Rashes After Swimming in Children
For a child who develops a rash after swimming, immediately apply 1% hydrocortisone cream to the affected area 3-4 times daily and administer oral antihistamines (cetirizine, loratadine, or fexofenadine) to control pruritus. 1, 2
Immediate Management Approach
First-Line Treatment
- Apply topical 1% hydrocortisone cream to affected areas not more than 3-4 times daily for children 2 years and older 1
- For children under 2 years, consult a physician before applying topical corticosteroids 1
- Administer oral antihistamines (cetirizine, loratadine, or fexofenadine) for significant pruritus 2
- Use gentle, soap-free cleansers and apply moisturizers (oil-in-water creams or ointments) to avoid removing natural skin lipids 2
Determine the Likely Cause
The etiology depends on the water source and clinical presentation:
Chlorinated Pool Exposure:
- High chloramine levels in pools are associated with eye irritation and skin rashes 3
- Chemical irritant dermatitis from disinfection by-products (DBPs) is common 3
- Treatment is symptomatic with topical corticosteroids and antihistamines 2, 1
Freshwater Exposure (Lakes, Ponds):
- Cercarial dermatitis ("swimmer's itch") is the most likely diagnosis, caused by penetration of bird schistosome cercariae (particularly Trichobilharzia species) into the skin 4, 5, 6
- Presents as a prickling or itching sensation immediately after water exposure, followed by macules, papules, or even urticarial and vesicular eruptions with repeated exposures 6
- This is an allergic reaction that is temperature-dependent, with higher water temperatures increasing cercarial emergence and transmission 4
- Treatment is entirely symptomatic with antihistamines and topical corticosteroid cream 6
Clinical Assessment
Key Features to Identify
- Timing of rash onset: Immediate prickling suggests cercarial dermatitis; delayed onset may indicate chemical irritation 6
- Location: Exposed skin areas are most affected 3, 6
- Appearance: Maculopapular eruption, urticarial lesions, or vesicles suggest cercarial dermatitis; generalized erythema suggests chemical irritation 6, 7
- Associated symptoms: Pruritus is common in both etiologies 3, 2, 6
Rule Out Infectious Complications
- If yellow crusts or discharge are present, obtain bacterial culture and treat with appropriate antibiotics for suspected superinfection 2
- Consider fungal infection (tinea) if the rash has a discoid or annular pattern with scaling, particularly in intertriginous areas 2, 7
When to Escalate Care
- Refer to dermatology if the rash is resistant to initial treatment or if the diagnosis is uncertain 2
- Monitor for side effects of topical steroids, especially with prolonged use on the face or intertriginous areas 2
- Most swimming-related skin diseases are relatively minor and either heal spontaneously or respond quickly to treatment 8