Skin Rash Should Not Be Ignored
An unrecognized case of skin DCS resolves spontaneously. (2012, Tobago)
>A 58-year-old female (5'10" tall, 165 pounds) went on recreational dive trip in Tobago. She dived multiple dives a day for six consecutive days. The maximum depth of her dives did not exceed 80 fsw. On the fourth day of diving, she noticed a rash on her torso. She was unsure of the cause and reported taking Aleve for "inflammation" with no improvement noted. She continued to dive and noticed the "rash" improved while underwater. The torso discoloration then resolved after her last dive (day six) and prior to her flight home. She reported no issues on the flight home.
>After returning to Canada, she did an Internet search for "blotchy skin rash after diving" and noticed skin bends as a top hit. At that point she contacted DAN and was directed to a referral physician.
>On examination, two days after her return home and three days after her last dive, she was completely asymptomatic and had no physical findings to report. She is intact neurologically with no pertinent findings to report.
>Skin manifestations of decompression sickness (DCS) are not uncommon, but many divers are not aware of it. Skin manifestations alone may not require treatment, but they require medical evaluation to exclude possible neurological symptoms of which the diver may not be aware.
>Skin DCS is sometimes associated with difficulty breathing and coughing, which is called "chokes." In such cases it is very likely that neurological symptoms are present. Neurological symptoms may be present without chokes, too. First aid surface oxygen should be administered in case of chokes and neurological symptoms while the patient is being transported to an emergency room.
>In this case, her symptoms resolved spontaneously. However, it is not advisable to continue diving with skin rash. Divers with skin rash should be examined for neurological symptoms.
— Petar Denoble, M.D., D.Sc.