Journal Reading

DERMATOLOGICAL CONDITIONS OF AQUATIC ATHLETES

Marthen Y. Matakupan
2015-84-050
Abstract
 Numerous manuscripts have described dermatologic
conditions commonly seen in swimmers
 This review provides an update on water dermatoses
and discusses newly described conditions
 The categories described include infectious and
organism-related dermatoses, irritant and allergic
dermatoses, and sun-induced dermatoses
Abstract
 Useful to differentiate between exposure to
freshwater and exposure to saltwater
 The risk of melanoma amongst swimmers is
increased, and the use of SPF 30 or greater
sunscreen and protective clothing is highly
recommended
Abstract
 A guide for dermatologists, athletes, coaches, and
other medical professionals in recognition and
treatment of these conditions
CONDITIONS RELATED TO IMPAIRED SKIN BARRIER AS A
RESULT OF CONTACT WITH WATER

 Excessive dryness (swimmer’s xerosis)

 Aquagenic acne
CONDITIONS RELATED TO IMPAIRED SKIN BARRIER AS A
RESULT OF CONTACT WITH WATER

Excessive dryness (swimmer’s xerosis) caused by

 sebum dilution with water,

 osmotic effect

 stripping off the stratum corneum.

 Taking long showers with scrubs and soaps after

activity also precipitates the problem

CONDITIONS RELATED TO IMPAIRED SKIN BARRIER AS A
RESULT OF CONTACT WITH WATER

Aquagenic acne occurs due to

 The rebound effect of sebum over-production after
continuously washing off the oils from the skin surface
 The effect of chlorinated compounds in pool water,

 Occlusion of the sebaceous glands by denuded

epidermis,
 Use of comedogenic moisturizing creams and
sunscreens.
Allergic contact dermatitis
 Swimmers have a higher incidence of positive skin
prick tests, asthma, allergic rhinoconjunctivitus, and
bronchial hyperactivity
 Increased allergy rates may be partly explained
by the use of chlorinated or brominated
disinfectants
Allergic contact dermatitis
 Disinfectants may cause allergic contact dermatitis
(‘‘pool water dermatitis”)
 Compounds proven to cause pool water dermatitis:
include gaseous chlorine, sodium and lithium
hypochloride, 1-bromo-3-chloro-5,5-
dimethylhydantoin (BCDMH), potassium
peroxymonosulfate, and aluminum chlorohydrate
Allergic contact dermatitis

Allergic contact dermatitis to new swim wear

Irritant contact dermatitis
 Irritant contact dermatitis in athletes usually develops as
a result of chronic friction
 “pool toes” and “pool palms” is caused by friction of
the feet and palms against the pool’s rough cement
bottom
 These irritant dermatoses usually resolve spontaneously,
but persistent nodules can be treated with topical
keratolytics and intralesional corticosteroids
Irritant contact dermatitis

Fingertips that desquamate from the friction of the contact with the sides of the pool
Bacterial infections
 Current studies show that Pseudomonas
contamination is common in pools
 Hot tub folliculitis presents as a disseminated itchy
pustular rash that appears within two days of water
exposure
Bacterial infections

Buttock folliculitis
Bacterial infections

Pseudomonal infection of external ear canal

Bacterial infections
 Swimmers also show increased rates of skin
colonization by Staphylococcus and Streptococcus
 Recent European and American studies have shown
that most swimming pools and showers are
contaminated with Mycobacteria  M. Marinum
 It causes “fish tank” or “swimming pool” granuloma
 dorsum of the hands, fingers, and elbows
Bacterial infections
 Patients can be treated with clarithromycin,
minocycline and trimethoprimsulfamethoxazole;
multidrug therapy with ethambutol and rifampin is
needed if disseminated disease is present
Fungal infections
 Several studies have shown that swimming pools are
contaminated with dermatophytes, which increases the
risk of infection
 Kamihama et al found that 63.6% of swimmers are
dermatophyte carriers
 The incidence of tinea pedis among aquatic athletes is
not well studied,  early reports: may be up to 10%
Fungal infections
 Trichophyton mentagrophytes accounts for up to
85% of infections and has been isolated from
swimming pool decks and locker room floors
 Tinea pedis caused by Corynebacteria, which
presents with the small punched out depressions and
an unpleasant smell
Fungal infections

Tinea pedis on the foot of a swimmer

Viral infections
 Swimmers and those who use common showers have
a greater incidence of plantar warts and molluscum
contagiosum
Viral infections

Plantar warts on the foot of a swimmer

Hair conditions
 Green hair discoloration, often seen in light-haired
athletes, is an effect of bleach and copper ion
deposition that are used to kill algae
 Seborrheic keratosis may also undergo green color
change along with the hair due to copper ion
deposition
Freshwater dermatitis

Coral reef dermatitis that became infected secondary to trauma

Freshwater dermatitis

Jellyfish sting on patella

Environment-related conditions
Sun exposure in athletes may be extreme and can
lead to a higher risk of:
 basal cell carcinoma

 squamous cell carcinoma

 melanoma
Environment-related conditions
 Use of SPF 30 or greater sunscreen and protective
clothing is highly recommended to athletes
 When counseling swimmers on sunscreen usage, one
should advise use of a sunscreen that contains SPF
30 or greater, is water resistant, and provides
broad spectrum UVA and UVB coverage
Environment-related conditions

Basal cell carcinoma on superior Squamous cell carcinoma on dorsal forearm

aspect of ear of swimmer
Environment-related conditions

Squamous cell carcinoma on helix of ear Melanoma on the leg

Conclusion
 Aquatic athletes present a unique set of challenges
for the dermatologist
 It is important to educate athletes, parents, and
coaches in an attempt to prevent short and long
term dermatological sequela
TERIMA KASIH