a while look a bit weather-beaten.

I kept this thought in mind when I was at a local road race in New York. Again, many of the runners who had been out doing their thing for a number of years looked a bit leathery.

Following this realization, I began an informal survey in my office. “How do you take care of your skin?”, I began asking. Much to my surprise, many of my patients did little more than apply sunscreen once on their face briefly at the start of their exercise regimen. (This was, in fact, so interesting to me that I am currently doing a study on this issue.)

The facts on skin-related injury are staggering. It is now estimated that one in 50 Caucasians will develop a form of skin cancer in their lifetime. Rates among people with pigmented skin are increasing as well. This is a substantial increase, especially in the past 15 years. According to Dr. Barney Kennet, a dermatologist based in New York, “the numbers of people coming into my office with sun damaged skin and sun-related cancers has grown tremendously in the past ten years.”

What are the factors that lead to sun-damaged skin and skin cancers? With a thinning ozone layer, increased time in the sun leads to increased skin damage.

Who is at greatest risk? Genetics play a role and skin pigmentation and a family history of skin cancer are both important. But even more important is a history of deep sunburn. Repeated, deep, painful sun damage has been strongly linked to pre-cancerous skin lesions.

The key to prevention is avoiding these repeated burns. As Dr. Amy Knopper, a dermatologist from Kansas City told me, “You can’t pick your skin pigment, but you can sure pick what you do to with what you’ve got. Take good care!”

Ok—so that sounds good, but let’s get real, triathlons and other endurance events are run during the middle of the day. Personally, I can recall the sun beating down on my back in Kona during the Ironman Triathlon, thinking to myself, “I’m sorry skin, I’m sorry.” Much to my dismay, by the way, there is a residual burn on my back from that day, despite my efforts at sunblock use.

Are triathletes and other endurance athletes taking skin protection seriously enough? The hydration message seems to have gotten through, as has the threat of hyponatremia and the benefits of stretching and weight training. But is the sunburn prevention message resonating? Unfortunately, I’d say, not yet. Yes, there are some aid stations along the course of some races that have sunblock, but often, these are few and far between.

Until we arrive at the day when skin care and sunburn prevention are taken as seriously as they should be, the onus, my friends, is on you. If you are involved in outdoor endurance sports, you must protect your skin. This means consistent use of waterproof sun block. SPF (sun protection factor) means the relative time it will take for you to burn your skin. For example, if you might burn in 10 minutes normally, then an SPF of 15 enables you stay in the sun for 150 minutes without burning. Of course, these numbers have different ramifications for everyone, so being vigilant is key. For me, I try to find a product that stays on when wet and is at least a SPF 30.

Throughout race day, take the extra time to apply a bit more sunblock, even if it “costs you” a few minutes. Likewise, when you are training, load up on skin protection. Slop it on, all over yourself, and make sure to bring some for later. Also, make sure to use adequate head protection to prevent burns to your face, ears, and the top of your head.

And what about getting a tan? As many members (especially female ones) of my triathlon team tell me during our long bike rides, “It’s OK to fake it; we all do!” Meaning, if you want to be darker and it’s important to you, use fake tan. Even if it doesn’t offer sun protection, it’s much safer than a real suntan.

And lastly, if there are any new or funny looking moles or patches on your skin, speak to your doctor or dermatologist. (They can be very small, by the way.) All types of skin cancer are treated more easily when they are caught early.

As we spend hours making ourselves faster, fitter, and healthier, let’s be sure to remember that our skin needs love. Protect it—unless you are a lizard or a snake, you only get one coat!

Jordan D. Metzl, MD, is a nationally recognized sports medicine specialist at Hospital for Special Surgery in New York City. In addition to his medical practice, Dr. Metzl is a 25-time marathon runner and four-time Ironman finisher.