Strange Bumps After Scape on a Wreck Dive

[enortham]

About a month and a half ago I scraped my finger on probably coral on a wreck in the Philippines. After a few days strange bumps that are a little painful when pressed on showed up beside where I scraped my finger and a few further down my finger that wern't near the cut at all. About two weeks later they went away. Now a month after they cleared up their back. Any idea what they could be and how to get rid of them. I attached a picture of them from the start of the second break out.

Thanks,

Eric

 

[DocVikingo]

Hi Eric,

What is described/pictured appears to be a reaction to envenomation by a cnidarian of some type, most probably a hydrozoan. If a milleporinan such as fire coral was observed on the area that was touched it is a likely candidate, although that level of specificity is academic for the purposes of this discussion.

When such an organism is scraped against, a burning/stinging sensation and skin rash typically appear soon after contact, say within 5-30 minutes. The rash usually will be red in color with numerous small blisters and/or hive-like areas, and will itch, sometimes intensely.

The skin lesions often clear within a couple of weeks, although rashes lasting many months occasionally are seen. The fact that bumps also develop nearby the point of maximum contact is not unusual. Once released, the as yet unfired stinging organs of hydrozoans can be moved about by water, rubbing of the area and similar mechanical actions.

In certain hypersensitive individuals, a delayed recurrent allergic reaction may occur 1-2 months, or even longer, after initial clearing. And, rarely, this cycle may repeat itself.

In terms of treatment, OTC oral and topical antihistamines, such as those marketed as Benadryl, may provide some relief. In the case of severe delayed recurrent reactions, topical corticosteroids may be the treatment of choice.

A dermatologist would be in the best position to evaluate and treat such a condition.

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.

Regards,

DocVikingo

 

[Missdirected]

Hey I had those or something similar. My doc gave me some cream that took care of them. They had not bothered me too much so I kept ignoring them - every now and then they would itch. After a long while of just having them be a nuisance, I finally went to the doc.

 

[fisherdvm]

Hi Eric,

What is described/pictured appears to be a reaction to envenomation by a cnidarian of some type, most probably a hydrozoan. If a milleporinan such as fire coral was observed on the area that was touched it is a likely candidate, although that level of specificity is academic for the purposes of this discussion.

When such an organism is scraped against, a burning/stinging sensation and skin rash typically appear soon after contact, say within 5-30 minutes. The rash usually will be red in color with numerous small blisters and/or hive-like areas, and will itch, sometimes intensely.

The skin lesions often clear within a couple of weeks, although rashes lasting many months occasionally are seen. The fact that bumps also develop nearby the point of maximum contact is not unusual. Once released, the as yet unfired stinging organs of hydrozoans can be moved about by water, rubbing of the area and similar mechanical actions.

In certain hypersensitive individuals, a delayed recurrent allergic reaction may occur 1-2 months, or even longer, after initial clearing. And, rarely, this cycle may repeat itself.

In terms of treatment, OTC oral and topical antihistamines, such as those marketed as Benadryl, may provide some relief. In the case of severe delayed recurrent reactions, topical corticosteroids may be the treatment of choice.

A dermatologist would be in the best position to evaluate and treat such a condition.

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.

Regards,

DocVikingo

Oh, don't undersell yourself, DocVikingo. I think primary care docs can treat it just fine. I would use a superpotent to potent topical steroid (class I or II) ointment or cream every other week, unless there is signs of infection.

The spreading to the base of the finger, or even the hand and wrist, is simply from inflammatory mediators, and is unlikely a sign of infection, in this case.

Persistance can last for months or years, but might subside faster with the use of a prescription steroid (not over the counter hydrocortisone).

I would see a dermatologist, or a good physician (like DocVikingo).

By the way, what is your specialty??

 

[enortham]

The bumps didn't appear until a few days or maybe even a week after I cut my finger. One other thing I should note is that after I cut it I could have contracted something while holding on to the drop line during the safety stop. The bumps seem more like pimples that are deep under the skin and not very rash like at all. I don't know if that would change your diagnosis.

I did see a dermatologist before the bumps appeared because the cut appeared slightly infected at the time and I had to see the dermatologist for something else anyway. He just said to contact him if it got worse. I'm not in the States anymore so I was trying to avoid going to the doctors.

 

[fisherdvm]

It might be forming warts or verrucae. The papilloma virus can infect wounds. Or it simply could be scar tissue, which might take a while to remodel, and return to normal. A month and a half out could also signify a foreign body response to embedded matter...

Can't say. You probably should see a dermatologist. Or just give it tincture of time and see. If it were me, I would give you a prescription for some potent topical steroid and see. I think a skin biopsy at this point is an overkill.

Take more photo and repost if it get worse.

 

[DocVikingo]

Hi Eric,

Based on your description, it still appears that an allergic reaction of some sort is involved, although this new information does raise other possibilities.

In any event, another dermatological evaluation does seem in order.

Best of luck.

DocVikingo

 

[enortham]

Here are some new photos taken about 24 hrs after the last one I posted. They are developing similar to how they progressed the first time except this time they are only in one spot. Last time I had a few bumps that appeared lower on my finger nowhere near the initial cut.

 

[DocVikingo]

Morning Eric,

Well, it doesn't appear that scar tissue or wart formation, or any similar processes, are involved.

Regards,

DocVikingo

 

[fisherdvm]

Those look like fluid filled vesicles, based on the photo. However, wart (HPV) still can not be ruled out. I would see a dermatologist, he can shave some of the top off. If it is wart, it is solid.

It is too inflammatory for my comfort... At this point, I would probably recommend a surgical procedure like a skin biopsy to be sent for both pathology, and culture for mycobacterium if the exam show no evidence of wart.