Skip to main content
SpringerLink
Log in

Bath Attendants

  • Living reference work entry
  • First Online:
Kanerva’s Occupational Dermatology

  • 283 Accesses

Abstract

Bath attendants work in indoor or outdoor swimming facilities or, less frequently, at the seaside. Irritant and allergic occupational dermatitis in bath attendants can be induced by water, disinfectants, sunscreens, swimming clothes, or equipment. Especially repeated and prolonged wet work causes skin irritation and impairs the skin barrier function. Contact dermatitis to disinfectants is rarely observed and mainly caused by chlorinated or brominated by-products in the swimming pool water such as trihalomethanes (e.g., trichloromethane, chloroform), haloamines, haloacetic acids and haloketones; substances added to eliminate amines and organic contaminants such as potassium peroxymonosulfate; or disinfectants used to disinfect pool edges, showers, bathrooms or pediluvia such as sodium hypochlorite, aldehydes and quaternary ammonium compounds. Contact dermatitis associated with disinfectants used in swimming pools are rather due to irritancy, but may also be caused by true sensitization. Urticaria induced by swimming in pools can be cold-induced urticaria, aquagenic urticaria, or contact-urticaria to chlorinated water. Rare causes of occupational dermatoses in bath attendants are skin infections due to pathogens in the pool water, aquagenic pruritus, or skin cancer induced by exposure to UV-light during outdoor activities.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • Alomar A, Vilaltella I (1985) Contact dermatitis to dibutylthiourea in swimming goggles. Contact Dermatitis 13(5):348–349

    Article  CAS  PubMed  Google Scholar 

  • Azurdia RM, King CM (1998) Allergic contact dermatitis due to phenol-formaldehyde resin and benzoyl peroxide in swimming goggles. Contact Dermatitis. 38(4):234–5

    Google Scholar 

  • Bentley B 2nd (1993) Cold-induced urticaria and angioedema: diagnosis and management. Am J Emerg Med 11(1):43–46

    Article  PubMed  Google Scholar 

  • Blauvelt A, Duarte AM, Schachner LA (1992) Pool palms. J Am Acad Dermatol 27(1):111

    Article  CAS  PubMed  Google Scholar 

  • Cammann K, Hubner K (1995) Trihalomethane concentrations in swimmers’ and bath attendants’ blood and urine after swimming or working in indoor swimming pools. Arch Environ Health 50(1):61–65

    Article  CAS  PubMed  Google Scholar 

  • Caro J, Gallego M (2007) Assessment of exposure of workers and swimmers to trihalomethanes in an indoor swimming pool. Environ Sci Technol 41(13):4793–4798

    Article  CAS  PubMed  Google Scholar 

  • Choong KY, Roberts LJ (1999) Molluscum contagiosum, swimming and bathing: a clinical analysis. Australas J Dermatol 40(2):89–92

    Article  CAS  PubMed  Google Scholar 

  • Chu H, Nieuwenhuijsen MJ (2002) Distribution and determinants of trihalomethane concentrations in indoor swimming pools. Occup Environ Med 59(4):243–247

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dalmau G, Martinez-Escala ME, Gazquez V et al (2012) Swimming pool contact dermatitis caused by 1-bromo-3-chloro-5,5-dimethyl hydantoin. Contact Dermatitis 66(6):335–339

    Article  CAS  PubMed  Google Scholar 

  • Dooms-Goossens A, Gevers D, Mertens A et al (1983) Allergic contact urticaria due to chloramine. Contact Dermatitis 9(4):319–320

    Article  CAS  PubMed  Google Scholar 

  • Fantuzzi G, Righi E, Predieri G 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(4):1379–1391

    Article  PubMed  PubMed Central  Google Scholar 

  • Fisher AA (1987) Contact dermatitis to diving equipment, swimming pool chemicals, and other aquatic denizens. Clin Dermatol 5(3):36–40

    Article  CAS  PubMed  Google Scholar 

  • Fisher AA (1988) Swimming pool granulomas due to Mycobacterium marinum: an occupational hazard of lifeguards. Cutis 41(6):397–398

    CAS  PubMed  Google Scholar 

  • Fisher AA (1993) Aquagenic pruritus. Cutis 51(3):146–147

    CAS  PubMed  Google Scholar 

  • Fitzgerald DA, Wilkinson SM, Bhaggoe R et al (1995) Spa pool dermatitis. Contact Dermatitis 33(1):53

    Article  CAS  PubMed  Google Scholar 

  • Frances AM, Fiorenza G, Frances RJ (2004) Aquagenic urticaria: report of a case. Allergy Asthma Proc 25(3):195–197

    PubMed  Google Scholar 

  • Gardinier S, Guehenneux S, Latreille J et al (2009) Variations of skin biophysical properties after recreational swimming. Skin Res Technol 15(4):427–432

    Article  PubMed  Google Scholar 

  • Geller AC, Glanz K, Shigaki D et al (2001) Impact of skin cancer prevention on outdoor aquatics staff: the Pool Cool program in Hawaii and Massachusetts. Prev Med 33(3):155–161

    Article  CAS  PubMed  Google Scholar 

  • Gies P, Glanz K, O’Riordan D et al (2009) Measured occupational solar UVR exposures of lifeguards in pool settings. Am J Ind Med 52(8):645–653

    Article  PubMed  PubMed Central  Google Scholar 

  • Gilligan P, Horst AV (2010) Allergy to a hot tub water treatment chemical: an unexpectedly common cause of generalized dermatitis in men. J Clin Aesthet Dermatol 3(2):54–56

    PubMed  PubMed Central  Google Scholar 

  • Goette DK (1984) Raccoon-like periorbital leukoderma from contact with swim goggles. Contact Dermatitis 10(3):129–131

    Article  CAS  PubMed  Google Scholar 

  • Gould D (1983) Dermatoses associated with brominated swimming pools. Br Med J (Clin Res Ed) 287:913

    Article  Google Scholar 

  • Gustafson TL, Band JD, Hutcheson RH Jr et al (1983) Pseudomonas folliculitis: an outbreak and review. Rev Infect Dis 5(1):1–8

    Article  CAS  PubMed  Google Scholar 

  • Hall DM, McCarty F, Elliott T et al (2009) Lifeguards’ sun protection habits and sunburns: association with sun-safe environments and skin cancer prevention program participation. Arch Dermatol 145(2):139–144

    Article  PubMed  PubMed Central  Google Scholar 

  • Heitkemper T, Hofmann T, Phan NQ et al (2010) Aquagenic pruritus: associated diseases and clinical pruritus characteristics. J Dtsch Dermatol Ges 8(10):797–804

    PubMed  Google Scholar 

  • Hostynek JJ, Patrick E, Younger B et al (1989) Hypochlorite sensitivity in man. Contact Dermatitis 20(1):32–37

    Article  CAS  PubMed  Google Scholar 

  • Jacobs JH, Spaan S, van Rooy GB et al (2007) Exposure to trichloramine and respiratory symptoms in indoor swimming pool workers. Eur Respir J 29(4):690–698

    Article  CAS  PubMed  Google Scholar 

  • Jacobson JA (1985) Pool-associated Pseudomonas aeruginosa dermatitis and other bathing-associated infections. Infect Control 6(10):398–401

    Article  CAS  PubMed  Google Scholar 

  • Kagen MH, Wolf J, Scheman A et al (2004) Potassium peroxymonosulfate-induced contact dermatitis. Contact Dermatitis 51(2):89–90

    Article  PubMed  Google Scholar 

  • Kanerva L, Alanko K, Estlander T et al (1997) Occupational allergic contact urticaria from chloramine-T solution. Contact Dermatitis 37(4):180–181

    Article  CAS  PubMed  Google Scholar 

  • Kelsall HL, Sim MR (2001) Skin irritation in users of brominated pools. Int J Environ Health Res 11(1):29–40

    Article  CAS  PubMed  Google Scholar 

  • Lazarov A, Nevo K, Pardo A et al (2005) Self-reported skin disease in hydrotherapists working in swimming pools. Contact Dermatitis 53(6):327–331

    Article  PubMed  Google Scholar 

  • 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 (Lond) 48(7):461–463

    Article  CAS  Google Scholar 

  • Maibach H (1975) Scuba diver facial dermatitis: allergic contact dermatitis to N-isopropyl-N-phenylpara-phenylenediamine. Contact Dermatitis 1(5):330

    Article  CAS  PubMed  Google Scholar 

  • Massin N, Bohadana AB, Wild P et al (1998) Respiratory symptoms and bronchial responsiveness in lifeguards exposed to nitrogen trichloride in indoor swimming pools. Occup Environ Med 55(4):258–263

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Morgan J (1983) Dermatoses associated with brominated swimming pools. Br Med J (Clin Res Ed) 287:913

    Google Scholar 

  • Morren MA, Przybilla B, Bamelis M et al (1994) Atopic dermatitis: triggering factors. J Am Acad Dermatol 31(3 Pt 1):467–473

    Article  CAS  PubMed  Google Scholar 

  • Neering H (1977) Contact urticaria from chlorinated swimming pool water. Contact Dermatitis 3(5):279

    Article  CAS  PubMed  Google Scholar 

  • Osmundsen PE (1978) Contact dermatitis due to sodium hypochlorite. Contact Dermatitis 4(3):177–178

    Article  CAS  PubMed  Google Scholar 

  • Pardo A, Nevo K, Vigiser D et al (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(2):122–126

    Article  CAS  PubMed  Google Scholar 

  • Parrat J, Donze G, Iseli C et al (2012) Assessment of occupational and public exposure to trichloramine in Swiss indoor swimming pools: a proposal for an occupational exposure limit. Ann Occup Hyg 56(3):264–277

    CAS  PubMed  Google Scholar 

  • Penny PT (1991) Hydrotherapy pools of the future – the avoidance of health problems. J Hosp Infect 18(Suppl A):535–542

    Article  PubMed  Google Scholar 

  • Penso-Assathiany D, Flahault A, Roujeau JC (1999) Warts, swimming pools and atopy: a case control study conducted in a private dermatology practice. Ann Dermatol Venereol 126(10):696–698

    CAS  PubMed  Google Scholar 

  • Rycroft RJ, Penny PT (1983) Dermatoses associated with brominated swimming pools. Br Med J (Clin Res Ed) 287(6390):462

    Article  CAS  Google Scholar 

  • Salvaggio HL, Scheman AJ, Chamlin SL (2013) Shock treatment: swimming pool contact dermatitis. Pediatr Dermatol 30(4):494–495

    Article  PubMed  Google Scholar 

  • Sasseville D, Geoffrion G, Lowry RN (1999) Allergic contact dermatitis from chlorinated swimming pool water. Contact Dermatitis 41(6):347–348

    Article  CAS  PubMed  Google Scholar 

  • Scheuer E, Warshaw E (2006) Sunscreen allergy: a review of epidemiology, clinical characteristics, and responsible allergens. Dermatitis 17(1):3–11

    Article  PubMed  Google Scholar 

  • Seki T, Morimatsu S, Nagahori H et al (2003) Free residual chlorine in bathing water reduces the water-holding capacity of the stratum corneum in atopic skin. J Dermatol 30(3):196–202

    Article  PubMed  Google Scholar 

  • Sibbald RG, Black AK, Eady RA et al (1981) Aquagenic urticaria: evidence of cholinergic and histaminergic basis. Br J Dermatol 105(3):297–302

    Article  CAS  PubMed  Google Scholar 

  • Siebenhaar F, Degener F, Zuberbier T et al (2009) High-dose desloratadine decreases wheal volume and improves cold provocation thresholds compared with standard-dose treatment in patients with acquired cold urticaria: a randomized, placebo-controlled, crossover study. J Allergy Clin Immunol 123(3):672–679

    Article  CAS  PubMed  Google Scholar 

  • Stenveld H (2012) Allergic to pool water. Saf Health Work 3(2):101–103

    Article  PubMed  PubMed Central  Google Scholar 

  • Tlougan BE, Podjasek JO, Adams BB (2010) Aquatic sports dermatoses: part 1. In the water: freshwater dermatoses. Int J Dermatol 49(8):874–885

    Article  PubMed  Google Scholar 

  • Treudler R, Tebbe B, Steinhoff M et al (2002) Familial aquagenic urticaria associated with familial lactose intolerance. J Am Acad Dermatol 47(4):611–613

    Article  PubMed  Google Scholar 

  • Tsai TF, Maibach HI (1999) How irritant is water? An overview. Contact Dermatitis 41(6):311–314

    Article  CAS  PubMed  Google Scholar 

  • Tuyp E, Mitchell JC (1983) Scuba diver facial dermatitis. Contact Dermatitis 9(4):334–335

    Article  CAS  PubMed  Google Scholar 

  • Valsecchi R, Cassina GP, Migliori M et al (1985) Tego dermatitis. Contact Dermatitis 12(4):230

    Article  CAS  PubMed  Google Scholar 

  • van Joost T, Habets JM, Stolz E et al (1987) Sodium hypochlorite sensitization. Contact Dermatitis 16(2):114

    Article  PubMed  Google Scholar 

  • Yankura JA, Marks JG Jr, Anderson BE et al (2008) Spa contact dermatitis. Dermatitis 19(2):100–101

    PubMed  Google Scholar 

  • Zwiener C, Richardson SD, DeMarini DM et al (2007) Drowning in disinfection byproducts? Assessing swimming pool water. Environ Sci Technol 41(2):363–372

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany

    Richard Brans

  2. Institute for interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm), University of Osnabrück, Am Finkenhügel 7a, 49076, Osnabrück, Germany

    Richard Brans

Authors
  1. Richard Brans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard Brans .

Editor information

Editors and Affiliations

  1. Department of Dermatology, University of Osnabrück, Osnabrück, Niedersachsen, Germany

    Swen Malte John

  2. Department of Dermato-allergology, Gentofte Hospital, Hellerup, Denmark

    Jeanne Duus Johansen

  3. Dept. of Dermatology and Allergology, VU University Medical Centre, Amsterdam, The Netherlands

    Thomas Rustemeyer

  4. Dept. of Dermatology and Allergology, Friedrich Schiller University, Jena, Thüringen, Germany

    Peter Elsner

  5. Department of Dermatology, University of California San Francisco, San Francisco, California, USA

    Howard I. Maibach

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this entry

Cite this entry

Brans, R. (2017). Bath Attendants. In: John, S., Johansen, J., Rustemeyer, T., Elsner, P., Maibach, H. (eds) Kanerva’s Occupational Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-40221-5_123-2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-40221-5_123-2

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40221-5

  • Online ISBN: 978-3-319-40221-5

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation