Swimming with eczema: chlorine, lakes and after-swim care

Swimming lessons, the community pool in January, the lake at the cottage in July: water is a big part of a Canadian childhood. If your child has eczema, you might wonder whether all that chlorine and lake water is making things worse. The short answer is that most kids with eczema can swim happily with a bit of preparation. Here’s what the water does to eczema-prone skin and how to protect it.

Should kids with eczema swim at all?

Yes, in most cases. A 2023 review in Pediatric Dermatology, written by dermatologists who looked at the research on swimming and eczema, concluded that children with eczema shouldn’t miss out on swimming because of unfounded concerns. They noted that swimming is an essential life skill, that the water can feel cooling on eczema, and that swimming involves less noticeable sweating than many sports, which helps children who find heat and sweat trigger their itch.

The same review found that most large studies showed no link between swimming in early life and developing eczema later. A few studies suggested a link, but they relied on parents’ reports and had other weaknesses.

There’s an emotional side too. The authors point out that some children with eczema avoid swimming because they’re self-conscious about their skin, and that being left out of activities like swimming can lead to teasing and upset. Keeping your child in the water is worth the effort.

What does chlorine do to eczema-prone skin?

Chlorine is added to pools to kill germs. For some children with eczema it’s irritating; for others it seems to make little difference.

There is some lab evidence that it affects eczema-prone skin more. A small Japanese study had people soak their forearms in water with different amounts of chlorine. In people with eczema, even the lower chlorine levels reduced the outer skin layer’s ability to hold on to water, while in people without eczema it took a higher level to have the same effect. That’s one reason eczema-prone skin can feel tight and dry after a swim.

Other things in pool water matter too. The 2023 review notes that pool water is usually kept slightly alkaline, while healthy skin is slightly acidic, and that the minerals added to pool water can also be drying. On the flip side, diluted chlorine has an antiseptic effect, which is the idea behind the bleach baths some doctors prescribe for eczema. Harvard Health notes that a bleach bath essentially turns the bathtub into something like a swimming pool.

So chlorine isn’t simply good or bad. The practical approach is to protect the skin and watch how your child responds.

How to protect skin before a swim

• Moisturize first. The National Eczema Society suggests applying your usual moisturizer, ideally an ointment (a thicker, greasier moisturizer), before getting in the pool, using more than usual so it acts as a barrier to the water. Harvard Health gives the same advice. The 2023 review adds that children often tolerate a greasier moisturizer for swimming than they would day to day.
• Put safety first. For weaker swimmers, the National Eczema Society suggests skipping the pre-swim layer for safety reasons and moisturizing afterwards instead.
• Outdoors, add sunscreen. For outdoor swimming, the society suggests applying moisturizer about 30 minutes before sunscreen, and choosing sunscreens with titanium dioxide or zinc oxide. Harvard Health recommends a broad-spectrum, fragrance-free sunscreen.
• Check the timing. If you can, find out when your pool adds chlorine and avoid swimming right afterwards, when levels are highest.
• Choose gear carefully. Rubber in goggles, caps and masks can irritate or cause an allergy in some children with eczema, the 2023 review notes. Harvard Health suggests silicone-lined options.

The after-swim routine that matters most

What you do in the ten minutes after the swim may matter more than anything else.

1. Get the swimsuit off quickly. The 2023 review advises removing swimwear promptly, since wet fabric left on the skin can irritate it and encourage infection of the hair follicles.
2. Rinse in fresh water. Shower as soon as you can with a gentle, fragrance-free wash. If the pool showers use chlorinated water, the National Eczema Society suggests showering at home as soon as you get there. Don’t linger on the pool deck, since the skin is still exposed to chlorine fumes there.
3. Pat dry. Gently, with a clean towel. No rubbing.
4. Moisturize generously. The society recommends using more moisturizer than usual after swimming. A small German study in babies found that those who were moisturized after swimming lessons kept more stable skin oil and pH levels than those who weren’t.

Rinse goggles, caps and swimsuits in fresh water too. The moisturizers page lists fragrance-free options whose claims have been reviewed.

What about lakes and the ocean?

Many families swear by lake or sea swims for eczema, and some children find salt water stings. The 2023 review found no good-quality evidence either way on salt water and eczema. If a chlorinated pool keeps bothering your child, the National Eczema Society suggests trying a different pool, a saltwater pool, or fresh or sea water in summer.

Canadian lakes come with their own itch to know about: swimmer’s itch. HealthLink BC explains that it’s an allergic rash caused by tiny parasites from snails, found in lakes, ponds and coastal waters across Canada, mostly in the warm summer months and in shallow water near the shore. It shows up as tingling and then red spots within about 12 hours and can last up to two weeks. It isn’t eczema, but on eczema-prone skin the extra itch is unwelcome. To lower the risk, avoid weedy shallows, enter from a dock where you can, and towel off right away after getting out. The 2023 review also suggests bringing a container of fresh water to rinse off after sea swimming.

When should your child skip a swim?

• During a bad flare. The National Eczema Society advises avoiding swimming when eczema is flaring badly, and the 2023 review agrees it’s reasonable to wait out severe flares.
• When the skin looks infected. Weeping, yellow crusts, pus or sudden painful spots need a doctor’s visit, and swimming can wait until it’s healed.
• When it’s a new pool and you’re unsure. Try a short swim first and see how the skin reacts.

When to talk to your doctor

See your doctor or pharmacist if the skin is regularly worse after swimming despite moisturizing before and after, if you notice a rash in the shape of goggles or a cap, or if a lake rash isn’t settling after a couple of weeks or looks infected. Your doctor can also advise on when to apply any prescribed cream around swim time.

Swimming is good for kids with eczema, and chlorine doesn’t have to be the enemy. A layer of moisturizer before, a fast change and a fresh-water rinse after, then a generous layer of moisturizer again: that simple routine keeps most children happily in the water, from the local pool in winter to the lake in summer.