Hidradenitis Suppurativa and Ocean Swimming: 5 Things To Consider | myHSteam

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Hidradenitis Suppurativa and Ocean Swimming: 5 Things To Consider

Medically reviewed by Raj Chovatiya, MD, PhD, MSCI
Posted on July 7, 2023

No one wants to miss out on a day at the beach, especially if you’re planning a special vacation. But for people with hidradenitis suppurativa (HS), bacteria in the ocean water can pose a serious risk of infection. “If you have lesions, can you swim in the ocean?” asked a member of myHSteam. “I only have a few that are seeping. We are going on vacation, and I am scared I’ll get some flesh-eating disease.”

While salt water is said to have healing properties, this applies more to sterile saline solution, not ocean water. Here’s what you should know to stay safe before diving into the ocean with HS lesions.

1. Check Water Quality Testing

Various factors can contaminate ocean water. Pollution, animal waste, and sewage are a few examples. As a result, ocean water may contain bacteria, parasites, and viruses that can make people sick, especially if they have an open wound or a weakened immune system.

Vibrio is one example of an ocean bacteria found in warm water. Although rare, it’s possible to develop a serious infection when swimming in infected waters with compromised skin. An untreated infection can become fatal if it enters the bloodstream. The Centers for Disease Control and Prevention (CDC) estimate that 80,000 people get sick from vibriosis in the U.S. each year, and about 100 are killed by the disease.

Local environmental programs perform water testing at public beaches. You can research the beach you plan to visit ahead of time to look for specific warnings. However, just because a beach passes water testing doesn’t mean it’s safe for someone with broken areas of skin. Most beaches aren’t tested on a daily basis, and rainfall or other factors can alter the water quality.

In addition, public swimming pools, hot tubs, and water parks usually undergo routine testing. But a CDC study showed that over 10 percent fail this testing and are forced to shut down. You can buy test strips to see if pool water contains the recommended concentration of bromine or chlorine as disinfectants. Test strips may be particularly helpful for a small or private pool with limited users. Unfortunately, crowded pools and natural bodies of water can be contaminated if someone with diarrhea or illness shares the same water. Without constant monitoring, it’s difficult to judge the water quality in these spaces.

2. Assess Your Lesions

Many people with HS experience lesions that are slow to heal or don’t heal at all. The severity of the disease varies from person to person, so the risks of swimming aren’t the same for everyone. Depending on whether you’re facing a flare-up or if your skin condition is under control, you may be cleared to swim in public places, especially if the water quality is good.

To be sure, make an appointment with your dermatologist to evaluate your wounds and get individualized medical advice. Your health care provider may suggest additional precautions you can take to stay safe.

3. Stay Clean and Cool

Sand on the beach is another potential source of illness. It’s a good idea to wash your hands with soap and water after digging in the sand, especially before eating or if you have HS lesions near your hands. People with HS could also consider wearing protective gloves when handling sand.

Spending too much time in the heat can trigger HS symptoms, especially in a tight swimsuit that doesn’t let your skin breathe. One myHSteam member explained, “Stress and anxiety contribute to flare-ups, along with the heat. I’ve been working hard to keep my anxiety at bay and make sure I stay somewhat cool, especially in the heat of summer.” Limit your time in the hot sun, and plan your beach day in the morning or afternoon rather than at midday.

4. Find Safe Places To Swim

Even if the ocean isn’t safe for you, swimming can be a healthy exercise option for people with HS. One myHSteam member noted how good they feel in a pool. “I went swimming, and for a brief moment while I was in the chlorine pool, I didn’t have any pain. Shortly after, the pain came back, but now I found a way to relieve the pain. It’s too bad I can’t spend the rest of my life in a pool,” they said.

Swimming is a low-intensity activity that can help you stay cool while you avoid sweating or overheating. If you have a pool or know someone with a private pool that you can use, swimming and water aerobics are two potential ways to maintain a healthy and active lifestyle. Just educate yourself on properly disinfecting and testing the water, and avoid using the pool with large groups of people.

One member of myHSteam shared their thoughts on swimming in pools versus natural bodies of water. “I get HS breakouts from public pools at gyms but have no issues swimming in lakes or oceans,” they said. “I pick up germs at the gym, and the chlorine breaks down my natural skin barrier. … People with infections are not supposed to swim in a swimming pool anyway because the chlorine doesn’t kill everything.”

Another member shared, “I was lucky enough to have a swimming pool in my backyard. My doctor actually told me to get in the pool. However, public pools are not always properly treated with chemicals,” they said. “Lakes and rivers have bacteria in them. … If you have an open wound, be cautious. You don’t want to add insult to injury and get a secondary infection from bacteria and germs in the water.”

5. Act Quickly To Treat Infection

If you have an open wound that is exposed to potentially contaminated water, be sure to wash the area with clean water and soap or an antimicrobial body wash right away. Signs of a skin infection may include:

  • Pain
  • Pus
  • Discoloration
  • Swelling
  • Itching

Many of these symptoms overlap with the usual symptoms of HS. But if you notice a change or a flare-up, particularly after swimming in the ocean, you should see your doctor for additional testing and follow-up. Don’t hesitate to get medical attention for wounds that have a foul odor, feel warm to the touch, or have a different color or amount of drainage. Fever, chills, nausea, or vomiting are all signs that you should seek medical care.

Your dermatologist may take a biopsy of the area and prescribe antibiotics like clindamycin or dapsone as treatment. They can also help monitor your condition to make sure it isn’t worsening or turning into a systemic or widespread infection.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 33,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Do you go swimming with HS lesions? How do you stay safe at the beach or when swimming at public pools? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on July 7, 2023
All updates must be accompanied by text or a picture.

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Raj Chovatiya, MD, PhD, MSCI is an assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago, Illinois. Learn more about him here
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here

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