Incident Insights: Skin DCS

Reported incident

While on a dive trip a dive buddy team planned to do three dives per day over two consecutive days. Although experienced divers they were guided by a divemaster on a series of drift dives with minimal stress. The first dive of the second day was 22 metres for 62 minutes, the next dive was to 20 metres for 60 minutes. Though there was a strong current, nothing seemed out of the ordinary until the team surfaced, and one buddy’s computer shut down for 24 hours. The other computer did not register any violations.

The team decided to continue with the third dive after a two-hour surface interval, however one buddy stayed above 10 metres while the other descended to 28 metres. Both divers logged a bottom time of 50 minutes for the third dive.

Approximately two hours after returning to shore, the diver on the deeper profile noticed pain to light touch around the torso without discolouration. The diver decided to call the DAN Emergency Hotline as a precaution and the medic team confirmed that based on what he described it was likely to be a symptom of skin decompression sickness (DCS). But by the time the diver called the hotline he was asymptomatic, and DAN recommended medical evaluation to ensure nothing was missed. Then in absence of any other findings, DAN also recommended that the diver stay out of the water for 30 days.

The diver cancelled the remaining dive based on the recommendation from the DAN Medic.

Review

Skin DCS symptoms do not always present with outward skin issues. Common symptoms of skin DCS include an itchy rash, marbled pattern on the skin and deep tissue tenderness. These manifestations typically appear on areas that we tend to accumulate bodily fat, like the abdomen, lower back, buttocks, thighs, upper arms, breasts.

Decompression models are not very effective in predicting outcomes of reverse profiles. Although this cannot be seen as a smoking gun, this is a plausible explanation for this incident as it is likely to build the inert gas load in the body, putting the diver more at risk for decompression related illnesses.

Recommendations

Cutaneous manifestations of decompression illness (DCI) might present within minutes to several hours following a dive. The earlier the manifestations and the more dramatic, the more serious the decompression insult. When suspecting DCS, a physician should evaluate any skin manifestation, as there may be other subtle signs that could support or rule out a diagnosis of DCI. If the evaluating physician is not familiar with diving medicine, they can always consult with DAN 24/7. Not all forms of cutaneous DCS are necessarily associated with poor outcomes, but some will greatly benefit from an early diagnosis and treatment.

Skin Bends: What to do

Treatment

Oxygen first aid should immediately be commenced for a diver exhibiting DCS-related skin changes, and the diver should be evaluated by a physician. A rash unaccompanied by other symptoms usually doesn’t need to be treated by recompression. But if your physician discovers signs of neurological effects, hyperbaric oxygen treatment in a recompression chamber is usually advised. Appropriate treatment for skin mottling or swelling will depend on the results of a physical examination. Skin changes associated with any other manifestations of DCS should be treated as an emergency.

Preserving the evidence

If you experience any skin change after a dive, be sure to take a photo of it because it may have disappeared by the time you see a physician.

DAN Hotline

Call the DAN Diving Emergency Hotline promptly for advice: 1800 088 200 within Australia or
+1-919-684-9111 Internationally.

For more information visitWorld.DAN.org