Swimmer's Shoulder, Hot Tub Buns: Swimming May Be Hazardous to Your Skin

Reviewed by Aman Shah, MD on August 04, 2000
From the WebMD Archives

Aug. 4, 2000 -- Green hair and bikini yams? No, it's not a posthumous Dr. Seuss book. These are two of the skin conditions that swimmers may develop as they cool off this summer with a dip in the ocean or pool.

Competitive swimmers "are less likely to suffer from injuries caused by direct contact with unyielding surfaces, opponents, or bulky equipment," write Rodney S.W. Basler, MD, and colleagues in this month's Journal of the American Academy of Dermatology. However, "the aqueous medium in which they compete creates its own special group of skin conditions that are either unique to the sport or shared with other academic disciplines."

And, you don't have to be Mark Spitz or Janet Evans to develop these problems, either. "If you have dry skin, even one dip in the pool can tip you over into eczema," says Alexa Boer Kimball, MD, an assistant professor of dermatology at Stanford University School of Medicine in Palo Alto, Calif. Kimball, team physician for the Adventure Racing Team, tells WebMD, "If people know they have sensitive skin, they should take precautions." She recommends applying lotion "as soon as you get out of the shower."

As you might expect, the most common skin problems associated with swimming arise from exposure to sun and chlorine. "I can't tell you how many times I have been at a meet and forgotten to use sunscreen, or missed a spot and been burned in an odd spot -- often near the top of my bald head," says Matthew Luebbers, head coach of the Marine Corps Community Services Semper Fit/Aquatics Okinawa Dolphins team in Okinawa, Japan.

A competitive swimmer himself, Luebbers coaches workouts as long as 7,000 meters, which means he -- and the people he coaches -- can spend upwards of two hours in the sun. "Swimming outside without getting burned can be a challenge," he tells WebMD.

The biggest risk swimmers face from sun exposure isn't sunburn -- it's skin cancer. "A high level of disregard to [dermatologists'] warnings [to wear hats and sunscreens] is demonstrated on every beach and swimming pool deck," write Basler and his co-authors. Children under the age of 15 who spend lots of time in the sun are at particular risk.

Jim Miller, MD, chairman of the Sports Medicine Committee of the U.S. Masters Swimming Association, tells WebMD, "What is a good tan? The answer is, there isn't one." He suggests swimming early in the morning or in the evening whenever possible, to avoid the strongest rays. The worst time to swim is from 12 noon to 3 pm, when the sun really beats down. Unfortunately, that's also when a cool dip is most tempting. If you've just got to go for a lunchtime swim, Miller points out that most sunscreens last about 90 minutes in the water. After that, they should be reapplied. "These are not all-day products," he says.

Although it may look interesting, green hair is not a serious medical problem. It results when chlorine interacts with the pigment in hair that is dyed or naturally blond, gray, or white. "Mini-epidemics" have been reported in areas where the pool water has a high copper content. Using shampoos and conditioners specially formulated to remove chlorine from the hair helps keep the green out.

Other problems result from swimming equipment. Many swimmers develop "goggle face," a rash or swelling caused by allergies to the neoprene or latex contained in some types of goggles. To avoid this problem, Miller suggests that you not use goggles containing these materials if you are allergic.

Even bathing suits themselves may be a source of irritation. "It's simple friction: wet skin rubbing against wet skin," says Carin, a competitive swimmer. "I wear the high-necked suits from Speedo and always get the chafe unless I use Vaseline around the neckline. It looks like you've got a neckful of hickies. Lovely."

Lower down, "bikini bottom" may appear on the buttocks 3-5 days after spending the day in a wet, tight-fitting bathing suit. As the name implies, the rash is most often seen in women, and it usually follows the pattern of the suit. Even worse are "hot tub buns," caused by bacteria that flourish in less-than-hygienic hot tubs. According to Basler and his colleagues, "this malady can run a painful and protracted course, creating difficulty sitting in one position for any extended period." To cure it, doctors prescribe antibiotic acne creams and advise patients not to wear tight-fitting clothes or bathing suits for at least 10 days.

Men, too, have their own unique complaints. Several swimmers have noted a rough, reddened patch on the front of one shoulder that appears about 30 minutes after a swim. The culprit? Stubble. The patches develop when the previous night's growth brushes against the shoulder as a man turns his head to breathe while doing strokes. The solution: Shave before you swim.

Except for skin cancer, most of these conditions are minor and easily treated or avoided. "Shower and rinse after swimming," says Luebbers. "Use a shampoo designed to wash out chemicals. Wear a cap. Use a moisturizing lotion after swimming and showering, and use a sunscreen and reapply after swimming. Nothing too earth shattering here -- it's all common sense."