What is the treatment for dermatitis caused by chlorine exposure from a pool?

Treatment for Chlorine-Induced Dermatitis from Pool Exposure

For dermatitis caused by chlorine exposure from swimming pools, the primary treatment involves immediate removal from exposure, thorough rinsing with fresh water, application of moisturizers, and topical hydrocortisone for inflammation and itching. 1, 2

Initial Management

1. Remove from exposure

   • Immediately leave the pool area and move to fresh air 3
   • Rinse skin thoroughly with clean, lukewarm water (not hot) to remove chlorine residue 1
   • Gently pat dry rather than rubbing the skin 1

2. Moisturize affected areas

   • Apply moisturizer promptly after rinsing and drying the skin 1
   • Use tube-based moisturizers rather than jar products to prevent contamination 1
   • For severe cases, consider the "soak and smear" technique:
     • Soak affected areas in plain water for 20 minutes
     • Immediately apply moisturizer to damp skin 1

3. Anti-inflammatory treatment

   • Apply hydrocortisone cream to affected areas up to 3-4 times daily 2
   • For adults and children over 2 years: apply directly to affected areas
   • For children under 2 years: consult a physician before using hydrocortisone 2

Treatment Based on Dermatitis Type

Irritant Contact Dermatitis (ICD)

Most chlorine-related pool dermatitis is irritant in nature:

• Identify and avoid the irritant (chlorinated water) 1
• Apply barrier creams containing humectants 1
• Consider topical steroids if conservative measures fail 1
• For persistent cases, seek dermatology consultation 1

Allergic Contact Dermatitis (ACD)

Some cases may be allergic reactions to pool chemicals like potassium peroxymonosulfate (used in "shock treatments"):

• Allergens should be identified and avoided 1, 4, 5
• Apply topical steroids to mitigate flares 1
• For recalcitrant cases, consider patch testing to identify specific allergens 1
• More severe cases may require stronger topical steroids or systemic therapy 1

Special Considerations

For Atopic Dermatitis Patients

• Patients with atopic dermatitis are more sensitive to chlorine exposure 6
• Water-holding capacity of the skin is significantly decreased even at low chlorine concentrations (0.5 mg/L) 6
• More aggressive moisturizing regimen may be needed 1

For Children

• Children are particularly vulnerable to pool chemical exposures 3
• Medical evaluation is necessary if:
  • Symptoms don't improve after removal from exposure
  • Symptoms are worsening
  • The exposure was significant 3

Prevention Strategies

1. Before swimming:

   • Apply moisturizer as a protective barrier 1
   • Consider using barrier creams specifically designed for water exposure 1

2. After swimming:

   • Shower immediately with lukewarm water and mild soap 1
   • Apply moisturizer while skin is still slightly damp 1
   • Avoid hot water which can further irritate skin 1

3. Pool considerations:

   • Swimming in pools using alternative disinfection methods may reduce risk 7
   • Pools disinfected with gaseous chlorine show higher rates of contact dermatitis than those using other chlorine compounds 7
   • Consider swimming in outdoor pools which have lower concentrations of chlorine byproducts in the air 3

When to Seek Medical Care

• Persistent or worsening symptoms despite home treatment
• Signs of infection (increased redness, warmth, swelling, pus)
• Widespread rash or severe discomfort
• Respiratory symptoms accompanying the skin reaction 3

For recalcitrant cases not responding to the above measures, dermatology consultation is recommended for consideration of stronger treatments such as more potent topical steroids, phototherapy, or systemic therapy 1.