Cutis marmorata in decompression illness may be cerebrally mediated: a novel hypothesis on the aetiology of cutis marmorata

Journal Article

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Diving and hyperbaric medicine

Diving.Hyperb.Med.

Jun

LR: 20160224; JID: 101282742; CIN: Diving Hyperb Med. 2015 Dec;45(4):261. PMID: 26687315; OTO: NOTNLM; 2015/03/03 [received]; 2015/04/04 [accepted]; ppublish

Australia

1833-3516; 1833-3516

PMID: 26165529

eng

Case Reports; Journal Article; Research Support, Non-U.S. Gov't; IM

Unknown(0)

26165529

INTRODUCTION: Cutaneous decompression sickness (DCS) is often considered to be a mild entity that may be explained by either vascular occlusion of skin vessels by bubbles entering the arterial circulation through a right-to-left shunt or bubble formation due to saturated subcutaneous tissue during decompression. We propose an alternative hypothesis. METHODS: The case is presented of a 30-year-old female diver with skin DCS on three separate occasions following relatively low decompression stress dives. Also presented are the fi ndings of cutaneous appearances in previously reported studies on cerebral arterial air embolism in pigs. RESULTS: There was a close similarity in appearance between the skin lesions in this woman (and in other divers) and those in the pigs, suggesting a common pathway. CONCLUSIONS: From this, we hypothesize that the cutaneous lesions are cerebrally mediated. Therefore, cutaneous DCS might be a more serious event that should be treated accordingly. This hypothesis may be supported by the fact that cutis marmorata is also found in other fi elds of medicine in a non-diving context, where the rash is referred to as livedo reticularis or livedo racemosa. These are associated with a wide number of conditions but of particular interest is Sneddon's syndrome, which describes the association of livedo racemosa with cerebrovascular events or vascular brain abnormalities. Finally, there is a need for further research on the immunocytochemical pathway of cutaneous DCS.

Kemper,T.C., Rienks,R., van Ooij,P.J., van Hulst,R.A.

4Department of Anesthesiology/Hyperbaric Medicine, Academic Medical Center, Amsterdam, Cardiothoracic Surgery Onze Lieve Vrouwe Gasthuis, Amsterdam, Oosterpark 9 1091 AC Amsterdam, The Netherlands, Phone: +31-(0)6-5799-3488, E-mail: t.kemper@me.com.; Depa

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2015