As a nurse practitioner at an internal medicine practice in Houston, I have seen and treated many patients with unusual conditions such as Dengue fever and cutaneous anthrax. However, one dermatitis patient stands out in my memory, because I figured out the cause of his problem after a dip in the hot tub.

JM was a patient that was seeking help for his chronic rash.  He had been to several doctors and specialists who had prescribed every cream and pill that they could think of to help alleviate his symptoms.  Nothing worked for JM.  He had a skin biopsy performed by a dermatologist.  It showed chronic dermatitis, but did not assist in determining the cause.  The patient showered everyday and had changed detergents, soaps, shampoos and lotions, but still no change in symptoms.  

JM had a diffuse erythematous exanthe, consisting mostly of flat wheals that covered about 60% of his chest, abdomen, back and upper arms.  There was no herald patch; no vesicles or bullae; no clusters or distinct patterns. It was exquisitely itchy and more so at night, which was disturbing his sleep patterns.  

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I prescribed corticosteroid creams and oral antihistamines, but there was little relief for JM.  These medications helped a little, but did not resolve the problem.

Then one cool Texas evening while I was soaking in my hot tub, I sensed that there was something not quite right with the water.  I felt a little tightness in my skin and experienced a burning sensation.  I got out and tested the water.  The pH was very high, around 8 or 9.  

This was a similar feeling I had when we first moved into our house and started using the showers.  We had the water tested and determined that we needed a filter to adjust heavy minerals and pH.  The light bulb went off!  

The very next day, I immediately phoned JM to find out what the water source was for his home.  He had well water and no filter.  Bingo!  I told him about my experience with the water in my home and the hot tub, and suggested that this may be the cause of his problem.  

JM had his water tested and I was right.  The pH was 9-10 and very heavy with magnesium and calcium.  There was also bacterial contamination.  JM had a whole house filter installed that adjusted pH.  He also understood that he needed to have regular maintenance on his well, something he took for granted and did not do.  

I saw him for a follow up a few weeks later, and his skin condition had nearly resolved.  Now whenever I see patients who complain of chronic dermatitis for which there is no discernable cause, and all treatments to control symptoms have been unsuccessful, the first thing I ask about is the type of water in their home. Is it well or public? More often than not, these folks have well water and do not have it regularly tested for contaminants.  

Water testing is especially important for folks who live near old industrial sites where there may be ground water contamination from buried waste.  I direct patients to go to the Environmental Protection Agency’s Web site to determine if they are living near a federally designated cleanup area that may contain contaminated ground water. In any case, I always advise them to have their water tested and have their wells maintained.

Tell us about your most memorable patient by December 15, 2010, and you’ll be eligible to win an Apple iPad!