Abstract
On a daily basis, pool cleaners handle a variety of entities that are potentially hazardous to the skin. The aquatic environment of the swimming pool exposes workers to potential contact allergens and irritants and aids in the transmission of infectious agents. In addition, ultraviolet radiation and genotoxic substances generated as disinfection by-products may increase the risk of cancer in these individuals.
Sanitizing and pH-stabilizing agents commonly used in swimming pools include chlorine, hypochlorite salts, trichloro-s-triazinetrione (8), muriatic acid, and copper. Several of these chemicals are known to cause irritant dermatitides, and some, such as muriatic acid, may yield severe chemical burns. When mixed improperly with hypochlorite salts, TST can result in explosions, also leading to burns and even fatalities in those who work with the substance. Cases of allergic contact dermatitides following exposure to various pool water chemicals – chlorine included – have also been reported.
Many common viruses, dermatophytes, and bacteria are waterborne and capable of causing cutaneous infection in humans. Tinea pedis, verruca vulgaris, molluscum contagiosum, Pseudomonas folliculitis, and atypical mycobacterial infections are all skin diseases that may be transmitted by contact with infected water and thus have potential to affect pool workers.
Ultraviolet light and water disinfection by-products such as trihalomethanes (THMs) and haloacetic acids can potentially increase cancer risk in swimming pool workers. THMs and chloroform are activated to mutagens by the enzyme glutathione-S-transferase-theta (GSTT1-1). In particular, bladder cancer risk from THMs seems to be higher in subjects with GSTT1-1 gene.
There is a paucity of literature specific to swimming pool workers; therefore, much of this chapter will extrapolate from relevant skin reactions reported in populations with similar exposures. Whenever possible, studies specific to swimming pool workers will be discussed and cited.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Behroozy A, Keegel TG (2014) Wet-work exposure: a main risk factor for occupational hand dermatitis. Saf Health Work 5(4):175–180
Borrego L, Hernandez N, Hernandez Z, Penate Y (2016) Povidone-iodine induced post-surgical irritant contact dermatitis localized outside of the surgical incision area. Report of 27 cases and a literature review. Int J Dermatol 55(5):540–545
Bruch MK (2007) Toxicity and safety of topical sodium hypochlorite. Contrib Nephrol 154:24–38
Caballero MR, Lukawska J, Dugué P (2010) A hidden cause of perioperative anaphylaxis. J Investig Allergol Clin Immunol 20:353–354
Centers for Disease Control and Prevention (CDC) (2000) Pseudomonas dermatitis/folliculitis associated with pools and hot tubs–Colorado and Maine, 1999–2000. MMWR Morb Mortal Wkly Rep 49:1087–1091
Chen MJ, Lin CH, Duh JM, Chou WS, Hsu HT (2011) Development of a multi-pathway probabilistic health risk assessment model for swimmers exposed to chlo- roform in indoor swimming pools. J Hazard Mater 185(2–3):1037–44
Cheung JP, Fung BK, Ip WY (2010) Mycobacterium Marinum infections of the deep structures of the hand and wrist: 25 years of experience. Hand Surg 15:211–216
Choong KY, Roberts LJ (1999) Molluscum contagiosum, swimming and bathing: a clinical analysis. Australas J Dermatol 40:89–92
Conklin RJ (1990) Common cutaneous disorders in athletes. Sports Med 9:100–119
Coskey RJ (1974) Onycholysis from sodium hypochlorite. Arch Dermatol 109:96
De la Cuadra-Oyanguren J, Zaragoza-Ninet V, Sierra-Talamantes C, Alegre de Miquel V (2014) Postsurgical contact dermatitis due to povidone iodine: a diagnostic dilemma. Actas Dermosifiliogr 105:300–304
Dalmau G, Martinez-Escala ME, Gazquez V, Pujol-Montcusi JA, Canadell L et al (2012) Swimming pool contact dermatitis caused by 1-bromo-3-chloro-5,5-dimethyl hydantoin. Contact Dermatitis 66:335–339
Dastychová E, Necas M, Vasku V (2008) Contact hypersensitivity to selected excipients of dermatological topical preparations and cosmetics in patients with chronic eczema. Acta Dermatovenerol Alp Panonica Adriat 17:61–68
Dhir GG et al (1977) Contact dermatitis caused by copper sulfate used as coloring material in commercial alcohol. Ann Allergy Asthma Immunol 39:204
Dolenc-Voljc M, Zolnir-Dovc M (2010) Delayed diagnosis of Mycobacterium marinum infection: a case report and review of the literature. Acta Dermatovenerol Alp Panonica Adriat 19:35–39
Dooms-Goossens A et al (1983) Allergic contact urticaria due to chloramine. Contact Dermatitis 9:319
Fage SW, Faurschou A, Thyssen JP (2014) Copper hypersensitivity. Contact Dermatitis 71:191–201
Fantuzzi G, Righi E, Predieri G, Giacobazzi P, Mastroianni K et al (2010) Prevalence of ocular, respiratory and cutaneous symptoms in indoor swimming pool workers and exposure to disinfection by-products (DBPs). Int J Environ Res Public Health 7:1379–1391
Fisher AA (1987) Contact dermatitis to diving equipment, swimming pool chemicals and other aquatic denizens. Clin Dermatol 5:36–40
Fisher AA (1988) Swimming pool granuloma due to Mycobacterium marinum: an occupational hazard of lifeguards. Cutis 41:397–398
Fitzgerald DA et al (1995) Spa pool dermatitis. Contact Dermatitis 33:53
Gentles JC, Evans EGV (1973) Foot infections in swimming baths. Brit Med J 3:260–262
Gilligan P, Horst A, Zirwas M (2010) Allergy to a hot tub water treatment chemical: an unexpectedly common cause of generalized dermatitis in men. J Clin Aesthet Dermatol 3:54–56
Gluckman GJ (1995) Mycobacterium marinum. Clin Dermatol 13:273–276
Guida M, Onofrio VD, Galle F, Gesuele R, Valeriani F et al (2016) Pseudomonas aeruginosa in swimming pool water: evidences and perspectives for a new control strategy. Int J Environ Res Public Health 13:919
Hansen KS (1983) Occupational dermatoses in hospital cleaning women. Contact Dermatitis 9:343–351
Hautmann G, Lotti T (1994) Atypical mycobacterial infections of the skin. Dermatol Clin 12:657–668
Hinz T, Klingmüller K, Bieber T, Schmid-Wendtner MH (2009) The mystery of green hair. Eur J Dermatol 19:409–410
Hirsh BC, Johnson WC (1984) Pathology of granulomatous diseases: mixed inflammatory granulomas. Int J Dermatol 23:585–597
Hlavsa MC, Robinson TJ, Collier SA, Beach MJ, Centers for Disease Control and Prevention (CDC) (2014) Pool chemical-associated health events in public and residential settings – United States, 2003–2012, and Minnesota, 2013. MMWR Morb Mortal Wkly Rep 63:421–440
Hojyo-Tomoka MT et al (1973) Pseudomonas infection in superhydrated skin. Arch Dermatol 107:723–727
Hostynek JJ et al (1989) Hypochlorite sensitivity in man. Contact Dermatitis 20:32–37
Hudson PI et al (1985) Duration of whirlpool-spa use as a risk factor for Pseudomonas dermatitis. Am J Epidemiol 122:915–917
Huriez C et al (1962) L’allerge aux sels d’ammonium quaternaire. La Semaine des Hospitaux 41:2301–2304
Johnston JM, Izumi AK (1987) Cutaneous mycobacterium marinum infection. Clin Dermatol 5:68–75
Julià Manresa M, Vicente Villa A, Gené Giralt A, González-Enseñat MA (2009) Aeromonas hydrophila folliculitis associated with an inflatable swimming pool: mimicking Pseudomonas aeruginosa infection. Pediatr Dermatol 26:601–603
Kanerva L, Alanko K, Estländer T, Sihvonen T, Jolanki R (1997) Occupational allergic contact urticaria from chloramine-T solution. Contact Dermatitis 37:180–181
Karagas MR, Villanueva CM, Nieuwenhuijsen M, Weisel CP, Cantor KP et al (2008) Disinfection byproducts in drinking water and skin cancer? A hypothesis. Cancer Causes Control 19:547–548
Kim IH, Seo SH (1999) Occupational chemical burns caused by bromine. Contact Dermatitis 41:43
Kirk I, Kaminski GW (1976) Mycobacterium marinum infection. Aust J Dermatol 17:111–117
Leung A (1985) Erythema multiforme following swimming in a chlorinated pool. J Natl Med Assoc 77:13
Linell F, Norden A (1954) Mycobacterium balnei: a new acid-fast bacillus occurring in swimming pools and capable of producing skin lesions in humans. Acta Tuberculosa Scand 33(Suppl):1–84
Lombardi P, Gola M, Acciai MC, Sertoli A (1989) Unusual occupational allergic contact dermatitis in a nurse. Contact Dermatitis 20:302–316
López Sáez MP, de Barrio M, Zubeldia JM, Prieto A, Olalde S et al (1998) Acute IgE-mediated generalized urticaria-angioedema after topical application of povidone-iodine. Allergol Immunopathol (Madr) 26:23–26
Loughney E, Harrison J (1998) Irritant contact dermatitis due to 1-bromo-3-chloro-5,5-dimethylhydantoin in a hydrotherapy pool. Risk assessments: the need for continuous evidence-based assessments. Occup Med 48:461–463
Martinez TT, Long C (1995) Explosion risk from swimming pool chlorinators and review of chlorine toxicity. Clin Toxicol 33:349–354
Massé M, Falanga V, Zhou LH (2008) Use of topical povidone-iodine resulting in an iododerma-like eruption. J Dermatol 35:744–747
McCausland WI, Cox PJ (1975) Pseudomonas infection traced to motel whirlpool. J Environ Health 37:455–459
Mirabelli MC, Vizcaya D, Margarit AM, Anto JM, Arjona L et al (2012) Occupational risk factors for hand dermatitis among professional cleaners in Spain. Contact Dermatitis 66(4):188–196
Mollohan CS, Romer MS (1961) Public health significance of swimming pool granuloma. Am J Public Health 51:883–891
Murthy MB, Krishnamurthy B (2009) Severe irritant contact dermatitis induced by povidone iodine solution. Indian J Pharm 41:199–200
Neering H (1977) Contact urticaria from chlorinated swimming pool water. Contact Dermatitis 3:279
Ng SK, Goh CL (1989) Contact allergy to sodium hypochlorite in Eusol. Contact Dermatitis 21:281
Nielsen J (1994) The occurrence and course of skin symptoms on the hands among female cleaners. Contact Dermatitis 34:284–291
Norrlind R, Wahlberg JE (1962) Two cases of benzalkonium hypersensitivity to quaternary ammonium compounds. Acta Dermatovenereologica 42:230–234
O’Cleireachain MR, Macias LH, Richey KJ, Pressman MA, Shirah GR et al (2014) The blue man: burn from muriatic acid combined with chlorinated paint in an adult pool construction worker. J Burn Care Res 35(4):e269–e272
Olsen JR, Gallacher J, Piguet V, Francis NA (2014) Epidemiology of molluscum contagiosum in children: a systematic review. Fam Pract 31:130–136
Osmundsen PE (1978) Contact dermatitis to sodium hypochlorite. Contact Dermatitis 4:177–178
Panyakapo M, Soontornchai S, Paopuree P (2008) Cancer risk assessment from exposure to trihalomethanes in tap water and swimming pool water. J Environ Sci (China) 20:372–378
Pardo A, Nevo K, Vigiser D, Lazarov A (2007) The effect of physical and chemical properties of swimming pool water and its close environment on the development of contact dermatitis in hydrotherapists. Am J Ind Med 50:122–126
Pellicano R et al (1997) Linear IgA bullous dermatosis after contact with sodium hypochlorite. Dermatology 194:284–286
Perrenoud D et al (1994) Frequency of sensitization to 13 common preservatives in Switzerland. Contact Dermatitis 30:276–279
Person JR (1985) Green hair: treatment with a penicillamine shampoo. Arch Dermatol 121:717–718
Peterson J, Shook BA, Wells MJ, Rodriguez M (2006) Cupric keratosis: green seborrheic keratoses secondary to external copper exposure. Cutis 77:39–41
Piggott CD, Hayes B, Robb CW, Thomas L, Creech CB et al (2007) Chemical burn induced by cutaneous exposure to a concentrated sodium hypochlorite and alkyl sulfate solution. Cutan Ocul Toxicol 26:189–194
Rahimi S, Lazarou G (2010) Late-onset allergic reaction to povidone-iodine resulting in vulvar edema and urinary retention. Obstet Gynecol 116(2):562–564
La Rosa G, Della Libera S, Petricca S, Iaconelli M, Briancesco R et al (2015) First detection of papillomaviruses and polyomaviruses in swimming pool waters: unrecognized recreational water-related pathogens? J Appl Microbiol 119:1683–1691
Rycroft RJ, Penny PT (1983) Dermatoses associated with brominated swimming pools. BMJ 287:462
Salvaggio HL, Scheman AJ, Chamlin SL (2013) Shock treatment: swimming pool contact dermatitis. Pediatr Dermatol 30(4):494–495
Sasseville D, Geoffrion G, Lowry RN (1999) Allergic contact dermatitis from chlorinated swimming pool water. Contact Dermatitis 41:347–348
Sato K, Kusaka Y, Suganuma N, Nagasawa S, Deguchi Y (2004) Occupational allergy in medical doctors. J Occup Health 46(2):165–170
Sausker WF (1987) Pseudomonas aeruginosa folliculitis (“splash rash”). Clin Dermatol 5:62–67
Shemer A, Gupta AK, Amichai B, Baum S, Barzilai A et al (2016) Increased risk of tinea pedis and onychomycosis among swimming pool employees in Netanya area, Israel. Mycopathologia 181:851–856
Shippert BW (2010) Pool chemical blast injury. Ann Emerg Med 55:370–372
Stanford D, Georgouras K (1996) Allergic contact dermatitis from benzalkonium chloride in plaster of Paris. Contact Dermatitis 35:371–372
Staniforth P (1980) Allergy to benzalkonium chloride in plaster of Paris after sensitization to cetrimide. J Bone Joint Surg (Br) 62:500–501
Suneja T, Belsito DV (2008) Occupational dermatoses in health care workers evaluated for suspected allergic contact dermatitis. Contact Dermatitis 58:285–290
Taplin D et al (1965) Environmental influences on the microbiology of the skin. Arch Environ Health 11:546–550
Tate D, Mawer S, Newton A (2003) Outbreak of Pseudomonas aeruginosa folliculitis associated with a swimming pool inflatable. Epidemiol Infect 130:187–192
Uter W, Lessmann H, Geier J, Schnuch A (2008) Is the irritant benzalkonium chloride a contact allergen? A contribution to the ongoing debate from a clinical perspective. Contact Dermatitis 58:359–363
Velazquez D, Zamberk P, Suarez R, Lazaro P (2009) Allergic contact dermatitis to povidone-iodine. Contact Dermatitis 60:348–349
Waddington E (1967) An outbreak of swimming pool granuloma. Trans St Johns Hosp Dermatol Soc 53:122–124
Wahlberg JE (1962) Two cases of benzalkonium hypersensitivity to quaternary ammonium compounds. Acta Derm Venereol 42:230–234
Wentworth AB, Yiannias JA, Davis MDP, Killian JM (2016) Benzalkonium chloride: a known irritant and novel allergen. Dermatitis 27(1):14–20
Yigit O, Soyuncu S, Eray O, Enver S (2009) Inhalational and dermal injury due to explosion of calcium hypochlorite. Cutan Ocul Toxicol 28(1):37–40
Yoder JS, Hlavsa MC, Craun GF, Hill V, Roberts V, Centers for Disease Control and Prevention (CDC) et al (2008) Surveillance for waterborne disease and outbreaks associated with recreational water use and other aquatic facility-associated health events – United States, 2005–2006. MMWR Surveill Summ 57:1–29
Zhe GCS, Green A, Fong YT, Lee HY, Ho SF (2016) Rare case of type I hypersensitivity reaction to sodium hypochlorite solution in a healthcare setting. BMJ Case Rep. https://doi.org/10.1136/bcr-2016-217228
Zwiener C, Richardson SD, DeMarini DM, Grummt T, Glauner T et al (2007) Drowning in disinfection byproducts? Assessing swimming pool water. Environ Sci Technol 41:363–372
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this entry
Cite this entry
Blank, N.R., Cohen, D.E. (2020). Swimming Pool Worker Dermatoses. In: John, S., Johansen, J., Rustemeyer, T., Elsner, P., Maibach, H. (eds) Kanerva’s Occupational Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-68617-2_193
Download citation
DOI: https://doi.org/10.1007/978-3-319-68617-2_193
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-68615-8
Online ISBN: 978-3-319-68617-2
eBook Packages: MedicineReference Module Medicine