Possible Skin Bends?

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LastManOut

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Hey everyone, just wondering if anyone can help me out with this.

A friend of mine (we are both experienced instructors) and I went diving on the Yongala Wreck out of Ayr, Far North Queensland, Australia last year, and after two air dives to 30 metres and 25 metres respectively (at around half an hour each), on computers, and with around a two hour surface interval and extra long safety stops included. Hardly hardcore diving and the current was totally manageable, and both of us surfaced feeling fine.

However, that afternoon during our drive North to Cairns, my friend noticed that she was itchy across her stomach area and raised her shirt to find a rash spreading. We discounted this straight away as an over-tight wetsuit and decided we would monitor it. At this stage she didn't feel unwell, however she was slightly tired from what we assumed was a couple of decent sized dives and long travel days beforehand, and after all she hadn't dived in a while.

Half an hour later the red splotches had worsened and covered approximately 2/3 of her stomach and a few small isolated patches on her back, some being very slightly purple, and most of it being sensitive/uncomfortable. Being in far north Queensland we were a fair way from a hospital and it was getting late, so we traced a line around the outside of the rash to see if it moved at all or dissipated. After another half an hour and it had moved completely but seemed to be receding, and her condition was good, so we kept fluids up and decided if anything exacerbated we'd go to the hospital in Cairns. After another day of no further complications it went completely away and we thought nothing more of it.

I was reading my TDI Decompression Procedures Manual yesterday and suddenly it clicked. My jaw nearly fell off. Type I DCS - Skin Bends. How hadn't I thought of it before? Cutis Marmorata - itchy -> marbling/pain -> justification for recompression. I think because we were doing such basic dives we discounted the idea of DCS completely... Neither of us had ever had a problem in thousands of dives! I was quite angry with myself that I hadn't picked it at the time, but you just don't ever think of the worst case scenario. I have certainly learned my lesson.

I am only assuming that this is what it could have been though... it just seems to fit perfectly. Now that I have told my friend about it, she is quite upset and worried that an undeserved skin bend may ruin her dive career due to the lack of recompression therapy for something that could have been far more serious, and she believes that now she may have a predisposition for further DCS troubles. Admittedly she has lost a fair bit of weight since then especially fat around her stomach (which is a perfect slow-tissue environment), and I don't believe that this should preclude her from further diving activities due to a lack of ensuing complications or worsening overall condition at the time. However I am not a Doctor, but I know that some of you are.

Any thoughts or advice? I would be very grateful. I can send photos to you if you need to see, as we took close up shots as well.

And please, this is very important to me - serious answers only please.

Thankyou all in advance.

Nick
 
Hi Nick,

The dives described, while perhaps not "hard core," could be sufficient to generate an adequate nitrogen loading to potentially contribute to DCS.

"Skin bends" or cutaneous DCS (a form of Type I DCS) usually presents as a constant and intense itching that doesn't require touch or movement to provoke discomfort. It most typically affects the torso, shoulders and arms and may be associated with a mottled/marbled rash (cutis marmorata). In the diver, the mottling is most often reddish, but may include bluish to slightly purplish areas. It tends to clear within 24 hours, and often more quickly. Of course, fatigue also can be a symptom of DCS.

It probably would be useful to post photos if this can be done

Given what is described was simply an unexplained skin bend, the fact, in and of itself, that it went untreated shouldn't be of concern as it is extremely improbable any lasting harm was done.

Regarding the likelihood of future DCS-like events, it is good the diver in question has lost a fair bit of fatty tissue, including in the stomach region, and presumably is somewhat more fit than previously. Also, it is reported that, "Neither of us had ever had a problem in thousands of dives." Based on the limited history provided, a predisposition to DCS does not appear compelling. However, if another instance of signs or symptoms of possible DCI should occur further diving would be ill-advised until an appropriate medical work-up cleared the individual for return to SCUBA.

Helpful?

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.
 
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