Many patients develop an increase in skin dryness and an exacerbation of inflammatory manifestations and itching, but a cost/benefit balance must be made by evaluating the pros and cons
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My 9 year old daughter has suffered from atopic dermatitis in the past and has very sensitive skin. She loves swimming and the pool, for her often when she gets out of the water she itches and itches. What can we do?
He answers Stefano Cambiaghimedical director Pediatric Dermatology, Maggiore Policlinico Hospital, Milan (GO TO THE FORUM)
Sports activities in general and swimming in particular are associated with a better state of psychophysical and mental health and should be encouraged at any age. Numerous patients suffering from atopic dermatitis abandon sports in the swimming pool (noto, water polo, diving) and water courses to the risk of worsening of their dermatitis and the embarrassment created by the visual impact of the eczematous skin. it is clear that early swimming does not predispose children to the development of atopic dermatitis and therefore there is no particular risk inherent in aquatics courses in childhood and swimming in children of inducing atopic dermatitis. for known as many patients already suffering from atopic dermatitis develop an increase in skin dryness and an exacerbation of both the inflammatory manifestations and pruritic symptoms after bathing in pools with chlorinated water.
Immersion in hard water and swimming in pools are both linked to an increase in the occurrence of eczematous manifestations in atopic patients. The negative effects of swimming in a pool would be linked to a greater sensitivity of the skin of patients with atopic dermatitis to exposure to chlorine, which would add to the effect of the more or less prolonged stay in the water. The measurement of skin water loss, which offers an indirect estimate of the ability of the epidermis to act functionally as a barrier against external stimuli, highlights a decreased water-holding capacity of the stratum corneum in atopic patients compared to non-atopic ones after exposure to chlorine. To these negative effects must be added the dilution of the surface hydrolipidic film with increased dryness of the skin for staying in the water and the possibility that the disinfectant agents present in the pool water (chlorine, but not only) act as irritants on the hyper-reactive and sensitive skin of the atopic patient.
Furthermore the chlorine and other molecules dispersed in the pool water impregnate the shirts of the wet swimsuitusually of synthetic fiber, being able to induce phenomena of occlusion and direct irritation, and predisposing children to the development of bacterial folliculitis in case of persistence of the damp garment after getting out of the tub. Finally, it should be remembered that in subjects affected by respiratory atopy there is also the possibility that permanence in chlorinated water acts as a trigger for episodes of bronchial asthma. Although these negative aspects of swimming in the pool must always be kept in mind, they must be balanced with other considerations. First of all, it should be remembered that swimming offers the possibility of performing excellent aerobic physical exercise for patients of any age and how the ability to swim is considered a fundamental ability of the human being (sometimes a life saver!).
A study has shown that in fact the correct barrier effect of the epidermis is reconstituted within half an hour after getting out of the water. Apart from that, other positive aspects that need to be taken into consideration are the possible reduction of bacterial colonization skin linked to the presence of antiseptics in the pool water, the relief of itching while staying in the fresh water and the possibility of carrying out a sporting activity that does not involve profuse sweating, a notoriously irritating effect on the eczematous manifestations of atopic . It should also be remembered that sleep disturbance is one of the main features of atopic dermatitis and that physical activities such as swimming represent a valid non-pharmacological treatment for this kind of problem. As always in good medical practice, also in this case before recommending or not recommending swimming in a pool in a patient with atopic dermatitis, a cost/benefit balance must always be made, evaluating the pros and cons and also taking into account the personal inclinations of the subject.
Given the possible pejorative effect on the skin’s barrier capacity, it makes sense advise against swimming in the pool during periods of exacerbations or in periods of re-ignition of the eczematous manifestations of dermatitis. Even in the case of exuding or possibly impetiginised skin manifestations (due to bacterial overlap, in particular from staphylococcus), it would be advisable to refrain from going to the swimming pool for avoid becoming potential sources of bacterial infection for other usersat least until resolution of the exuding and/or crusted manifestations. On the other hand, it is the doctor’s duty to encourage all patients, including those with atopic dermatitis, to pursue a lifestyle that is healthy and that improves the general qualityavoiding isolation in themselves and the risk of developing obesity and cardiorespiratory pathologies.
Self applying an emollient to the skin before entering the pool constitutes an unproven useful practice, performing a cleansing shower with fresh, non-chlorinated water after getting out of the tub, applying an emollient immediately after dryingthe rapid removal of the wet costume after the exit, the avoidance of diving immediately after the chlorination of the waters and a test attendance of the swimming pool to evaluate your skin’s response to water before making an annual membership constitute valid indications which allow a good part of subjects with atopic dermatitis – even if not all – to enjoy the benefits of swimming in the pool.
June 5, 2023 (change June 5, 2023 | 07:50)
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