CHLORINE ----------------------------------------- I have seen five schoolchildren and two adults who had itchy papular lesions on the trunk, extremities and neck. All of their skin lesions begun from August of this year, and all of them went swimming three times to every day a week from several years ago in the indoor pool. In Japan nine thousand people were infected and eleven people died by the outbreak of E.coli O-157 this year. So the many swimming pools were close or the concentration of chlorine of the pool was raised from August in a fluster by managers. I expect the cause of this eruption was the high concentration of the chlorine, because the papules of some patients disappeared in about one week from suspension. In adult cases(60 and 63-y-o -- every day swimmer !!) the reduction of frequency of swimming and the amply use of Anderm and petroleum jelly ointment before swimming every time was effective. The literature presented that the chloroform was raised in swimming pool water disinfected with chlorine, and the chloroform was adopted as the substance for allergy test, however, I did not find the exact action or effect of chlorine to rash on the data base. Eiichi Yagi MD -------------------- Do you feel that a contact urticaria can become eczematoid with scratching? The reason that I ask is that people who intuit that they have a "reaction" to chlorine usually present with a dry papular eruption. Several of my patients with aquagenic urticaria believe that they can tolerate ocean water. Is it the salt in the ocean water or the chlorination of our pools and showers? Do all communities chlorinate indoor plumbing as we do here in Monona, Wisconsin, USA? Diane Thaler -------------------- I have recently seen a 15 year old who develops a fine papular itchy rash from swimming in chlorinated swimming pools. Recently, the family experimented with a pool which had less than .4 parts per million chlorine and she tolerated the pool. The rash also occurs with shower water but not with ocean water. No other symptoms occur. The rash lasts as much as one week. I thought we where dealing with an irritant reaction until the patients mother told me that a wet towel wetted with high chlorine water and placed on one forearm led to a similar eruption on both forearms. Any thoughts as to mechanism of action and what to tell patient besides stay away from high chlorine pools? (patient is competitive swimmer and can't change the water that she competes in.) Steven Shama -------------------- Contact urticaria to chlorinated swimming water has been reported. Perhaps try a systemic antihistamine (Claritin, Zyrtec). Neering H. Contact urticaria from chlorinated swimming pool water. Contact Dermatitis 1977;3:279. Trey Truett, MD -------------------- I believe the pool papulosis may be caused by chloramines.These products are formed by chlorine atoms combining with nitrogenous compounds like skin, urine,etc.This can be measured by a pool maintenance firm.A high level requires draining and cleaning the pool. BOB AYLESWORTH MD -------------------- Diane Thaler was wondering about chlorine and carcinogenesis and I was wanting to add my $0.02 to the discussion about rashes related to chlorine exposure. Chlorine itself is probably not carcinogenic, but chlorinated organics that are derived from contaminates in chlorinated water may be. The effect is weak, but may be real. I think this argues mainly for purer water sources rather than just having municipalities treat substandard water heavily with chlorine. As far as skin problems and chlorine, it is an irritant. I would expect that anyone sensitive to irritant reactions (for the most part atopics) would be expected to get a generalized irritant reaction from immersion in water that had a high chlorine content (such as an overtreated swimming pool or hot tub). This may trigger a generalized atopic eruption which then may have a life of its own. If the chlorine content is high enough, anyone is going to get an irritant reaction. Mark Naylor, M.D. -------------------- Mark, thanks for the info. What are the organics which may be chlorinated in the water supply? As an aside, we have high amounts of copper in our water-so anyone with patients with Wilson's Disease etc. might consider having the patient's water supply checked. Which brings up the question of bottled water. How do we know what is in the bottled water. I wonder if someone is not just filling up the bottles with their garden hose-or contaminated spring or well water. Diane Thaler --------------------