swimming pool itching

[pmnh]

I have been swimming my entire life and love to do water aerobics.  In the past 4 years (I am 34 y.o.), I get a severe rash every time I go into the pool.  It starts under my arms and behind my knees and is usually up and down my arms and lower legs within 12 hours.  It consists of very small, fluid-filled bumps spaced an inch or so apart, and each bump has a tiny, clear glassy head.  It is so itchy that it usually becomes a more or less continuous rash within days, worst under my arms.  If I continue going to the pool, it consumes my entire body except my head, hands, and feet.

The rash has been diagnosed by two dermatologists as eczema, but usually after the point where I have been scratching for weeks on end (it takes 4-6 weeks to get an appt).  I have so far found no relief.  I have been pregnant or breastfeeding for two of the 4 years - this condition did begin well before I was pregnant - and am not comfortable using steroid creams (I wouldn't be comfortable under normal circumstances).  I have tried Elidel, but it causes a sun sensitivity which is difficult because I own a farm and spend a great deal of time outdoors.  I would prefer to *prevent* this but have also tried barrier creams to no avail.  Whether or not I take a cool shower with Aveeno after leaving the pool seems to make no difference;  chlorine-removing shampoo also does not help.  I have also tried 6 different pools in the four years, at various times of the year (I live in NH).  I shower 1-2x daily and LOVE hot showers, so general exposure to just plain water does not cause this.  I have no other sensitivities or conditions, except that I am not a person who has taken much medication in the past.

Water aerobics is by far my best and most favorite activity - I have a weight problem and really need to continue doing what I love.  I am currently pregnant and very frustrated because I can't go to this safest form of exercise!

After a hiatus, I went to a new pool for one class two weeks ago and the itchy bumps began a few hours later.  Two weeks later, I have not once gone back to the pool yet am still itching severely under my arms (it's a crusty rash at this point).

I guess I am wondering if this could be an allergy - should I try to see an immunologist?  Are there any dermatology routes I should continue to pursue?  I am even considering investigating natural medicine or acupuncture.  Any ideas would be welcome - I am not giving up!

[Alan Rockoff, MD]

I am perplexed by your post.  For one thing, none of my eczema patients (and I have many) gets worse in pools--they often ask about chlorine, etc., so this is a common worry they bring up.  Second, I have never seen Elidel sun sensitivity anything like that which you describe.  Third, hives from water would be--as you say yourself--present after any water, not just pool water (unless it's just in cold water..?.  If you only saw dermatologists "after the point where I have been scratching for weeks on end", I think you need to arrange to be seen sooner--right away, in fact--before you have done any scratching.  That way proper diagnosis, and testing if needed, can be done.  Meantime, you might try tasking an antihistamine like Benadryl or Claritin an hour before going into the water.  Perhaps a visit to an allergist might help as well.

Best.

Dr. Rockoff

[pmnh]

A related discussion, update on swimming pool rash was started.