Swimming Health: How to Manage Swimmer’s Itch, Swimmer’s Ear and Chlorine Rash

Whether you're doing laps at the gym, splashing around at the lake or letting the kids loose at the pool, swimming comes with a few health questions worth knowing the answers to. Christine Davis, MD, UnityPoint Health, covers the most common ones — from swimmer's ear to post-swim rashes — and explains when to treat them at home and when to call your doctor.

Should You Swim with an Ear Infection?

Swimming with an ear infection isn’t straightforward. You should avoid fully submerging your head in water if you have an ear infection, but whether you should swim at all depends on the type of infection and where you’re swimming.

“Fresh, open water swimming carries more risk of making an infection worse,” Dr. Davis says.

Ear Tubes and Swimming Guidelines

Parents of children with ear tubes often worry about pool time, too.

Dr. Davis says the research offers some reassurance.

“Most kids with tubes don’t need to wear earplugs in a standard pool, though it’s always worth checking with your ear, nose and throat (ENT) surgeon. Deep diving and open water swimming do carry more risk for children with tubes, however.”

What is Swimmer’s Ear?

Swimmer’s ear is an inflammatory condition that affects the external ear canal — the area between the opening of the ear and eardrum. It’s typically caused by a bacterial infection like pseudomonas and staphylococcus aureus (staph, for short). Both thrive in moist environments.

Cases peak in the summer months when more people are swimming. But despite the name, you don’t have to be a swimmer to get swimmer’s ear.

“It can happen from the shower, or if you just sweat a lot. It’s the moist environment that causes it,” Dr. Davis says.

Some people are more prone to swimmer’s ear than others, including those with diabetes, other immune-compromising conditions or children with ear tubes. But the condition can happen to anyone.

Signs of Swimmer’s Ear

The most common symptoms of swimmer’s ear include:

• Persistent pain that makes the ear feel tender or painful to touch
• Redness, swelling or warmth of the ear and surrounding skin
• White, yellow or green discharge draining from the ear canal

“If left untreated, it can even spread to a cellulitis — a more serious skin infection — on the skin around the ear,” Dr. Davis says.

How to Get Rid of Swimmer’s Ear

Home remedies — vinegar, candle wicks and the like — are popular but unreliable fixes. Most cases of swimmer’s ear require an evaluation and some type of topical treatment.

“These home remedies aren’t necessarily dangerous, but you probably don’t want to substitute them for a topical antibiotic. Swimmer’s ear can get bad if left untreated and lead to more systemic infections — and obviously your ear is near your brain, so you want to seek prompt medical care," Dr. Davis says.

Treatment typically involves prescription antibiotic ear drops, sometimes combined with a steroid. Oral antibiotics are generally only needed when the infection has spread beyond the ear canal. Most patients notice improvement within 24 to 72 hours, with the full treatment course lasting about 7 to 10 days.

How to Get Water Out of Your Ears After Swimming

Dr. Davis says this is an area where that old piece of advice from your mom actually holds up.

“Tilt your head and gently pull on the outer ear to drain any trapped water. If you watch summer Olympics, the swimmers do that a lot,” she says.

Other options to get rid of water in your ear include:

• Over-the-counter acetic acid or alcohol-based drying drops, are especially useful for frequent swimmers
• Hold a hair dryer on a cool setting near the ear to gently dry the canal

If you already have an infection and can’t swim, Dr. Davis recommends the hair dryer trick after showering to help keep the ear canal dry in the meantime.

Ear Pain After Swimming

For general ear pain after swimming, brief discomfort from pressure changes during diving is normal and should clear before you leave the pool. Persistent ear pain, however, warrants a visit to the doctor. In the meantime, ibuprofen or acetaminophen can help with pain.

Why Do I Have a Rash After Swimming? 

A post-swim rash is a common complaint during summer months. Depending on where you were swimming and what your skin was exposed to, the cause could be anything from a microscopic parasite to a chemical reaction to the water itself.

What is Swimmer’s Itch?

Swimmer's itch is an allergic skin reaction caused by microscopic parasitic larvae found in freshwater lakes and ponds. The parasites are carried by birds and mammals, like ducks and muskrats, shed into the water and passed through freshwater snails before being released as larvae. When those larvae contact a swimmer's exposed skin, they burrow in just beneath the surface. However, they can't survive in the human body and die almost immediately.

This creates an allergic reaction and causes the rash.

"It's your body's immune response to a dead parasite in your skin, basically," Dr. Davis says.

The result is an itchy, bumpy rash only on skin that was directly exposed to the water, since the larvae can't penetrate through swimsuit fabric.

“The rash can last anywhere from one week to three weeks. Cases peak in summer when water is warmest, and repeated exposures can make reactions progressively worse over time,” Dr. Davis adds.

Tip for Swimmers: The larvae tend to float near the surface and drift toward the shoreline, which is why wading children are often hit the hardest. Towel dry children or have them shower immediately after leaving the water to help rub the larvae off before they have a chance to burrow.

How to Get Rid of Swimmer’s Itch

Most cases of swimmer’s itch resolve on their own, but the itching can be uncomfortable. Treatment options include:

• Cool compresses
• Oral antihistamines, such as Benadryl or cetirizine
• Over-the-counter hydrocortisone or other topical corticosteroids
  
  

To reduce your risk, in addition to rinsing and towel drying thoroughly as soon as you leave the water, try to avoid areas known to have had outbreaks. If itching leads to heavy scratching, watch for signs of secondary bacterial infection such as increased redness, warmth or pus-like drainage.

However, not every post-swim rash is swimmer’s itch. Dr. Davis outlines other common causes.

Chlorine Rash (Chemical Irritant Dermatitis) 

Despite how commonly people say they have a "chlorine allergy," a true allergic response to chlorine is rare.

More often, what people experience is irritant dermatitis — a skin reaction to the various chemicals used to treat pool water, like chlorine, bromine or other compounds.

“So, it might not be a chlorine allergy specifically, but a chemical irritant reaction instead,” Dr. Davis says.

This type of rash typically shows up as raised, itchy bumps or redness. Unlike swimmer’s itch, which spares covered skin, a chemical irritant reaction can develop anywhere water contacted the skin, including underneath swimsuit fabric.

If you’ve been swimming in a lake or river, a rash could also be a reaction to plants (such as poison ivy), bug bites or other environmental irritants in or near the water.

A true allergic reaction to pool chemicals is more serious and may include hives, swelling of the lips or tongue or difficulty breathing. Dr. Davis says these symptoms warrant emergency care, followed by evaluation by an allergist with patch testing.

When to See a Doctor

If swimmer’s ear, swimmer’s itch and chlorine rash are mild, they can be managed at home. However, some situations need a doctor to take a look. Depending on the severity of your symptoms, schedule an appointment or head to the emergency room if you experience:

• A rash that’s severe, widespread or gets worse after a week or two
• Ear pain that persists after leaving the water (beyond brief pressure discomfort from diving)
• Signs of secondary bacterial infection: redness, warmth, pus-like drainage or fever
• Symptoms beyond the skin — such as difficulty breathing or swelling of the face or throat
• Any symptoms if you’re diabetic, immunocompromised or otherwise higher-risk

“What it comes down to is whether the symptoms are a change in what’s normal for you, or if they’re not improving. When in doubt, come in and get seen,” Dr. Davis says.

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