Sir,

The “hammam” is a bath of humid steam. In Moroccan Arabic, it literally means “hot water” or “hot spring,” as it purifies the body and mind. It is also called the Moorish bath and holds significant social importance. It is synonymous with hygiene and beauty.

Because of the popularity of this traditional bath in Morocco, it is important to recognize the benefits and risks of this ritual on the skin in order to inform and advise the population to prevent any type of skin-related complications.

This cross-sectional study was conducted at the dermatology department of Mohammed VI University Hospital in Tangier from March to July 2023. A questionnaire was distributed via social networks to gather data from the general population, which was then analyzed using Google Forms.

We received a total of 160 responses. Over half of the participants were women (63.1%). Regarding age, 40.63% were in the 21-to-30-year-old age group. Among the participants, 70% reported a history of dermatosis. The most commonly mentioned types of dermatoses were atopic dermatitis (32, or 18.6%), cutaneous mycoses (31, or 18.2%), cutaneous xerosis (29, or 16.86%), eczema (21, or 12.21%), rosacea (19, or 11%), psoriasis (10, or 6%), and vitiligo (10, or 6%).

A majority of the participants, over 50%, regularly visited the hammam (more than once a month). On average, they spent about one hour and thirty minutes in the bath. Regarding preferences, 46% of respondents chose to stay in the hot room throughout the session. Moreover, 80% of respondents applied black soap to their skin before the friction procedure, while over 90% used a loofah glove to exfoliate their skin. 75% reported skin irritation after friction.

A significant proportion of the questionnaire participants, exceeding 55%, reported developing a dermatosis after their visit to the hammam.

The most frequently mentioned types of dermatoses were cutaneous mycoses (59 individuals, or 42.5%), warts (21 individuals, or 15%), bacterial infections (20 individuals, or 15%), and cholinergic urticaria (8%).

More than half of the surveyed individuals believed that hammam worsened their dermatosis. Among them, 30% suffered from rosacea, 25% from psoriasis, 16% from atopic dermatitis, 12% from eczema, 10% from vitiligo, and 7% from cholinergic urticaria. Interestingly, 55% of the participants had consulted a dermatologist regarding their dermatosis.

Regarding post-hammam care, 80% of the participants used skincare products, including moisturizing creams (47%), natural oils (12%), and lemon (10%).

The hammam is a place of relaxation where one can unwind and enjoy the soothing warmth and atmosphere. It may aid in skin purification: the heat and humidity of the hammam open the skin’s pores, facilitating the elimination of toxins and impurities [1].

Although the bath may be pleasurable, there is a potential risk of transmitting fungal, bacterial, and viral infections (such as mycoses, condylomas, and warts) since hammams in Morocco are public spaces [2].

Furthermore, it should be noted that the heat present in the hammam may trigger cholinergic urticaria or worsen itching in individuals with atopic dermatitis due to the sweating effect.

The combination of hot baths and emollient creams may promote the exfoliation of hyperkeratotic scales characteristic of psoriasis. However, it is crucial to avoid excessive friction on the skin to prevent the Koebner phenomenon, which could lead to the exacerbation of skin lesions [3,4].

In conclusion, our study underscored the relationship between visiting the hammam and the development or worsening of dermatosis in many participants. It is essential to educate patients about the potential risks associated with hammam visits, particularly, for those with pre-existing skin conditions. Consulting a dermatologist is highly advisable for tailored advice and appropriate follow-up for individual cases.

REFERENCES

1.Zhang X, Lei L, Jiang L, Fu C, Huang J, Hu Y, et al. Characteristics and pathogenesis of Koebner phenomenon. Exp Dermatol. 2023;32:310-23.

2.Van Geel N, Speeckaert R, Taieb A, Picardo M, Böhm M, Gawkrodger DJ, et al;VETF members. Koebner’s phenomenon in vitiligo:European position paper. Pigment Cell Melanoma Res. 2011;24:564-73.

3.Baadsgaard O, Lindskov R. Cholinergic urticaria with anaphylaxis induced by exercise or heating. Acta Derm Venereol. 1984;64:344-6.

4.Reid G, Lynch JP 3^rd, Fishbein MC, Clark NM. Mucormycosis. Semin Respir Crit Care Med. 2020;41:99-114.