Skin Bends and Future Diving

[natalieinca]

I have now had what I think are skin bends three times. Each time I was within the limits of my computer and had not gone particularly deep or ascended particularly fast according to my dive computer. I was diving air each time.

The first time was on the 5th day of diving. There was a doctor in the group and she thought it was some type of allergy - that something had gotten into my wetsuit. It started a couple hours after getting out of the water. It was a painful, mottled looking, flat rash which disappeared within a couple of hours. It was mostly on my torso, but also on my thighs. I just took some Benadryl, applied some Cortisone cream and ended up diving the next day without incident (I thought it was an allergy or I would have stopped diving).

The second time was two years later after four dives in two days. It was just a tiny spot on my stomach and again disappeared within an hour or so. (I had done three separate single days of diving in between this trip and the first incident without any problems).

The third time was six months later, also after four dives in two days. (I had not dived since the prior incident). It was on my torso, under my armpit area. Probably about the size of a hand print. That time I called DAN immediately. Even though I was on the big island of Hawaii, they told me there was not a dive doctor in the area. Again it went away within an hour or two. DAN did think it sounded like skin bends. They told me that as long as there were no neurological symptoms and it went away, I did not need any kind of treatment.

I am wondering if I should stop diving or if being more conservative with my dive profiles and always diving Nitrox will be enough. I really love diving, and was hoping to plan a live aboard trip a couple of months from now. After speaking with DAN immediately following the last incident, I was under the impression that having solely skin bends symptoms was not that dangerous. I was also under the impression that skin bends is not well understood and that the connection between skin bends and more serious DCS was not very well known either. After doing some more research online and on this board, I am feeling spooked about going diving again. And especially about planning a long dive trip.

I understand that I should see a dive doctor, but when doing so, I obviously won't have the rash at the time that I go.

 

[Quero]

I had something like this happening to me, and I was also worried that it was skin bends. I talked to a hyperbaric doctor here on Phuket (Dr. Luba Matic) who told me he though it was probably an allergy of some sort, but he authorized a PFO test just to rule that out. My PFO test came back negative--my heart is perfect--so we concluded that it is indeed an allergy of some kind. My "skin bends" would only happen when I sat in the sun after a dive, and only in the area exposed to the sun, and as it turned out, a few years later I got a mild sunburn without diving, and suffered quite a severe allergic reaction. The conclusion drawn from of all of this is that it wasn't anything in the water I was allergic to, but rather that my body has developed some photo-sensitive immune system reaction to UV radiation. All I have to do is stay out of the sun! You may find that you do indeed have some sort of allergy, though perhaps yours does stem from something in the water, but don't conclude without further investigation that you're suffering from skin bends and simply quit diving as a result.

 

[Duke Dive Medicine]

Natalie, are there any photos of the rash?

 

[Instructor_Tom]

nattalieinca;

I didn't see in your post what kind of run times you had on the dives where you got the rash/skin bends. I have not had skins bends but there are folks in my shop that have experienced them on long technical dives. the prolonged exposure of water to the skin could be the cause as it was with them. the folks I know resolved their problem by diving a dry suit on those long and extensive dives.

just a though....


Sent from my iPad using Tapatalk HD

 

[chillyinCanada]

Natalie did you have any pain with the mottling?

Skin bends does generally show in the fattiest tissue, tummy, hips, thighs. If you are carrying extra weight you may reduce your chances in future by losing weight too.

The mottling in your armpit area seems unusual.

Have you seen pictures of others' skin bends? The mottling is quite distinctive.

 

[natalieinca]

I have a few picture of the last time it happened (see below). It is hard to tell in the pictures, but the color looked pretty red in real life. It was only red - it never turned purple or anything. It was painful, and not particularly itchy. I am fairly thin so I don't think it is an extra body fat issue.



The first time it happened on the 5th day of diving. That day I did a 38 min dive, max depth 85 ft and 2nd dive was 52 min, max of 68 ft. Looking at the details on my computer, it does look like I pushed the limits on my computer. I have an Oceanic VT Pro - it has a "tissue loading bar graph" where the 8th bar is a decompression dive. I did hit 7 bars on both of those dives, and got out of the water with 5 and 6 bars respectively.

The second time, it happened on the second day of diving. First dive that day was 50 min, 74 ft max and second dive was 47 min, max depth of 68 ft. I did hit seven bars on the second dive and came out of the water with 6.

The third time was also on the second day of diving. The evening before I did the Manta dive in Kona - where most of the second dive was spent at 15 feet. The day it happened I did a 52 min dive max depth of 57 feet and a 59 min dive max depth of 76 feet. The highest my tissue loading bar graph got was 5 and I ended the 2nd dive with 4. So that trip I never went beyond 5 bars on my tissue loading graph.

None of the dive profiles show any alarming ascent rates.

I did get a new wetsuit before the trip where it first happened and I have worn that wetsuit on each of the dives when I've gotten a rash. I have never had an issue while diving a dry suit, although I don't usually do multiple days of cold water diving in a row. I did dive with the wetsuit - three dives in one day without an issue. It is Mares trilastic - I don't know if there's anything unusual in their neoprene. I've done about 300 dives, generally in a (different) wetsuit.

Thanks for your help, Natalie

 

[miketsp]

My wife used to get occasional skin bends when diving to the limits of her circa 1995 computer (Beuchat Maestro Pro).
Since she changed to a Suunto Vyper some years back it never again happened.

We found we had to set the Maestro to 20% conservative for it to emulate the Vyper.

 

[sealark]

I would suggest you dive nitrox and use air tables and see what happens. Your dive profiles are pushing it.

 

[chillyinCanada]

Where were you diving and what season (month)?

The pain you felt was it on the surface of your skin or did it seem deeper?

 

[uncfnp]

I'm sure Duke Dive Medicine and others will give you more info and correct my mistakes but as I understand it, there are two types of "skin bends" one more serious than the other. The less serious is the bright red, itchy rash. It looks much like your photo. I would describe it as an almost urticarial or hives like reaction. It starts about 2 hours after the dive and is gone in just a few more hours. There may be some localized swelling and tenderness as well. The "fatty" areas of the body are most affected. There are no other symptoms. This type rash is not associated with a PFO. I recall reading somewhere that it maybe a histamine reaction to cutaneous bubble release but it was just theory and I don't recall the source.

The other is a much more serious reaction and causes a characteristic marbling rash called cutis marmorata. It is a deep red to purple rash and may also be itchy and about 20% of divers will also have neurological symtoms (edit-and may be associated with a PFO). It is treated by a ride in the chamber. A photo of cutis marmorata from Alert Diver...




I don't know the risk of future dives with recurrent "bends," especially of the less serious kind. I hope Duke can help with this question...