Database: MEDLINE <1966 to April Week 3 2002> Search Strategy: Aquatic skin disorders ------------------------------------------------------------------------------1 exp Skin Diseases/ (330671) 2 exp Skin Manifestations/ (16140) 3 (aqua$ or water).af. (236277) 4 (1 or 2) and 3 (3276) 5 limit 4 to (human and english language) (2105) 6 exp Skin Diseases/et or exp Skin Manifestations/et (65420) 7 5 and 6 (764) 8 exp sports/ (42049) 9 7 and 8 (34) 10 (exp *Skin Diseases/et or exp *Skin Manifestations/et) and (aqua$ or water).ti. and 5 (101) 11 limit 10 to review articles (13) 12 9 or 11 (43) 13 from 12 keep 1-43 (43) *************************** <1> Unique Identifier 5547158 Medline Identifier 71131845 Authors Blenkarn GD. Aquadro C. Hills BA. Saltzman HA. Title Urticaria following the sequential breathing of various inert gases at a constant ambient pressure of 7 ATA: a possible manifestation of gasinduced osmosis. Source Aerospace Medicine. 42(2):141-6, 1971 Feb. <2> Unique Identifier 1969706 Medline Identifier 90209812 Authors Parrish DO. Title Marine envenomations and aquatic dermatology. [letter; comment.]. Comments Comment on: Am Fam Physician. 1989 Aug;40(2):97-106 ; 2569260 Source American Family Physician. 41(4):1092-4, 1099, 1990 Apr. <3> Unique Identifier 2569260 Medline Identifier 89333444 Authors Soppe GG. Institution Memorial Medical Center of Long Beach, California. Title Marine envenomations and aquatic dermatology. [see comments.]. [Review] [15 refs] Comments Comment in: Am Fam Physician. 1990 Apr;41(4):1092-4, 1099 ; 1969706 Source American Family Physician. 40(2):97-106, 1989 Aug. Abstract Jellyfish stings are usually mild except those caused by species in the South Pacific. The box jellyfish can produce a severe cardiorespiratory insult. The sting of the Portuguese man-of-war is more potent than that of the common jellyfish. The Indo-Pacific area is the source of the most venomous bony fish. Many injuries can be avoided by wearing shoes when walking in shallow water or tide pools. Aquatic-related skin infections may involve unusual organisms. Swimmer's itch, a disease of freshwater bathing, is caused by cercariae. Seabather's eruption produces a rash in swimsuit-covered areas; the etiology is not clear. [References: 15] <4> Unique Identifier 8806373 Medline Identifier 96399997 Authors Fleisher JM. Kay D. Salmon RL. Jones F. Wyer MD. Godfree AF. Institution Department of Preventive Medicine and Community Health, State University of New York, Brooklyn 11203-2098, USA. Title Marine waters contaminated with domestic sewage: nonenteric illnesses associated with bather exposure in the United Kingdom. [see comments.]. Comments Comment in: Am J Public Health. 1996 Sep;86(9):1203-4 ; 8806367 Source American Journal of Public Health. 86(9):1228-34, 1996 Sep. Abstract OBJECTIVES: This study identified possible dose-response relationships among bathers exposed to marine waters contaminated with domestic sewage and subsequent risk of nonenteric illness. METHODS: Four intervention follow-up studies were conducted within the United Kingdom. Healthy volunteers (n = 1273) were randomized into bather and nonbather groups. Intensive water-quality monitoring was used to assign five bacteriological indices of water quality to individual bathers. Illnesses studied were acute febrile respiratory illness, and eye, ear, and skin ailments. RESULTS: Fecal streptococci exposure was predictive of acute febrile respiratory illness, while fecal coliform exposure was predictive of ear ailments. Estimated thresholds of effect occurred at bather exposures above 60 fecal streptococci and 100 fecal coliform per 100 ml of water, respectively. Although no relationship was found between eye ailments and indicator organism exposure, compared with nonbathers, bathers were at higher risk for eye ailments. CONCLUSIONS: Nonenteric illness can be transmitted via recreational contact with marine waters contaminated with sewage. These results argue against the use of a single indicator to establish water quality standards. <5> Unique Identifier 3706597 Medline Identifier 86212751 Authors Dewailly E. Poirier C. Meyer FM. Title Health hazards associated with windsurfing on polluted water. Source American Journal of Public Health. 76(6):690-1, 1986 Jun. Abstract We documented the risks associated with windsurfing on sewage polluted water. Seventy-nine windsurfers and 41 controls were studied over a nineday period for occurrence of symptoms of gastroenteritis, otitis, conjunctivitis, and skin infection. Relative risks were 2.9 for occurrence of one or more of these symptoms and 5.5 for symptoms of gastroenteritis. Relative risk increased with the reported number of falls into the water. <6> Unique Identifier 9647271 Medline Identifier 98309486 Authors Luong KV. Nguyen LT. Title Aquagenic urticaria: report of a case and review of the literature. [Review] [21 refs] Source Annals of Allergy, Asthma, & Immunology. 80(6):483-5, 1998 Jun. Abstract OBJECTIVE: To present a case of aquagenic urticaria and to review the literature regarding this very rare physical urticaria. METHOD: We described the clinical history of a patient with aquagenic urticaria. A water challenge test was performed, with plasma histamine levels measured before and after the challenge. RESULT: Our patient presented with a history of severe itching and wheals within five minutes of contact with water, regardless of its temperature or source (sea or tap water). A water challenge produced hives but serum histamine levels did not change. Prophylaxis with antihistamine or anticholinergic medications was not effective. CONCLUSION: Exposure to water can cause urticaria in susceptible patients and antihistamine and anticholinergic medication may not prevent the reaction. The mechanism of this phenomenon remains poorly understood. [References: 21] <7> Unique Identifier 4625029 Medline Identifier 72219175 Authors Jolly HW Jr. Seabury JH. Title Infections with Myocbacterium marinum. Source Archives of Dermatology. 106(1):32-6, 1972 Jul. <8> Unique Identifier 8645596 Medline Identifier 96249067 Authors Rosso S. Zanetti R. Martinez C. Tormo MJ. Schraub S. SanchoGarnier H. Franceschi S. Gafa L. Perea E. Navarro C. Laurent R. Schrameck C. Talamini R. Tumino R. Wechsler J. Institution Registro de Cancer de Granada, Escuela Andaluza de Salud Publica, Spain. Title The multicentre south European study 'Helios'. II: Different sun exposure patterns in the aetiology of basal cell and squamous cell carcinomas of the skin. Source British Journal of Cancer. 73(11):1447-54, 1996 Jun. Abstract The role of sun exposure in development of basal cell and squamous cell carcinomas among different populations from south Europe was investigated. Between 1989 and 1993 we interviewed incident cases and a random population sample of controls from five centres where a cancer registry was operating, whereas we selected a sample of hospital-based cases and controls from the other three centres. We gathered information on life-long exposure to sunlight during different activities. Results are analysed for 1549 basal cell carcinoma (BCC) cases and 228 squamous cell carcinoma (SCC) cases compared with 1795 controls. We observed a statistically significant increase of risk of SCC with increasing sun exposure beyond a threshold of 70,000 cumulated hours of exposure in a lifetime. Sun exposures during work and holidays were, however, inversely correlated. Odds ratios (ORs) of SCC were up to eight or nine times the reference for the highest exposures (200,000 cumulated hours or more). BCC exhibited a 2-fold increase of risk for lower exposure (8000-10,000 cumulated hours in a lifetime) with a plateau and a slight decrease of risk for the highest exposures (100,000 cumulated hours or more). Outdoor work showed a significantly increased risk of SCC (OR 1.6 for more than 54,000 cumulated hours of exposure in a lifetime), whereas recreational activities such as sun exposure during holidays at the beach (OR 1.6 for more than 2600 cumulated hours of exposure in a lifetime) or during water sports (OR 1.6 for more than 2600 cumulated hours of exposure in a lifetime) were associated with an increased risk of BCC. Risk patterns were different in poor or good tanners with a significant risk trend for good tanners, whereas poor tanners were on a plateau of increased risk at any level of exposure. Solar radiation is associated with a risk of BCC even for relatively short periods of exposure such as during holidays and sports, whereas SCC develops later if exposure continues. The skin's ability to tan modulates the risk of BCC; subjects who tan poorly have a steady risk increase, whereas people who tan easily develop cancer only after prolonged exposures. <9> Unique Identifier 3664416 Medline Identifier 88026588 Authors Anonymous. Title Aquatic dermatology. Source Clinics in Dermatology. 5(3):1-173, 1987 Jul-Sep. <10> Unique Identifier 3311338 Medline Identifier 88026595 Authors Mandojana RM. Sims JK. Institution Department of Medicine (Dermatology Service), Tripler Army Medical Center, Honolulu, Hawaii. Title Miscellaneous dermatoses associated with the aquatic environment. [Review] [39 refs] Source Clinics in Dermatology. 5(3):134-45, 1987 Jul-Sep. <11> Unique Identifier 3664422 Medline Identifier 88026600 Authors Fisher AA. Institution Department of Dermatology, New York University Medical School, New York. Title Contact dermatitis to diving equipment, swimming pool chemicals, and other aquatic denizens. Source Clinics in Dermatology. 5(3):36-40, 1987 Jul-Sep. <12> Unique Identifier 3311340 Medline Identifier 88026601 Authors Steinman HK. Institution Department of Medicine, University of California at San Diego School of Medicine. Title Water-induced pruritus. [Review] [28 refs] Source Clinics in Dermatology. 5(3):41-8, 1987 Jul-Sep. <13> Unique Identifier 3311341 Medline Identifier 88026603 Authors Auerbach PS. Institution Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Title Natural microbiologic hazards of the aquatic environment. [Review] [102 refs] Source Clinics in Dermatology. 5(3):52-61, 1987 Jul-Sep. <14> Unique Identifier 3311343 Medline Identifier 88026606 Authors Nelson AM. Neafie RC. Connor DH. Institution Department of Infectious and Parasitic Disease Pathology, Armed Forces Institute of Pathology, Washington, DC. Title Cutaneous protothecosis and chlorellosis, extraordinary "aquatic-borne" algal infections. [Review] [58 refs] Source Clinics in Dermatology. 5(3):76-87, 1987 Jul-Sep. <15> Unique Identifier 10230574 Medline Identifier 99247189 Authors Nichols AW. Institution Department of Family Practice and Community Health, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA. Title Nonorthopaedic problems in the aquatic athlete. [Review] [40 refs] Source Clinics in Sports Medicine. 18(2):395-411, viii, 1999 Apr. Abstract This article discusses a number of medical conditions that are common to aquatic athletes. Exercise-induced asthma is particularly prevalent in swimmers because swimming is among the activities tolerated best by asthmatics. The healthcare professional frequently must evaluate and manage respiratory infections and infectious mononucleosis in swimmers, particularly in regard to the safe timing of return to training and competition. Dilutional sports pseudoanemia must be differentiated from the true anemias that are due mostly to iron-deficiency and intravascular hemolysis. Finally, the evaluation, management, and prevention of otitis externa, external auditory canal exostoses, and dermatologic disorders in swimmers are reviewed. [References: 40] <16> Unique Identifier 10617210 Medline Identifier 20083500 Authors Tsai TF. Maibach HI. Institution Department of Dermatology, University of California, San Francisco, USA. Title How irritant is water? An overview. [Review] [53 refs] Source Contact Dermatitis. 41(6):311-4, 1999 Dec. Abstract Water is a skin irritant which deserves attention because of its ubiquity. During the Vietnam war, soldiers suffered from painful swollen feet, so-called tropical immersion foot. In occupational dermatology, the importance of water as a skin irritant is especially appreciated. The irritancy of water has been demonstrated by occlusion experiments; occlusion with either closed chambers or water-soaked patches has been shown to produce clinical and histopathological inflammation. Functional damage, as revealed by increased transepidermal water loss, has also been shown. Repeated water exposure without occlusion caused an increase in blood flow on irritated skin; however, clinical evaluation did not show a difference in dryness or scaling. Several mechanisms such as osmolarity, pH, hardness and temperature might account for the irritancy of water. Extraction or dilution of natural moisturizing factors in the stratum corneum is another possible explanation. Occlusion per se also changes the physiology of skin and may trigger the activation of potentially active substances. However, much remains to be done to clarify the risk factors and mechanisms of water-induced irritation. [References: 53] <17> Unique Identifier 9169262 Medline Identifier 97312821 Authors Saltzer KR. Schutzer PJ. Weinberg JM. Tangoren IA. Spiers EM. Institution Department of Dermatology, University of Pennsylvania, Philadelphia, USA. Title Diving suit dermatitis: a manifestation of Pseudomonas folliculitis. Source Cutis. 59(5):245-6, 1997 May. Abstract Pseudomonas aeruginosa causes a variety of cutaneous infections. Pseudomonas folliculitis has been associated with a number of activities, particularly bathing in contaminated water and the use of contaminated objects while bathing. We present two unique cases in which the subjects noted Pseudomonas folliculitis after recreational use of diving suits. <18> Unique Identifier 9878980 Medline Identifier 99095030 Authors Burnett JW. Institution Department of Dermatology, University of Maryland School of Medicine, Baltimore 21201, USA. Title Aquatic adversaries: stonefish. [Review] [7 refs] Source Cutis. 62(6):269-70, 1998 Dec. <19> Unique Identifier 7648887 Medline Identifier 95376990 Authors Scott MJ. Scott MJ 3rd. Title Dermatologic stigmata in sports: water skiing. Source Cutis. 55(6):353-4, 1995 Jun. Abstract Every athletic endeavor results in dermatologic stigmata specific to it. We illustrate here such a stigmata associated with water skiing. <20> Unique Identifier 10879303 Medline Identifier 20337467 Authors Green JJ. Institution Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School at Camden, Cooper Hospital, USA. Title Localized whirlpool folliculitis in a football player. Source Cutis. 65(6):359-62, 2000 Jun. Abstract Pseudomonas aeruginosa folliculitis occurs in patients exposed to contaminated water. Most out-breaks are associated with whirlpools. The infection is characterized by follicular, erythematous papules and pustules located on immersed body surfaces. Most reported cases are the result of recreational water use, occur in a diffuse pattern, and are devoid of green pustular pigment changes. The case described occurred in a football player after whirlpool treatment for an ankle strain. Green pustules and a localized affected area are unusual aspects of this case. <21> Unique Identifier 6444569 Medline Identifier 80133624 Authors Fisher AA. Title Water-related dermatoses. Part I. Source Cutis. 25(2):132, 135-6, 139-40 passim, 1980 Feb. <22> Unique Identifier 322958 Medline Identifier 77161349 Authors Hicks JH. Title Swimming and the skin. [Review] [5 refs] Source Cutis. 19(4):448-50, 1977 Apr. Abstract Most skin diseases associated with swimming are relatively minor and either heal spontaneously or respond quickly to treatment. Exceptions are those diseases made worse by sunlight such as lupus erythematosus, skin cancer, or prematurely aged skin. With the use of better sunscreens in the future, that problem will be solved. [References: 5] <23> Unique Identifier 322960 Medline Identifier 77161351 Authors Hoeffler DF. Title "Swimmers' itch" (cercarial dermatitis). [Review] [24 refs] Source Cutis. 19(4):461-5, 467, 1977 Apr. Abstract Cercarial dermatitis is a parasitic disease affecting the skin. It may be encountered in fresh or salt water and is global in its distribution. It is a potential economic hazard to persons who work in aquatic environments and to the tourist industry. Cercarial dermatitis should be considered a potential risk whenever warm-blooded and molluscan hosts share a water resource with man. It is characteristically a self-limited, severely itching rash that lasts about one week and may be easily mistaken for insect bites. Prevention of the disease is difficult. Treatment is primarily directed toward relief of symptoms and prevention of infection. [References: 24] <24> Unique Identifier 3720354 Medline Identifier 86246519 Authors Parks A. Camisa C. Title Aquagenic angioedema. Source Cutis. 37(6):465-6, 1986 Jun. Abstract A 21-year-old man experienced persistent swelling of his lips and generalized pruritus without hives associated with swimming. Provocative testing with tap water produced transient edema and pruritus. Sweating and methacholine testing did not produce cholinergic urticaria. After several weeks, the angioedema gradually subsided, the reaction to tap water became negative, and the patient was able to swim again without reactions. Water should be added to the list of physical agents that cause angioedema as well as urticaria. <25> Unique Identifier 2242790 Medline Identifier 91055660 Authors Bircher AJ. Institution Department of Dermatology, University of Basel, Switzerland. Title Water-induced itching. [Review] [39 refs] Source Dermatologica. 181(2):83-7, 1990. Abstract In this paper the current knowledge on water-induced pruritus is reviewed. To the present, three forms, namely aquagenic pruritus (AP), aquagenic pruritus of the elderly (APE) and water-related itching in polycythemia rubra vera (PRV), have been recognized. Despite clinical similarities it appears that the pathophysiology is different in the three forms. The currently most effective treatment for AP is addition of sodium bicarbonate to the water, control of xerosis with emollients for APE and aspirin for water-induced itching in PRV. [References: 39] <26> Unique Identifier 9692609 Medline Identifier 98355337 Authors Chamot E. Toscani L. Rougemont A. Institution Institute of Social and Preventive Medicine, University Medical Center, Geneva, Switzerland. Title Public health importance and risk factors for cercarial dermatitis associated with swimming in Lake Leman at Geneva, Switzerland. Source Epidemiology & Infection. 120(3):305-14, 1998 Jun. Abstract Fifteen cohorts of healthy bathers were recruited at four Lake Leman beaches between 3 July and 23 August 1996 to assess the public health importance of cercarial dermatitis in Geneva, Switzerland. Telephone follow-up interviews were carried out after 2-7 days. Overall, 153 bathers out of 555 reported probable cercarial dermatitis at follow-up. Median daily attack rate was 27.7% (2.2-57.7%). Of the cases, 11.1% noticed more than 30 skin lesions, 19.6% described severe itching, 50.3% used a drug treatment, 3.9% visited a doctor and 15% claimed they would reduce their bathing activities. History of cercarial dermatitis, time spent in the water, hour of the day, barometric pressure and maximum daily atmospheric temperature predicted disease occurrence in multivariate analysis. While a benign disease, cercarial dermatitis may have a negative impact on the local water recreation industry. The identification of risk factors for the disease may help produce better preventive recommendations for the bathers. <27> Unique Identifier 10846254 Medline Identifier 20307974 Authors Kikuchi-Numagami K. Suetake T. Yanai M. Takahashi M. Tanaka M. Tagami H. Institution Department of Dermatology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai980-8574, Sendai, Japan. katsukon@mail.cc.tohoku.ac.jp Title Functional and morphological studies of photodamaged skin on the hands of middle-aged Japanese golfers. [erratum appears in Eur J Dermatol 2000 Jul-Aug;10(5):402.]. Source European Journal of Dermatology. 10(4):277-81, 2000 Jun. Abstract The skin of golfers' hands provides a suitable model to study the effect of chronic sun exposure, because one of their hands is exposed to the outer environment, especially sunlight, while the other one is always protected by a glove during play. Our purpose was to find out the influence of photodamage on the properties of the skin surface of middleaged Japanese by using non-invasive methods. We measured hydration state, and water barrier function of the stratum corneum (SC) and the color of the skin of the dorsum of the hands. In a separate study, we evaluated the skin surface contour by using replicas taken from the skin in a slightly stretched or relaxed position. We found a significant decrease in hydration of the skin surface of the exposed skin as compared to that of the protected skin, whereas no such difference was found with transepidermal water loss, a parameter for water barrier function of the SC. Luminance of skin color was also reduced in the sun-exposed skin. Replica analysis revealed that large wrinkles developing in a relaxed position were more prominent on the exposed than on the protected skin, while fine furrows noted in a slightly stretched position were shallower on the former than the latter. The data obtained indicate that the chronically exposed skin of golfers' hands shows morphological and functional changes resulting from long time exposure to the outer environment especially sunlight. Furthermore, bioengineering non-invasive methods are found to be useful to detect early photodamage of the skin in a more quantitative fashion which is rather difficult to demonstrate clinically. <28> Unique Identifier 1675631 Medline Identifier 91267684 Authors Addy JH. Institution Korle Bu Teaching Hospital, University of Ghana Medical School, Accra. Title Red sea coral contact dermatitis. Source International Journal of Dermatology. 30(4):271-3, 1991 Apr. Abstract Six of nine adults who developed Red Sea coral contact dermatitis had seafood allergies. Contact with the "fire" coral was followed by a series of skin eruptions starting with an immediate pruritic urticaria-like lesion which forced the victims out of the water. Within minutes the affected area became erythematous and edematous with eventual blister formation approximately 6 hours after the initial contact. The blisters resolved, leaving violaceous papules and plaques in a streaky fashion corresponding to where the coral brushed the skin. The lesions became shiny and lichenoid in 3 weeks while pruritus persisted. Treatment with topical corticosteroids and oral antihistamines reduced the severity of the disease but did not stop its evolution to the lichenoid stage. Complete resolution usually occurred after 15 weeks, leaving residual hyperpigmented macules. <29> Unique Identifier 9427071 Medline Identifier 98088510 Authors Tur E. Brenner S. Institution Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Sackler School of Medicine, Israel. Title The role of the water system as an exogenous factor in pemphigus. [Review] [60 refs] Source International Journal of Dermatology. 36(11):810-6, 1997 Nov. <30> Unique Identifier 1815082 Medline Identifier 92269224 Authors Peterson KA. Portouw SJ. Title The hazards of operational diving in heavily oil-polluted water. [Review] [15 refs] Source Journal of the Royal Naval Medical Service. 77(3):159-64, 1991 Winter. <31> Unique Identifier 3121990 Medline Identifier 88093891 Authors Verhaegen MJ. Title The aquatic ape theory and some common diseases. Source Medical Hypotheses. 24(3):293-300, 1987 Nov. Abstract The Aquatic Ape Theory claims that human ancestors once lived in a semi-aquatic habitat. Some human diseases might be explained by our aquatic past. Such problems include hyperventilation, periodic breathing, laryngo- and bronchospasm, vasomotor rhinopathy, seborrhea, dandruff, male pattern alopecia, rhinophyma, osteoarthritis, inguinal hernias, varicose veins, common obesity, myopia, and ear-wax. <32> Unique Identifier 449750 Medline Identifier 79199090 Authors Appleton CC. Lethbridge RC. Title Schistosome dermatitis in the Swan Estuary, Western Australia. Source Medical Journal of Australia. 1(5):141-5, 1979 Mar 10. Abstract The avian blood fluke, Austrobilharzia terrigalensis (Trematoda: Schistosomatidae), is recorded in Western Australia for the first time, and is implicated as the cause of dermatitis among users of the Swan estuary in Perth. Quantitative data provided by a questionnaire sent to affected people showed that infection occurred from November to March in the shallows throughout the "middle" estuary and that children from five to 14 years old were most frequently affected. Most cases of dermatitis were contracted between 11 a.m. and 12 noon--the time of day when the emergence of A. terrigalensis cercariae from the intermediate host, Velacumantus australis, reaches a peak. Exposure times varied considerably, but were generally between 30 and 90 minutes, with dermatitis appearing 12 to 24 hours later. The lesions, which were sometimes widespread over the body and itched severely, persisted for one to two weeks and longer if they were secondarily infected. Approximately 38% of affected people consulted doctors about their condition. These results are discussed in relation to findings on the ecology of the parasite's intermediate and definitive hosts. <33> Unique Identifier 7858410 Medline Identifier 95161922 Authors Nelemans PJ. Rampen FH. Groenendal H. Kiemeney LA. Ruiter DJ. Verbeek AL. Institution Department of Medical Informatics and Epidemiology, University of Nijmegen, The Netherlands. Title Swimming and the risk of cutaneous melanoma. Source Melanoma Research. 4(5):281-6, 1994 Oct. Abstract Recreational exposure to the sun may not explain fully current trends in melanoma incidence. The hypothesis was examined whether carcinogens in water play a role in the development of cutaneous melanoma. In a casecontrol study, 128 melanoma patients and 168 patients with other types of malignancy completed a detailed questionnaire on aquatic leisure time activities. All relative risk estimates were adjusted for age, gender, educational level, pigmentation characteristics, and exposure to sun habits. Regular swimming during the summer months in swimming pools and in open waters such as rivers and seas before the age of 15 years, was associated with odds ratios of 2.20 (95% confidence interval (CI), 1.054.62) and 2.41 (95% CI, 1.04-5.58), respectively, compared with no swimming at all or swimming in relatively unpolluted waters, such as lakes and fens. Melanoma patients learned to swim at a younger age; compared with those who never learned to swim or who learned to swim after the age of 12 years, the odds ratio was 1.87 (95% CI, 0.91-3.78) for those who learned to swim at ages 9-12 years, and 2.22 (95% CI, 1.164.26) for those who learned to swim before 9 years of age. Compared with persons who had no swimming certificates, an odds ratio of 1.25 (95% CI, 0.71-2.23) was found for persons with one or two certificates, and an odds ratio of 2.96 (95% CI, 1.25-6.96) for persons with three or more certificates. The positive association between a history of swimming and melanoma risk suggests that carcinogenic agents in water, possibly chlorination by products, play a role in melanoma aetiology. <34> Unique Identifier 865461 Medline Identifier 77192003 Authors Oyoo AO. Donnell D. Pendergast TJ. Title Epidemic of "swimmer's itch" traced to cercarial trematodes. Source Missouri Medicine. 74(5):218-9, 1977 May. <35> Unique Identifier 8336754 Medline Identifier 93330321 Authors Freudenthal AR. Joseph PR. Institution Office of Marine Ecology, Nassau County Department of Health, Mineola, N.Y. Title Seabather's eruption. Source New England Journal of Medicine. 329(8):542-4, 1993 Aug 19. Abstract BACKGROUND. Seabather's eruption is an annoying pruritic dermatitis that appears on the areas covered by the bathing suit as an erythematous macular or papular dermatitis, with or without urticaria. It occurs sporadically in Florida, the Caribbean, and as far north as Bermuda. The cause is not known. METHODS. We collected information in Nassau County, Long Island, New York, about cases of all types of water-related dermatitis reported by beach personnel, health providers, and affected swimmers from 1970 through 1991. Concurrently, we surveyed all Nassau County swimming waters, especially during the summer season (June through September), for the presence of organisms capable of causing dermatitis. In 1980 a sudden epidemic of a severe, unfamiliar dermatitis in ocean bathers prompted increased surveillance of cases and waters. Planula larvae of the phylum Cnidaria were collected from the ocean and beaches and inside bathing suits. They were examined, photographed, tested on healthy subjects, and observed in the laboratory for metamorphosis. RESULTS. Three outbreaks of seabather's eruption have occurred on Long Island since 1975. The first, in August 1975, affected a small number of swimmers on the eastern end of Long Island. In 1980 there were thousands of cases along the entire south shore of the island, and in 1990 there were hundreds in the same area. In nonepidemic years, five or fewer cases have been reported yearly. Surveillance for larvae revealed them to be present during the swimming season in epidemic years, but in nonepidemic years they did not appear until autumn, after the swimming season. Applying larvae to the skin of healthy subjects produced a dermatitis indistinguishable from seabather's eruption. All larvae metamorphosed in the laboratory to the adult sea anemone Edwardsiella lineata. CONCLUSIONS. Seabather's eruption, previously reported only as sporadic cases in southern climates, has occurred sporadically and in outbreaks 1000 miles north of most previously described cases. These Long Island episodes were probably caused by the planula larvae of E. lineata. <36> Unique Identifier 9242039 Medline Identifier 97386025 Authors Kamihama T. Kimura T. Hosokawa JI. Ueji M. Takase T. Tagami K. Institution Laboratory of Exercise and Environmental Health, Institute of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan. Title Tinea pedis outbreak in swimming pools in Japan. Source Public Health. 111(4):249-53, 1997 Jul. Abstract This study was conducted to show a higher prevalence of interdigital tinea pedis in athletes by comparing athletes and non-athletes, and to examine swimming pools as a route of infection. The subjects were 282 athletes, 137 non-athletes, and 140 students enrolled in a swimming class at the University of Tsukuba. This study included the taking of cottonswab samples from the interdigital skin surfaces of both feet and cultures, microscopical examinations of scales collected from subjects with lesions, and questionnaires. There was a significant difference between athletes and non-athletes in the prevalence of the relevant pathogens, and a higher risk of infection was shown in athletes. The study also found that 63.6% of the swimming class students were carriers, and that 85.0% of their dermatophytes were Trichophyton mentagrophytes. In addition, dermatophytes were also isolated from the floors of the swimming pool and the public baths. The results of these controlled studies suggested that there was a significant risk of dermatophytosis in both athletes and non-athletes using the swimming pool. <37> Unique Identifier 9018290 Medline Identifier 97171017 Authors Kumar S. Hlady WG. Malecki JM. Institution Division of Epidemiology and Disease Control, Palm Beach County Public Health Department, Riviera Beach, FL 33404, USA. Title Risk factors for seabather's eruption: a prospective cohort study. Source Public Health Reports. 112(1):59-62, 1997 Jan-Feb. Abstract OBJECTIVE: A prospective cohort study was performed to identify risk factors for seabather's eruption. METHODS: Study participants were recruited at four beaches in Palm Beach County, Florida, during three weekends of May and June 1993. Participants were interviewed by telephone after 48 hours regarding medical history, beach activities, development of rashes, and use of possible preventive measures. RESULTS: Seabather's eruption, defined by the occurrence of a rash within two days of exposure to seawater, was reported by 114 (16%) of 735 respondents. The strongest predictor of seabather's eruption was a past history of the condition. Children less than 16 years of age were also at increased risk, as were surfers. Showering with one's bathing suit off was a useful protective measure. CONCLUSION: The study's findings suggest that when the seasonal risk of seabather's eruption is present, children, people with a history of seabather's eruption, and surfers are at greatest risk. During the sea lice season, seabathers can minimize their risk by showering with their bathing suits off after seabathing. Length of the time spent in water was not significantly associated with seabather's eruption. <38> Unique Identifier 8679437 Medline Identifier 96245814 Authors du Peloux Menage H. Greaves MW. Institution St John's Institute of Dermatology, Guy's and St Thomas' Hospital Trust, London, United Kingdom. Title Aquagenic pruritus. [Review] [40 refs] Source Seminars in Dermatology. 14(4):313-6, 1995 Dec. <39> Unique Identifier 3153453 Medline Identifier 91027412 Authors Archer CB. Greaves MW. Institution St. John's Hospital for Diseases of the Skin and Institute of Dermatology, London, United Kingdom. Title Aquagenic pruritus. [Review] [14 refs] Source Seminars in Dermatology. 7(4):301-3, 1988 Dec. <40> Unique Identifier 1901428 Medline Identifier 91188363 Authors Evans AC. Martin DJ. Institution Ginsburg BD. Research Institute for Diseases in a Tropical Environment, South Africa Medical Research Council, Nelspruit, Tvl. Title Katayama fever in scuba divers. A report of 3 cases. Source South African Medical Journal. 79(5):271-4, 1991 Mar 2. Abstract Katayama fever or acute schistosomiasis probably occurs more commonly than is recorded. Interviews with a 3-man scuba diving team who had had contact with a large dam in an endemic area of the eastern Transvaal Lowveld at the same time and contact area on the same day during late summer of 1986 are discussed. Two, who had not previously been exposed to infected water, presented with Katayama fever, due to Schistosoma mansoni infection, 21 days after contact and it took 30-36 months for them to recover fully after several treatments. The third patient, a keen watersportsman and resident in the endemic area for a period of 10 years, presented with a mild infection, probably due to acquired immunity initiated during previous contacts with infected water; he took about a year to recover. The pathogenesis, clinical features, diagnosis and treatment of the 3 cases are described in the light of recent observations made elsewhere on Katayama fever cases and the effects of chemotherapy on the course of illness. The necessity of obtaining basic information on the travel and water-contact activities of patients in order to make a diagnosis is emphasised. <41> Unique Identifier 663876 Medline Identifier 78204745 Authors Robertson HT. Lakshminarayan S. Hudson LD. Title Lung injury following a 50-metre fall into water. Source Thorax. 33(2):175-80, 1978 Apr. Abstract The pulmonary complications of a 50-metre fall to the water (a form of suicide attempt producing 87% mortality) were studied in 15 survivors. Presenting findings included crackles, haemoptysis, and hypotension. The alveolar-arterial oxygen difference was greater than 150 mmHg (20 kPa) in nine subjects on admission. Ventilatory failure developed in 10 of the patients, including all of those with massive haemoptysis. Radiographic findings included pneumothorax and diffuse pulmonary opacities adjacent to the area of impact. Pneumothorax developed within 12 hours of admission in 10 of 15 subjects but was associated with rib fractures in only four subjects. The clinical course of the condition is consistent with the hypothesis that the traumatic pulmonary tears produced interstitial emphysema, with subsequent development of pneumomediastinum, subcutaneous emphysema, and pneumothorax. Pneumothorax is a common complication of severe lung contusion even in the absence of penetrating pleural injury. <42> Unique Identifier 1226583 Medline Identifier 76200250 Authors Philp RB. Freeman D. Francey I. Title Hematology and blood chemistry in saturation diving: II. Open-sea vs. hyperbaric chamber. Source Undersea Biomedical Research. 2(4):251-65, 1975 Dec. Abstract Hematograms, platelet function, and blood-enzyme chemistry were compared in two similar saturation-excursion dives, one conducted in a hyperbaric chamber and the other in the open sea. The chamber dive was more stressful in that it was preceded by a series of bounce decompression dives (one of which produced a 100% incidence of cutaneous pruritis in four subjects) and in that the excursions from saturation depth (60 fsw or 2.818 ATA) were longer and deeper (producing one case of O2 convulsions, one of confirmed decompression sickness, and several of Doppler-detected vascular bubbles). The chamber dive was associated with a marked and significant reduction in circulating platelet count; significant increases in plasma enzyme activities in the victim of O2 toxicity (LDH, CPK) and in one subject with Doppler bubbles and questionable bends symptoms (LDH, GOT, GPT) but not in another; and mild but significant anemia. In the open-water dive, one subject, who developed symptoms of gastroenteritis, showed moderate elevation of LDH, GOT, and GPT activity. No significant change in platelet counts occurred. Both dives were associated with elevated white-cell counts, apparently as a result of numerous minor infections, and reduced sensitivity of platelets of ADP-induced aggregation. <43> Unique Identifier 2818792 Medline Identifier 90056807 Authors Kolarova L. Gottwaldova V. Cechova D. Sevcova M. Institution Institute of Tropical Health, School of Postgraduate Medicine and Pharmacy in Prague, CSSR. Title The occurrence of cercarial dermatitis in Central Bohemia. Source Zentralblatt fur Hygiene und Umweltmedizin. 189(1):1-13, 1989 Oct. Abstract The occurrence of a dermatitis was reported from 4 natural water reservoirs in Central Bohemia (Czechoslovakia) in June and August 1985 and 1986. The clinical course of the disease was suggestive of cercarial dermatitis. Exanthema occurred most frequently under the bathing suits of afflicted persons, and on unprotected parts of their skin as well. A total of 5,865 snails (Lymnaea auricularia) were collected at the localities Novy rybnik in Pribram, Spaleny mlyn at Lisnice and Uhonice. Nine individuals of L. stagnalis were collected at Grado, Celakovice. Biological examination indicated cercariae of bird schistosomes (Trichobilharzia szidati) only at one locality--Spaleny mlyn, Lisnice. The question of cercarial dermatitis caused by species other than schistosome cercariae, especially by Diplostomum spathaceum which was abundant at Pribram, is discussed. Repeated outbreaks of cercarial dermatitis were stopped at one locality by chemical and mechanical snail control in a swimming pool. Chemical control by chlorinated lime and copper sulfate proved insufficient in the course of the season. The mechanical control (clearing of the mud and drying of the bottom of the pool) removed infected snails, reservoirs of the disease. Suggested changes in the composition of fish fauna should also reduce excessive reproduction of snails.