A fungus among us!

[FritzCat66]

So, I just got back from the dermatologist, diagnosed with my first scuba-related health issue. :shocked2: Although, as health issues go, this one is about as mild as they get.

I have been diagnosed with tinea versicolor, which is a skin infection caused by a variety of fungi in the Malassezia genus - technically, a form of yeast.

Basically, it forms splotches across my shoulders and upper arms. They don't hurt or itch or anything. This fungus is everywhere, all around us, but only a small percentage of folks actually get an infection like this, affecting the very top layer of skin. Don't I just feel special now.

Apparently there is a strong genetic component inclining me to be vulnerable to this, but it also typically requires oily skin, which I definitely have (thanks, Mom!).

The connection to diving might just be coincidental, but not at all unlikely. You see, despite perhaps have a genetic propinquity for it, I never remember experiencing these blotches before I was in my late thirties. Then I saw a few and didn't worry about them, they would fade a bit, but then come back. Then there were more, and the blotches started running together. This was a slow process that took years, and again there was never any pain, itching, or discomfort whatsoever. So, only now when I started seeing a few blotches on my forearm did I decide to actually see a dermatologist about it.

Discussing it with him (who happens to also be a diver, certified 35 years ago in San Diego!), I inquired why this would start happening now, especially given that it usually first appears on vulnerable individuals during adolescence, when the sebaceous glands generating the oils on which the yeast feeds are most active. While it could be random, upon reflection this started about the time I really started diving seriously, on a regular basis.

According to his reference material, and later all the information I could find out online, this fungus loves sweaty people with oily skin in damp, humid, semitropical or tropical climates. Living in and diving around Florida all the time, being frequently wrapped in a warm, damp wetsuit, and you might as well start farming this stuff!

Anyway, not a big deal. I've got some oral antifungals and some topical stuff to get rid of the acute symptoms, but according to my dermatologist and everything else I've read, I'll likely be fighting these blotchies the rest of my life, until I guess ultimately it wins and mushrooms sprout from my corpse.

Not that it will stop me from diving! If it does turn out to be dive-related, then of all the possible health problems you can get from diving, I'll gladly take this one.

I'm curious: Anyone else have something like this start to show up once you really started diving, when it hadn't before?

 

[TSandM]

No, but I have had tinea versicolor since I was in my 20s. I have found that I can keep it under almost total control by using Selsun Blue shampoo (the kind with the selenium in it) on a daily basis. Apparently, I wash enough selenium out of my hair to inhibit the stuff on my skin as well. If I change shampoos for any length of time, I develop active patches again.

 

[Louie]

I had an on-going bout of a fungus-related problem when I was living and working in the tropics a few years ago. It was brought on by a combination of never being completely dry for long and diving constantly (feet being in boots and fins). I lost a few toenails - no pain or discomfort, they just became loose and eventually fell off.
The doctor diagnosed the problem as something very commonly seen in divers in his neighbourhood, a common fungus infection, and his prescription was to keep my feet clean and dry - something easier said than done when you have to dive all the time. I had a friend who'd lost all of her toe nails to a similar problem and hers didn't grow back for several years.
It was no big deal. My feet looked a bit funny for a while and my nails grew back eventually - albeit crooked.

 

[PvtStash]

I get bouts of this as well... more common in the warmer months or when I've been putting on weight (sweating more seems to be the common demoninator)...

 

[flots am]

Basically, it forms splotches across my shoulders and upper arms. They don't hurt or itch or anything. This fungus is everywhere, all around us, but only a small percentage of folks actually get an infection like this, affecting the very top layer of skin. Don't I just feel special now.

I'm not a doc and don't really want to stick my nose into your doc's business, but DCS "skin bends" can also look like splotches.

Did he actually take a sample and test it or does he just think it looks like fungus?

flots.

 

[TSandM]

There is no similarity between tinea versicolor (depigmented patches that scale and fluoresce) and skin bends (discolored areas that itch or burn intensely). I don't think the two could be confused by anyone with medical training.

 

[FritzCat66]

No, but I have had tinea versicolor since I was in my 20s.

I get bouts of this as well... more common in the warmer months or when I've been putting on weight (sweating more seems to be the common demoninator)...

So, more winners in this wonderful genetic lottery, then! My doc mentioned the Selsun Blue trick, Lynne. Unfortunately, I don't really have any hair to shampoo - I typically just use the same bar soap up there as everywhere else. For right now, he's given me a 2.5% selenium sulfide cream I'm supposed to smear on the affected spots 20 minutes before I shower, and a script for oral ketoconazole, just a couple now, and a couple in a month.

If I can't keep it suppressed afterwards, I may look into making a body wash out of the shampoo. I've also been reading online that products with at least 5% tea tree oil have a good track record for keeping it down.

Lynne, I take it your initial outbreak had no coincidence with diving, then? The literature suggests that late adolescence is when it usually first appears on those of us vulnerable. There's not much info at all about such a late-onset exhibition as mine, which is why I'm curious as to the possibility of a diving connection. It really does line up in my case, and I can't think of any other significant lifestyle change that could explain the onset.

Not that it really matters as far as treatment goes, of course.

I had an on-going bout of a fungus-related problem when I was living and working in the tropics a few years ago. It was brought on by a combination of never being completely dry for long and diving constantly... The doctor diagnosed the problem as something very commonly seen in divers in his neighbourhood, a common fungus infection, and his prescription was to keep my feet clean and dry - something easier said than done when you have to dive all the time.

So there's a good story about an acute fungal infection brought about by diving. We tropical and semi-tropical divers really should be aware of the fungal risks; sounds like when dealing with our unicellular friends, an ounce of prevention really is worth a pound of cure.

...DCS "skin bends" can also look like splotches. Did he actually take a sample and test it or does he just think it looks like fungus?

Nah, he just looked at it closely, poked, and used a kind of blacklight wand under which the spots glowed with interesting colors - perhaps the source of the versicolor part of the name? He says he sees this often here in hot & humid Florida.

As TSandM mentioned, I think DCS skin hits are more painful and actually necrotize some of the flesh. Besides, a DCS hit would be an acute event, whereas this is obviously a chronic condition that has taken years to progress. Also, the initial lesions were almost perfectly round, from 5mm to about 12mm in diameter. Over time, more and more sprouted up and they started to merge into larger splotches. I don't think skin bends start from such perfect little circles and grow on their own.

 

[TSandM]

"Versicolor" refers to the fact that the patches of fungus get depigmented, making them look white (and be VERY sensitive to sunburn!)

I've used Selsun as a body wash before -- it works fine, and it's a lot cheaper than ketoconazole (with no systemic side effects, as well).

And yes, my first bout with it was long before I had even considered learning to dive. It wasn't in a humid place, either, but in Northern California, and the patch was on my upper back. I think it was pure genetics

 

[sansky]

Never heard of it. A few years ago I had a major rash on both my arms after diving. The doctor attributed it to new sunblock I had applied earlier and said since I was diving with a wetsuit that at depth it compressed and forced the sunblock in and affected the sucutaneous layer of skin.

Never had it since; stopped using that sunblock though ....

 

[mikerault]

Oral Ketoconazole will get rid of it for several months at a time.