Hello doctor, My brother was a varsity swimmer at his high school four years ago, but had to quit when it appeared that the chlorine was causing skin irritation. Ever since, his skin condition has persisted, which involves dry, brownish patches under his armpits (he has white skin), a cracked, scaly pattern of dry skin on his lower back, and dry skin patches all over his torso (reminiscent of desiccated ground pattern in a desert). He has been to many doctors, who have all prescribed various creams, none of which seem to work. I will attach a photo. Have you seen anything like this before?
Hello. I have reviewed the details and the attachment sent by you (attachment removed to protect patient identity). I have had the opportunity to examine and treat at least a hundred patients of similar description in the last five years related to allergy to swimming pool water intolerance. In the case of your brother, I think it is due to the hypersensitivity caused by chemicals used to disinfect water. The most common chemical used is bleaching powder that releases chlorine which is a powerful skin irritant. There are several measures that will need to be put in place simultaneously to help your brother's skin ailment. 1. Firstly, he must refrain from further exposure to swimming pool water or chlorinated water in any other setting. 2. At this stage, using topical steroids is the best option but any creams containing potent steroids should be avoided. Hydrocortisone is likely to proven better choice. 3. Once he feels and looks better, the same cream as described above can be diluted in a sequential manner to reduce the proportion of active steroidal agent and substituted by either a cold cream or moisturizer. This tapering may take up to and beyond a couple of months as the element of chronicity has crept in due to use of various preparation over the last few years. 4. For symptomatic relief, he might like using antiallergic. 5. He should be advised to use a mild soap sparingly and not try to rub the scales off but use liberal quantities of moisturizers as and when needed. I am sure that like other patients of mine, your brother will have a rewarding experience.