We have examined questions of rashes and breathing difficulties that potentially arise from showering in municipal tap water since 2002 when we first responded to reports of such problems afflicting residents in Maui, HI. In Maui, our team worked with a local medical doctor to demonstrate that the water did not have adequate levels of disinfectant and had high concentrations of a certain bacteria called P. aeruginosa, which is known to cause “hot tub rashes.” That bacteria was then identified within some consumers’ rashes.  The incidence of rashes decreased when changes to water treatment were made that removed nutrients from the water and increased chlorine.

Unfortunately, ever since that modest success story, we have not made much progress in understanding this issue, except to say that whatever causes the problem(s) seems to be very complicated.

The people in Flint MI began questioning the safety of bathing when the Flint River was in use, but this still remains a large concern of many citizens there even after switching back to Detroit water. Below we share our experiences and opinions to date with specific discussion relative to residents in Flint, MI.  The Q+A is also based on my experiences with my own daughter Ailene Edwards (now 14 years old), who had very serious rashes exacerbated by bathing when she was younger.

What causes rashes and breathing difficulties — possibly due to showering or bathing tap water exposures?

Over the years, I have personally seen and fielded complaints from consumers all over the country who believed that bathing and showering was either causing or exacerbating health problems including rashes and breathing problems. These complaints have come from systems served by private wells, as well as municipal systems using chloramine and chlorine. As a general rule, when these problems arise, they only affect a sub-set of the population. This suggests that site specific factors (e.g., water heater temperature or presence of a particular type of pipe in a neighborhood), genetics or other environmental factors play a role. In our family, Ailene was the only one who had severe problems.  Even in the Maui case study, where we believe it is highly likely that the water was causing rashes, “only” about 5-10% of the population was impacted. Although this incidence may “seem” low, the symptoms can be quite severe for the individual afflicted and caregivers (in my case, as a parent) can feel a lot of guilt trying to prevent pain and suffering.

Am I crazy to think that water might sometimes be causing breathing problems or rashes?

No. I am with you on this.

What can I do to stop the problems? 

As difficult as it is, you should experiment with sponge baths using distilled or deionized water, to see if that reduces the problems.  If so, you have a possible solution. My daughter eventually grew out of the rash problem that was caused by bathing in our well water.  Please note that our well water comes from a Jefferson National Forest aquifer and had no added chlorine or chloramine, so the fact that a given water causes a problem does not necessarily mean the water is contaminated or otherwise dangerous.

What can the water utility and EPA do to stop the problems?

The utility has to meet federal standards for water that makes it suitable for the majority of customers in terms of drinking, bathing, and showering.  Immunocompromised individuals (people with weakened immune systems) are always at elevated risk from harmful water exposures whether it is due to Cryptosporidium, Legionella, or other contaminants.  Disinfection by-product exposures in homes are controlled by measurements taken in the water distribution system—those measurements are designed to reduce exposures occurring in the homes.

It’s important to understand that bathing is never completely a “risk free” activity.  However, the dangers of not bathing are also significant, and not bathing also poses health risks. Each individual needs to balance that risk given their own circumstance.

What about bathing and showering in Flint MI?

Flint River Water.  When Flint River water was being used, federal standards for disinfection by-products (THMs) and bacteria were being exceeded. The treatment plant and the water distribution system were not being run in a satisfactory manner. Although Legionella is not currently regulated in homes, the levels of chlorine in the system were not sufficient to help control this problem, especially in large buildings (note: we have looked, and not yet found Legionella in smaller buildings in Flint).  Thus, health risks of bathing in Flint water were probably much higher than in other U.S. cities, until the switch back to Detroit water in October of 2015.

Detroit Water.  After the switch back to Detroit water, and subsequent close oversight of the system from the U.S EPA, FEMA and other outsiders, the system has been meeting U.S. standards for disinfection by-products and bacteria.  Chlorine residuals have improved dramatically .  Lead levels are still too high for drinking or using the water for cooking. However, you cannot breathe significant lead from water while showering or bathing, and it cannot pass through your skin into your blood at significant levels. Therefore, the risk of lead exposure during bathing is not concerning as long as children do not drink large quantities of bath water.

On the basis of my thorough review, there is currently no scientifically valid reason to believe that risks of bathing or showering in Flint are currently higher than in other U.S. cities.  We support the current U.S. EPA guidance that indicates bathing or showering in unfiltered Flint water is not riskier than in other cities. If you feel the water is harming yourself or your child, and are experiencing breathing difficulties or rashes that you think are due to the water, bathing or showering is certainly not recommended for the reasons mentioned above. We also understand that many consumers will not feel safe bathing or showering in Flint water, for a long time, due to a lack of trust in the water supply. 

Anecdotal Reports from Flint Residents

We have tracked what happened to rashes of a few families that left Flint.  In two cases discussed thus far, the consumers kept having the rashes weeks after they left Flint.  Their hypothesis is that whatever caused it, simply changing the water (i.e.,  by moving) is not getting rid of the problem. We point this out because the continuing problem of rashes in these residents, suggests that the current water may not necessarily be the source of the problem.

Will filters help Mitigate this Problem in Flint?

There is little reason to believe that purchasing and using expensive in-home filters will help reduce health problems including rashes or breathing problems.  Some “whole-house” filters with granular activated carbon actually increase problems with certain bacteria, including Legionella, because they can remove chlorine used to disinfect the water.  That said, if you feel that your in-home filter system is helping you personally, continue to use it. But in my experience, purchasing such systems has only a low likelihood of solving the rash and breathing problems.

The lead filters installed at the end of faucets will not remove chlorine from the home plumbing and are very unlikely to increase Legionella risks. While these filters are very effective at removing lead, there is very little reason to think that treating the water with these filters, will help reduce rashes or breathing problems.

Additional questions?

Feel free to e-mail us on [email protected].  We will try to keep this list updated as we learn more.

Q&A: Dr. Marc Edwards