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POWER SPORT THE-BEAUTY

Swimming and skin: What to know if a child has eczema

Three children bobbing in a pool on red, yellow, and green swimming noodles; two are wearing swim googles

Swimming is a great activity for children. It’s good exercise, it’s an important safety skill, and it can be a good way to get outside and get some fresh air and sunshine.

But for children with eczema — also known as atopic dermatitis — swimming can be complicated. Here’s how parents can help.

What is eczema?

Eczema is an allergic condition of the skin. It can be triggered by allergies to things in the environment, like pollen or cats, as well as by allergies to food. It can also be triggered when chemicals or other things irritate the skin, or when the skin loses moisture, or by excessive sweating.

Swimming and sun may be helpful for eczema

Swimming in a chlorinated pool can actually be helpful for eczema. Bleach baths, which are a commonly recommended eczema treatment, essentially make the bathtub like a swimming pool.

It also can be good for eczema to get some sun and be in the water. The trick is to optimize the benefits while preventing the possible problems.

What to do before and after swimming when a child has eczema

Here are some suggestions for parents:

  • If you’ll be outside, make sure you use sunscreen, preferably one with zinc oxide or titanium. Look for formulations for sensitive skin and avoid anything with fragrance. Consider using UV-protectant swimwear or shirts, especially if embarrassment about rashes is a problem.
  • Put on an emollient before swimming, especially in a chlorinated pool. A good grease-up before swimming can protect the skin. Don’t overdo it on the palms or soles; you want your child to be able to hold on to things, and you don’t want them to slip and fall. Talk to your doctor about the best emollient for your child.
  • If you are swimming in a pool for the first time, you might want to try a briefer swim than usual to be sure the chemicals aren’t too irritating. If possible, avoid going in a pool right after chlorine has been added.
  • Plan to change and shower right after swimming, using a mild soap or body wash without fragrance. Dab the skin dry with a clean towel (don’t use the one you used while swimming) and reapply emollient.
  • Look for silicone-lined swim caps and goggles, as they may be less irritating than rubber or other plastics. Be sure to rinse all swim gear after use.
  • If your child’s eczema is very inflamed, or is infected, it might be best to avoid swimming until it is better — or at least to get your doctor’s advice.

What else should you consider?

Be aware that some children and teens with eczema are embarrassed by it and don’t like to wear bathing suits that show a lot of skin. Follow your child’s lead on this.

If your child has frequent flares of eczema, or severe eczema, talk to your doctor about whether using regular topical steroids might help — and whether you should use them before swimming. If you are headed on a vacation where your child will be swimming often, or just headed into a time of year with lots of possible swimming, talk to your doctor about the best strategies to keep your child’s skin healthy.

For more information, visit the websites of the National Eczema Association and the American Academy of Dermatology.

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About the Author

photo of Claire McCarthy, MD

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

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POWER SPORT THE-BEAUTY

Prostate cancer in transgender women

close-up photo of a vial of blood marked PSA test alongside a pen; both are resting on a document showing the PSA test results

The transgender population is steadily increasing. Last year, investigators reported that 1.3% of people between the ages of 18 and 24 in the United States identify as transgender, compared to 0.55% of the country’s older adults. This trend has implications for public health, and one issue in particular concerns the risk of prostate cancer in transgender women.

Because removing the prostate can lead to urinary incontinence and other complications, doctors leave the gland in place when initiating hormonal treatments to induce female sex characteristics in transitioning people. This process, which is called feminizing or gender-affirming hormonal therapy (GAHT), relies on medications and surgery to block testosterone, a male sex hormone. Prostate cancer is fueled by testosterone, and therefore GAHT lowers overall risks for the disease. But transgender women can still develop prostate cancer in ways that remain poorly understood, according to the authors of a new paper.

“More individuals are openly identifying as transgender, particularly as advances are made in reducing the discrimination and marginalization that this group has faced,” says Dr. Farnoosh Nik-Ahd, a urologist at the University of California, San Francisco, and the paper’s first author. “Thus, it’s important to understand their health outcomes and how best to care for this population.”

Dr. Nik-Ahd and her colleagues wanted better insights into prostate cancer incidence and screening rates among transgender women, so they performed a comprehensive review of the literature that generated some notable findings. One is that that the prevalence of GAHT in the transgender population is still unknown. Some studies put the figure at roughly one in every 12,000 to 13,000 people who identify as transgender. But this is likely an underestimate, the authors claim, and it’s not broken out by sex.

Questions over GAHT

Similarly, little is known about the impact of GAHT on the likelihood of developing prostate cancer, the team reported. Prostate cancer rates do appear to be lower among transgender women than they are among cisgender men (men whose gender identify matches their sex at birth). For instance, one study found just a single case of prostate cancer among 2,306 transgender women receiving routine health care at a clinic in Amsterdam, Holland, between 1975 and 2006. Another study, also from Holland, detected six cases of prostate cancer among 2,281 transgender women over 17 years, which again is less than the comparable rate among cisgender men.

But the interpretation of these rates is limited by the fact that transgender women often experience barriers to care. Nearly a third of them live in poverty, and many avoid the health system for fear of mistreatment. Some scientists suspect that estrogen given during GAHT may somehow contribute to prostate cancer development when given over long durations. However, more confirmatory evidence is needed. Worryingly, one study found that survival among transgender women with prostate cancer is worse than it is in cisgender men with the disease, yet that research lacked data on GAHT use.

Interpreting PSA values for specific populations

Dr. Nik-Ahd’s team was especially concerned about the lack of guideline recommendations for prostate-specific antigen (PSA) screening in the transgender population. None of the available guidelines worldwide mention transgender women, and the PSA cutoff of 4 nanograms per milliliter (ng/mL) of blood — which raises suspicions for prostate cancer — is specific to cisgender men. PSA levels ordinarily plummet in people taking GAHT, so the limit for what’s considered normal in transgender women should be capped at 1.0 ng/mL, the researchers propose. In the absence of more specific guidance, they also recommend that people meeting age criteria for PSA screening get tested before starting on GAHT, in order to obtain a baseline value.

Many doctors are already familiar with other common drugs that alter PSA values — in this case with screening implications for cisgender men, points out Dr. Heidi Rayala, a urologist affiliated with Beth Israel Deaconess Medical Center in Boston, and a member of the Harvard Medical School Annual Report on Prostate Diseases editorial board. For instance, PSA values drop by half in men taking finasteride or dutasteride for hair loss (or to shrink an enlarged prostate). “Doctors take extra care when interpreting PSA in cisgender men who take these drugs,” she says. “The same care needs to be taken in interpreting PSA values in transgender women. And there needs to be broader education on this topic for both primary care doctors as well as the transgender community.

Dr. Nik-Ahd agrees. “Future research should aim to understand baseline PSA values for those on gender-affirming hormones, and to understand how to navigate some of the psychosocial barriers around PSA screening so as to not stigmatize transgender patients,” she says.

About the Author

photo of Charlie Schmidt

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

photo of Marc B. Garnick, MD

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD