Cercarial Dermatitis

Swimmer’s itch, duck itch, or cercarial dermatitis, is a short-term, immune reaction occurring in the skin of humans that have been infected by water-borne trematode parasites. Symptoms, which include itchy, raised papules, commonly occur within hours of infection and do not generally last more than a week.

The trematodes that cause swimmer’s itch are parasitic schistosomes that use both snails and vertebrates as hosts in their life cycles. Most cases are caused by parasites that use waterfowl as the vertebrate host. These avian schistosomes cannot complete their life cycles in mammals, but can accidentally infect humans, giving rise to mildly itchy spots on the skin. Within hours, these spots become raised papules that are more intensely itchy. The papules are caused by localized inflammatory immune reactions, each corresponding to the penetration site of a single parasite, which dies in the skin within hours.

Two schistosome genera that infect waterfowl and are associated with swimmer’s itch are Trichobilharzia and Gigantobilharzia. However, swimmer’s itch can also be caused by schistosome parasites of non-avian vertebrates, such as Schistosomatium douthitti, which infects snails and rodents.

The schistosomes that give rise to swimmer’s itch should not to be confused with those of the genus Schistosoma, which infect humans and cause the serious human disease schistosomiasis, or with larval stages of thimble jellyfish (Linuche unguiculata), which give rise to seabather's eruption.

Humans usually become infected with avian schistosomes after swimming in lakes or other bodies of slow-moving fresh water. Some laboratory evidence indicates snails shed cercariae most intensely in the morning and on sunny days, and exposure to water in these conditions may therefore increase risk. Duration of swimming is positively correlated with increased risk of infection in Europe and North America, and shallow inshore waters -- snail habitat -- undoubtedly harbour higher densities of cercariae than open waters offshore. Onshore winds are thought to cause cercariae to accumulate along shorelines. Studies of infested lakes and outbreaks in Europe and North America have found cases where infection risk appears to be evenly distributed around the margins of water bodies as well as instances where risk increases in endemic swimmer's itch "hotspots". Children may become infected more frequently and more intensely than adults but this probably reflects their tendency to swim for longer periods inshore, where cercariae also concentrate. Stimuli for cercarial penetration into host skin include unsaturated fatty acids, such as linoleic and linolenic acids. These substances occur naturally in human skin and are found in sun lotions and creams based on plant oils.