Skin bends or rash from hydroid of fire coral?

[morecowbells]

Sorry I have no pics from my rash I encountered about 2 months ago while diving in Roatan. After five days two dives a day diving in a full wetsuit, we walked back to the house. The journey involved about 10 minutes of walking up a steep hill. Near the end, I noticed a abrupt, burning on my left upper, inner thigh. I thought perhaps my swim shorts were rubbing and made my skin raw. Back at the house I took a shower and the burning rash was becoming super painful. I suspected possible fire coral or hydroid as the rash was about 5" long and 2" wide. Skin was red and had the appearance of chicken skin. Bumps were fine and red. I noticed a petechiae type of rash(broken capillary). I tested it by pushing against the rash with a clear glass, and it did not blanch which I feel confirmed the petechiae.

That night burning went away and rash almost gone by the next day. We did one dive(at this point I did not suspect skin bends). While loading up the truck to head back home the burning became intense. Area even more inflamed with intense burning. No blistering, no open wound. Just petechiae and scarlet red skin. At this point I started suspecting skin bends. No diving after that as our trip was winding down. There were no issues with flying and within a couple of days, rash almost completely gone, area almost leathery and tan.

Conundrum: I wore a full wetsuit the entire time, so the possibility of hydroid or fire coral in that area of wetsuit would be slim. The rash did not have the marbled or mottled appearance that I have heard about in cases of skin bends. I used regular air instead of Nitrox. Dive profiles were very conservative.

Any input on that could have caused this rash? I do not have any other dive trips until Oct. I am slightly apprehensive about staying in a more remote location if this may be a problem in the future. Thanks in advance for any input or theories.

 

[Donnah]

In Bonaire, someone in our group was diagnosed with "skin bends" on her arm. Looked like a bad sunburn and itched. She was put in a chamber for a short time and told not to dive for 6 months.

 

[tursiops]

The "walking up a steep hill" is a clue.....no exercise after a dive, is the best rule. Use nitrox.....why play odds that are a little uncomfortable?

Sent from my ASUS Transformer Pad TF700T using Tapatalk

 

[DocVikingo]

Hi morecowbells,

What is described seems unlikely to have been an event of cutaneous DCS (aka clinically significant "skin bends"). For openers, a skin reaction showing frank scarlet redness, fine red bumps & the "appearance of chicken skin" is not suggestive of cutaneous DCS. Also, a relatively pronounced case is not generally expected given only two dives a day with "very conservative" profiles.

Cutaneous DCS typically affects areas of the body rich in fatty tissue. The torso (especially the stomach area) and shoulders & arms often are involved, as may be the thighs. The condition may be associated with a violet to red rash or a mottled/marbled rash (cutis marmorata). The rash tends to clear within an hour or two, and almost always within 24 hours. An allergic reaction can of course appear anywhere on the body, including areas where cutaneous DCS is almost never seen (e.g., hands & feet). And healing time, while variable, is almost always longer than a couple of hours and can in some instances be relatively long-lasting, e.g., cnidarian envenomations. Allergic rashes also may wax & wane, which cutaneous DCS is very unlikely to do.

Cutaneous DCS usually presents as a constant & intense itching that might make one think of an allergic reaction. And, it may improve with an oral antihistamine or a topical antihistamine or steroid preparation. However, cutaneous DCS very likely will respond even better to the prompt & proper administration of 100% O2, which an allergic reaction will not do.

One would want to rule out other causes for the rash, such as a dermatitis related to abraison, excessive persipration, or a reaction to diving thermal protection.

BTW, here's what the rash associated with cutaneous DCS (cutis marmorata) tends to look like -->

https://www.jstage.jst.go.jp/article...2_52.1212/_pdf

MMS: Error (yes, the link works).

In conclusion, this is not to say that this wasn’t an incident of cutaneous DCS, and should it recur with diving consultation with diving medicine specialist or dermatologist with some knowledge of scuba would be prudent.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[morecowbells]

Thank you everybody for taking the time to reply to my question! My main concern was the development of this rash at the end of the uphill walk and the petechiae accompanying the bright red rash. Fortunately, my rash looked nothing like the pictures in the link provided. I encountered no marbling, no bruising or purple areas. Ordinarily I would not have made the steep walk home, but our truck had some issues. Crisis averted but I think I will stick with Nitrox the next time. Again, thanks for the information!

 

[Solly]

is it normal for any kind of DCS to have the symptoms away then back again?

 

[DocVikingo]

is it normal for any kind of DCS to have the symptoms away then back again?

Hi Solly,

In the absence of any further provocation, no. However, signs/symptoms of DCS can resolve and then reappear following additional nitrogen on & off-gassing, i.e., more scuba.

The OP reports returning for an additional dive the day afer the initial presentation & substantial resolution of the rash.

Regards,

DocVikingo