Aquatic Skin Disorders

Published on 14/03/2015 by admin

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Last modified 14/03/2015

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Aquatic Skin Disorders

Among the disorders acquired in water that affect the skin are various dermatoses, cutaneous larva migrans, infections, sensitivity to diving equipment, pseudomonal folliculitis, and otitis externa.

Disorders

Sargassum Algal Dermatitis

Signs and Symptoms

1. Skin erythema, urticarial papular pruritus

Treatment

1. Promptly wash with soap and water to remove toxins.

2. Treat a mild to moderate reaction with antihistamines and a topical medium-potency corticosteroid preparation (Table 55-1).

Table 55-1

Potency Ranking of Topical Steroids

These topical steroids must be applied twice daily. However, the actual application rate can vary upward a maximum of three to four times per day according to the prescriber’s discretion.

3. Treat a severe reaction with an oral corticosteroid, specifically prednisone, 60 to 100 mg for adults and 1 mg/kg for children, with a 2-week taper.

Sea Cucumber Dermatitis

Signs and Symptoms

1. Skin erythema, pain, and pruritus

Treatment

1. Promptly wash with soap and water to remove toxins.

2. Treat a mild to moderate reaction with a topical low- or medium-potency corticosteroid preparation (see Table 55-1).

3. Treat a severe reaction with an oral corticosteroid, specifically prednisone, 60 to 100 mg for adults and 1 mg/kg for children, with a 2-week taper.

Sea Moss Dermatitis (Dogger Bank Itch)

Sea moss dermatitis is caused by a plant (Fragilaria striatula) or sea chervils (genus Alcyonidium), which appear in seaweed-like animal colonies (mosses or “mats”), usually drawn up within fishing nets.

Signs and Symptoms

1. Irritation, first appearing on the hands and forearms (see Plate 43)

2. Recurrent exposures are more severe, characterized by vesiculated and edematous eruption of the hands, arms, legs, and face

Treatment

1. Treat as for mild poison oak dermatitis (see Chapter 40).

a. Depending on the severity of the reaction, apply calamine lotion or a topical medium- or high-potency corticosteroid preparation.

b. Give an oral antihistamine to help control itching.

2. Treat a severe reaction with an oral corticosteroid, specifically prednisone, 60 to 100 mg for adults and 1 mg/kg for children, with a 2-week taper.

Seaweed Dermatitis

Seaweed dermatitis is almost always secondary to irritation from contact with algae. For instance, the stinging seaweed Microcoleus lyngbyaceus (also known as Lyngbya majuscula) is green or olive colored, drab, and finely filamentous. The typical patient does not remove a wet bathing suit for a time after leaving the water.

Signs and Symptoms

1. In minutes to hours after exposure, a pruritic, burning, moist, and erythematous rash developing in bathing suit distribution, followed by bullous escharotic desquamation in the genital, perineal, and perianal regions (see Plate 44)

2. Lymphadenopathy, pustular folliculitis, and local infections

3. Oral and ocular mucous membrane irritation, facial rash, conjunctivitis

Treatment

1. Wash the skin vigorously with soap and water.

2. Apply a brief soak of isopropyl alcohol 40%.

3. Apply a topical corticosteroid preparation. This may need to be medium to high potency.

4. Treat a severe reaction with an oral corticosteroid, specifically prednisone, 60 to 100 mg for adults and 1 mg/kg for children, with a 2-week taper.

Protothecosis

The genus Prototheca consists of nonpigmented algae from the family Chlorellaceae. Prototheca wickerhamii and Prototheca zopfii are the most commonly isolated pathogens in human protothecosis.

Signs and Symptoms

1. Superficial cutaneous lesions present as papulonodules or verrucous plaques with or without ulcerations. Bullous lesions or, rarely, eczematous and cellulitis-like lesions may occur (see Plate 45).

2. Olecranon bursitis, with or without spontaneous drainage. A history of preceding trauma should suggest protothecosis.

3. Systemic infection may occur, particularly in immunosuppressed persons.

4. A case of esophageal protothecosis has been reported.

In cases associated with a traumatic episode, the initial lesion is a nodule or tender red papule, which enlarges, becomes pustular, and ulcerates. There may be a purulent, malodorous, and blood-tinged discharge. Satellite lesions surround the primary lesion and may become confluent. Regional lymph nodes may develop metastatic granulomas.

Treatment

1. Localized lesions can be excised.

2. Topical medications are unsatisfactory.

3. Algicidal agents, including ketoconazole, itraconazole, fluconazole, and miconazole, may inhibit or kill the organisms.

Human Pythiosis

The aquatic fungus-like organism Pythium insidiosum is a zoosporic plant pathogen and newly emerging human pathogen. It is found in tropical, subtropical, and temperate areas, preferentially in swampy environments. The zoospores encyst and form germ tubes, secreting an adhesive substance, cellulitic and macerating enzymes, and fungal products.

Signs and Symptoms

1. Begins as a pustule at the site of inoculation (see Plate 46)

2. Cellulitis and suppurative necrosis, usually of the lower extremities

3. Can cause systemic arterial inflammation and occlusion

Treatment

1. Treatment is not well established. Antifungal medication, such as amphotericin B or itraconazole given for up to a year, has been attempted.

Aquagenic Urticaria

Signs and Symptoms

1. Urticaria on exposure to water of any temperature

2. Eruption usually confined to the neck, upper trunk, and arms, whereas the face, hands, legs, and feet are spared (see Plate 47)

Treatment

1. Prevent or inhibit the reaction by applying petroleum ointment to the skin before water exposure.

2. Consider prophylaxis with an antihistamine 1 hour before exposure.

3. In persons with recurrent aquagenic urticaria, consider stanozolol 10 mg/day for symptom control.

Aquagenic Pruritus

Signs and Symptoms

1. Intense disabling itching without visible cutaneous changes on exposure to water of any temperature

2. Reaction within minutes of exposure and lasting between 10 minutes and 2 hours

3. Lack of concurrent skin disease or drug exposure

4. Symptoms may occur only in areas exposed to water. Typically the head, palms, soles, and mucosa are spared

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