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BenDiver
December 28th, 2009, 03:19 PM
Help!!

Not sure if I got this diving or just swimming at the beach in St Thomas USVI, but I have red blister-like bumps on the palms of my hands and they are very painful to the touch. Almost a stinging sensation when I apply pressure to them.. I have had them almost a week and I can barely grasp anything with my hands it hurts so much. Any ideas? I can attach a pic if needed. It's really weird, because it just on the palms of my hands and no where else and it has not spread. I may go to a dermatologist soon... THANKS!

Rutger
December 28th, 2009, 10:33 PM
Why have you not gone to a doctor? A medical professional is going to give you much more relevant information than random strangers on the internet. Good Luck!

TSandM
December 29th, 2009, 02:18 AM
It's essentially impossible to diagnose a dermatitis over the internet. This could be a contact injury from fire coral or something similar, or an allergic reaction to creosote or something similar on a line or piling, or it could be a viral illness like a cocksackie virus. Given the length of symptoms, I'd highly recommend you have a medical professional take a look at it.

DocVikingo
December 29th, 2009, 09:53 AM
Why have you not gone to a doctor? A medical professional is going to give you much more relevant information than random strangers on the internet. Good Luck!

Just curious, Rutger. What do you see as the appropriate function(s) of this Diving Medicine forum?

Thanks,

DocVikingo

PS: To those familiar with this forum the doctors who regularly contribute most certainly are not "random," and some would not consider us "strangers."

Rutger
December 29th, 2009, 04:21 PM
Firstly, let me say that my post was not intended to disparage the medical professionals who contribute their opinion in this sub-forum. We are all here to learn and share. That is the first function of any online forum.

Second, let me offer my apologies as a new member who did-not properly read the sub-forum heading. I was surfing "new posts" and jumped into this one. I'm not a medical professional, nor do I play one on TV. So I should not have even made a comment in this forum, leaving it up to those qualified to answer.

Finally, a comment on why I did post and to answer DocVikingo's question. I was surprised that an individual would let acute presentation of symptoms wait for a week and only then choose to solicit comments online. It is my layman's opinion that an online medical forum such as this would not be used as your PRIMARY form of medical diagnosis and treatment. It should be used to supplement the information gathered during primary investigation OR to seek guidance on how to go about seeking medical treatment as well as any myriad of secondary and topical discussion on medical matters that are not immediately life threatening.

My opinion is that if you have a condition that is causing debilitating pain to the loss of functionality (OP: "I have had them almost a week and I can barely grasp anything with my hands it hurts so much.") then why are you waiting a week to let the internet solve your problem. Why have you not already sought immediate primary care by a professional who can view and more reasonably be able to treat the problem first-hand (no pun intended).

What this forum cannot do is:

- Make a concrete diagnosis from a 3 sentence posting.
- Prescribe treatment
- Source and Administer medications.

This is simply my opinion in answer to DocVikingo's valid question. My appologies for hijacking the thread.

To the OP, I trust that your condition is improving and resolves swiftly. Take Care.

EDIT - Also, I am a Canadian. Perhaps this skews my perspective on seeking medical treatment. I had not considered that perhaps seeking medical advice from a physician at a clinic, office or hospital may result in a prohibitively expensive bill. The fact that my nation's medical fees ultimately come from our federal personal income tax means a visit to the Dr. only costs $25. For that price, I don't see a restriction preventing seeking care. Perhaps in this case, the OP is avoiding an expensive bill for something that a physician may tell him to get some $10 cortisone cream OTC.



Just curious, Rutger. What do you see as the appropriate function(s) of this Diving Medicine forum?

Thanks,

DocVikingo

PS: To those familiar with this forum the doctors who regularly contribute most certainly are not "random," and some would not consider us "strangers."

Hank49
December 29th, 2009, 05:06 PM
viral illness like a cocksackie virus.

I tried to look this up and only found "coxsackie". (not to second guess you Lynn, I was just curious)

In any case, it says coxsackie usually has no complications and recovery is in 7-10 days. Most stings from various marine organisms I've had here in the Caribbean are the same. It's burns or stings, then itches for a while and goes away. Bummer on your vacation though.

Mopar
December 29th, 2009, 05:18 PM
I would go see a Doc. if it was me.

TSandM
December 29th, 2009, 07:36 PM
Oops, my misspelling! And yes, coxsackie virus is usually self-limited, as are most contact dermatitis problems, but I have heard of people having prolonged symptoms after contact with stinging marine organisms.

The bottom line is to seek a consultation with a good professional (and for skin stuff, dermatologists really ARE better than the rest of us).

I think the biggest and best use of this forum is when someone has been told something from a non diving-savvy doctor, and wants to know if those of us who have education in both medicine AND diving might have a different perspective. Trying to assist people with specific symptoms rarely seems very useful to me, since I have enough trouble diagnosing people sometimes when they are in front of me and I can ask them questions and actually examine them!

DocVikingo
December 30th, 2009, 09:51 AM
Oops, my misspelling! And yes, coxsackie virus is usually self-limited, as are most contact dermatitis problems, but I have heard of people having prolonged symptoms after contact with stinging marine organisms.

Indeed. While skin eruptions resulting from marine contact and envenomations typically largely resolve within 10 days, severe envenomation can result in signs and symptoms that last up to a month or longer. Additionally, delayed hypersensitivity-type reactions have been described in which rash and itching recur 7-10 days after initial resolution. And, prior sensitization is always an issue in cutaneous manifestations of run ins with stinging marine/aquatic organisms. Such previous exposure may result in reactions persisting for up to 6 weeks.

Regards,

DocVikingo

BenDiver
December 30th, 2009, 12:05 PM
Ok..

1) I have an appointment with a doc tomorrow.. It takes a bit to schedule an appt with a dermatologist

2) I live in Minnesota, so the odds of them knowing what the hell this is are not good. I have had a few friends with stings and the docs up here have no idea. Also, have you looked on this forum at all? 90% of people say the docs didn't do a thing for them!

3) Thanks to everyone that actually posted trying to help me! I am very grateful.

4) The more ideas and research I have done on what is wrong with me, the better educated I am to converse with the doc.

Is this enough for you Rugter? :D

BenDiver
December 30th, 2009, 12:17 PM
Again.. I AM GOING TO A DOCTOR :D It's just the week between Xmas and New Years and it was really hard to schedule an appt with an expert. I really didn't think an Urgent Care doc in Minnesota would help much :)

I am just trying to figure out what the hell to tell the dermatologist when I see him. Cortisone cream hasn't really done anything. I am accountant, so please trust me when I say that I have research the crap out of this.. I was just hoping someone else could help point me in the right direction for more research.


The good news is it hasn't spread or gotten any worse. Thank you to Doc Vikingo and others for your help. It's officially been 7 days and no change. Hopefully the dermie will help tomorrow!

Hank49
December 30th, 2009, 12:22 PM
Ok..

1) I have an appointment with a doc tomorrow.. It takes a bit to schedule an appt with a dermatologist

2) I live in Minnesota, so the odds of them knowing what the hell this is are not good. I have had a few friends with stings and the docs up here have no idea. Also, have you looked on this forum at all? 90% of people say the docs didn't do a thing for them!


Good luck. I'm no doctor but I have been stung by a lot of different marine organisms here (I routinely clean a PVC pipeline we have going into the sea. Some days my buddy was miserable from so much itching and stinging) so I thought I'd throw that out there for you.

Web Monkey
December 30th, 2009, 12:28 PM
I am just trying to figure out what the hell to tell the dermatologist when I see him. Cortisone cream hasn't really done anything. I am accountant, so please trust me when I say that I have research the crap out of this.. I was just hoping someone else could help point me in the right direction for more research.


The good news is it hasn't spread or gotten any worse. Thank you to Doc Vikingo and others for your help. It's officially been 7 days and no change. Hopefully the dermie will help tomorrow!

You can try calling DAN for a referral. They might not have anybody really close to you, but can probably find someone qualified to take a look.

Terry

Wookie
December 30th, 2009, 12:38 PM
JTo those familiar with this forum the doctors who regularly contribute most certainly are not "random," and some would not consider us "strangers."

But DocV, all of your published photos are of the back of your head, neck, and back. I know I would only recognize you if you were walking away....:D

BenDiver
December 30th, 2009, 12:44 PM
Thanks guys. If the Dermie tomorrow has no clue, I will definitely call DAN. I am a DAN member as well, so that is probably a great idea to call them!

Thanks Hank, too.. I also have been stung by a lot of marine creatures. I call it a badge of honor, my wife calls me clumsy. :) To be honest, I really don't think I got this Scuba diving.. I was relaxing in the water at the beach.. Squeezing a lot of sand between my hands in the shallows (I love that feeling!) and that night my hands began to turn red and blister. I wonder if there was something in the sand underwater that got into my hands.. Some sort of parasite it my guess, although it hasn't spread so that is where I am dumbfounded.. I will post tomorrow after I talk to doc to let you all know.

I wish I would have found this site earlier, you guys rock!

TSandM
December 30th, 2009, 12:56 PM
If you give the dermatologist as good a history as you have given us, my guess is that he may very well want to biopsy one of the lesions. There might be some foreign body embedded in the skin that is causing the prolonged reaction.

Acanthurus
December 30th, 2009, 01:50 PM
Please let us know how it all works out....Good luck!

Hank49
December 30th, 2009, 05:57 PM
I was relaxing in the water at the beach.. Squeezing a lot of sand between my hands in the shallows (I love that feeling!) and that night my hands began to turn red and blister. I wonder if there was something in the sand underwater that got into my hands..

I kept a seawater aquarium in Hawaii and the Philippines and when I'd pick up a rock or get some sand that I didn't disinfect and put it in the tank, I'd usually end up with lots of anemones, they can sting, not to mention crabs, hydrozoans...the rocks and sand are "alive".

PineNut
December 30th, 2009, 07:34 PM
To consider include:

1.Dyshidrosis or Dyshidrotic Eczema (Pompholyx)
2.Foreign body response to slivers of diatomaceous crystals from the sand
3.Irritant dermatitis or friction induced dermatitis from grabbing scuba tank or dive boat ladder
4.Contact allergic dermatitis of the palms or soles often result in a bumpy or clear pebbles under the skin
5.Friction induced urticaria, perhaps from the seafood you had the night before

If the lesions are found both on the hands and feet, then dyshidrosis, pustular psoriasis, and hand foot and mouth disease should be considered.

Acanthurus
December 30th, 2009, 07:39 PM
To consider include:

1.Dyshidrosis or Dyshidrotic Eczema (Pompholyx)
2.Foreign body response to slivers of diatomaceous crystals from the sand
3.Irritant dermatitis or friction induced dermatitis from grabbing scuba tank or dive boat ladder
4.Contact allergic dermatitis of the palms or soles often result in a bumpy or clear pebbles under the skin
5.Friction induced urticaria, perhaps from the seafood you had the night before

If the lesions are found both on the hands and feet, then dyshidrosis, pustular psoriasis, and hand foot and mouth disease should be considered.

I actually was thinking that it sure sounds like dyhydrotic eczema - with the caveat that obviously I haven't seen it. This condition can be very painful!!

BenDiver
December 31st, 2009, 12:05 PM
Pine Nut, great ideas! Thanks! I am leaving to visit with the dermatologist soon. I don't have anything on my feet. However your #4 sounds exactly like what I have. I think that may be a combination with #2. Thank you all for helping out. What a great website with such friendly people willing to help out. I am truly grateful.

DocVikingo
December 31st, 2009, 01:08 PM
Quote:
Originally Posted by PineNut
To consider include:
1.Dyshidrosis or Dyshidrotic Eczema (Pompholyx)
2.Foreign body response to slivers of diatomaceous crystals from the sand
3.Irritant dermatitis or friction induced dermatitis from grabbing scuba tank or dive boat ladder
4.Contact allergic dermatitis of the palms or soles often result in a bumpy or clear pebbles under the skin
5.Friction induced urticaria, perhaps from the seafood you had the night before

If the lesions are found both on the hands and feet, then dyshidrosis, pustular psoriasis, and hand foot and mouth disease should be considered.


Regarding #5, what kind of seafood would one have for dinner that would cause "friction induced urticaria" of the hands and feet? Would have be some rough and resistant bivalves and crustaceans ; )

Regarding HFMD, the following describes (and contains photos of) of the condition --> Hand-foot-and-mouth disease - MayoClinic.com (http://www.mayoclinic.com/health/hand-foot-and-mouth-disease/DS00599). According to this definition and symptom description, the OP would seem to be a monosymptomatic case. As such, I find this a reach as a reasonable r/o dx.

Finally, leaving aside the rarity of pustular psoriasis (NOS), I don't find this compelling. Neither the description of the lesions nor the history appear consistent with palmoplantar pustulosis.

Regards,

DocVikingo

PineNut
December 31st, 2009, 02:11 PM
A good differential diagnosis is absolutely necessary for the work up of any medical condition, DocVikingo. Things don't happen in real life like they do in the movies or the text book.

As TSM suggested, hand foot and mouth disease, I left it in the differential diagnosis. And I commend her for suggesting it.

Histamine induced urticarial reaction can occur from consumption of fish and seafood (http://www.urticaria.thunderworksinc.com/pages/lowhistamine.htm), and can make one more prone to dermatographism or "friction induced" urticaria (http://allergies.about.com/od/urticariahives/a/dermatographism.htm), as I chose to pick the words.

I have had arguments against my diagnosis by other doctors. But by being tunnel vision - you will miss the diagnosis of atypical viral illnesses and diseases modified by other factors.

Example - pityriasis rosae rarely present in a christmas tree fashion, herpes zoster does not always present with stabbing pain nor skin lesions, and herpes simplex one does not always present with labial lesions. By sticking to the book - you will miss unusual diagnosis.

A week ago, I saw a man for scalp itching over 6 months. Conservative treatment did not work. An HIV was positive. He responded tremendously to Diflucan. You can argue that it is not pityrosporum folliculitis - but the fact is, he responded.

All good differential diagnosis require a good list. Then the peanut gallery can start throwing.

PineNut
December 31st, 2009, 02:19 PM
Other important differential to consider:

6. Perpetuation of an irritant dermatitis by a contact allergen (example topical neosporin, topical bacitracin, or topical diphenhydramine).

7. An unusual case of herpetic whitlow (where have you stuck your hand recently?? ) Just kidding, I was going to say up someone's .....

DocVikingo
December 31st, 2009, 02:26 PM
Ah, yes, "Pine Nut," now that you've made a few "adjustments" to your responses it's all quite clear.

BenDiver
January 7th, 2010, 03:15 PM
Well.. I am back from the doc! As I first suspected, she really didn't know exactly what it was except for the fact my hands had areas that were inflamed deep under the skin. She guessed it was some kind of foreign substance that my hands did not like and was not worried about it. She prescribed a topical steroid and sent me on my way. My hands are definitely getting better, so it was nothing serious and definitely not hand, foot, and mouth disease. :thumb:

Thanks again, guys!

DocVikingo
January 8th, 2010, 08:23 AM
As I first suspected, she really didn't know exactly what it was except for the fact my hands had areas that were inflamed deep under the skin. She prescribed a topical steroid and sent me on my way. My hands are definitely getting better, so it was nothing serious and definitely not hand, foot, and mouth disease.

Hi BenDiver,

Good news.

Appreciate the follow up -- it's how we learn. Your doctor's response certainly backs up what TSandM said regarding the difficulty in diagnosing many skin conditions.

And of course you don't have HFMD. I repost this link from my immediately prior post in this thread: Hand-foot-and-mouth disease - MayoClinic.com (http://www.mayoclinic.com/health/hand-foot-and-mouth-disease/DS00599)

Regards,

DocVikingo


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