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Skin - Miscellaneous

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - Every time I go diving I seem to pick up a bad dose of Athlete's foot. At least I think that's what it is. The skin between my toes flakes off and I get quite painful cracks developing, underneath my toes and on my heels as well. Am I right, and is there anything I can do to stop it happening? It's almost making me want to stop getting wet!

A - I’m not sure why this condition is called Athlete’s foot, as most people I’ve seen with it are as far from athletic as England are from winning the World Cup (there could be a lot of egg on my face next issue). Tinea pedis or ringworm of the foot is a classic fungal infection of moist skin folds. It’s essentially a trivial condition, but if it goes untreated, the breakdown in skin integrity can lead to secondary bacterial infections which can get really nasty. The fungus that causes it lives on wet towels, swimming pool floors and footwear (including dive boots). I suspect your boots are probably acting as a perfect damp incubator for the fungus, so every time you put them on you’re inoculating yourself with a fresh dose. My suggestions: firstly, get the condition treated. Try over-the-counter antifungal cream initially, and if it persists (it often takes months to clear completely) you can get oral antifungals and antibiotics from your GP. Get your boots thoroughly disinfected and cleaned, let them dry out completely, and see if that helps prevent reinfection. Make sure you always dry between your toes after your feet get wet, but don’t use the same towel for tackling the groin – jock itch is particularly embarrassing. Wear flip-flops or sandals in public showers or swimming pools to stop picking up new bugs. Sometimes antifungal powders help to dry the area and prevent infection, so whack some on if all else fails (be warned though, it tends to cake and leave all sorts of squidgy cheese-smelling deposits in your socks). Ripe!

Q - I'm in my 60's and over the years have developed deep laughter lines and creases around my brow and eyes. They say laughter keeps you young, but annoyingly it also causes my mask to leak. I've tried a couple of different brands but there's always a trickle that gradually fills up my mask. It probably doesn't help that I've got a fearsome set of whiskers too. Any tips on how to stop this?

A - The single page website of the BLF (Beard Liberation Front) seems to suggest the organization is now sadly defunct. Which is a shame, since previous “Beard of the Year” winners have largely been cricketers who’ve gone on to do great things – Flintoff and Panesar, to name but two. What you need, however, is a prominent and fulsome silicon skirt on your mask. This, coupled with judicious gobs of Vaseline or silicone grease in the areas that typically leak, should halt the ingress of water. If not, then it’s probably worth trying a few other models (change sizes as well as brands) as there’s no one-size-fits-all in the mask world. Over-tightening is a common culprit – get your local dive shop to take you through correct sizing and fitting. While you’re there, you could investigate purge masks, which allow water out through a one-way valve, thus easing the arduous task of constant mask clearing. If all else fails, one solution remains: targeted depilation of the immediate under-nose area, which permits a tight seal and shouldn’t disrupt your hirsute visage to any noticeable degree.

Q - Just wanted some information, could you help please? I am currently half way through a trimix course and I've got a tattoo planned on my back. Is it still ok to dive with a tattoo and if not how long would I need to leave it? Thanks so much.

A - Beckham-style wings? “APNOEA” in bold Cyrillic up your spine? A pod of dolphins leaping playfully across your trapezii? I’ve seen plenty of tats in the course of doing daily dive medicals, some pretty cool, others just unfathomable. Freshly tattoed skin is quite raw and susceptible to infection, so you need to wait until it’s fully healed up. How long that is depends on your individual metabolism and immune system – it probably takes at least a week or two though. Submerging the new tattoo too early in water might also cause the colours to fade or leech out completely. Then you’d have to go through all the pain again. Rather you than me!

Q - My wife is 49 years old and is in general good health although she takes ACE-inhibitors for high blood pressure. She has a dive medical every year and really enjoys her diving, and we have been fortunate enough to travel as far as Australia to dive in quite exotic locations as well as here in the UK. She now has about 130 dives but in the last eighteen months she has suffered terrible dry skin on her feet that cracks and splits, becoming quite painful, when we go on our diving jaunts and she dives for more than a couple of days. This has now started to spread to her fingertips. Although she can be in great pain and hobbles out of the airport arrivals on our return, she loves diving and would physically assault somebody who would suggest giving it up. We have tried all sorts of barrier creams, plastic bags on her feet before putting on dive boots and in case it is a combination of salt water immersion reacting with the dive boot materials/glue she has tried full foot fins. The pharmacist in El Gouna believed the problem to be immersion in salt water - can you suggest any possible remedy to prevent or even delay the problem?

A - A tough one this, as you seem to have tried everything sensible. So we are in the realms of exclusion. To see if it is the salt water, why not spend your next holidays in Leicestershire. Go for several dives at Stoney Cove. If, with the same kit, she has absolutely no problems, then you know it is the salt water. If she gets the same, then if could be the water/boot/fin angle. And so on, you could replace each item with an alternate to find a cause. However, if none of the above work, then I suggest moisturizer. Not a little bit, but shed loads, worked into the skin at the beginning and end of each day. That’s all that can prevent skin drying and cracking. A couple of the better ones are Unguentum Merck or Diprobase. You can get them at certain pharmacies. Good luck. And not being one for uneccessary violence, how could I suggest she not dives.

N.B. if I am being particularly thick and someone has any advice on this that does not involve the words Tea and Tree, please let me know and I will pass it on.

Q - Early last year I had a case of acute dermatitis, basically, my whole body was covered with the exception of hands, feet and face. After much application of various creams, lotions etc. I healed although it took 2 weeks. I have recently taken up scuba diving (May this year). All my dives to date have been in a semi-dry suit with hood. During my last two week-ends of diving I noticed a rash forming on my neck, underarms and groin area. These were itchy and I consulted my doctor. He said the dermatitis had returned, probably due to the chaffing of the hood combined with salt water. The rash on my neck has subsided, although the other places are still there but not quite as bad as before. I am now in the process of changing from a semi-dry suit to a dry suit. Is there anything on the market today that I can buy to minimise the effect of the chaffing/salt water? My doctor said I could possibly use petroleum jelly as a barrier. Would this work?

A - Ah back to my old friend the tub of Vaseline again. If you are about to switch to a dry suit then your problem is going to solve itself. As you can wear normal clothes underneath, that will spare your groin and armpits. That just leaves your neck and wrists. And if it’s chafing you hate, may I recommend a crushed neoprene suit with neoprene on the cuffs and collars. This is a lot softer on those body parts, and with my joyous O3 brand you use copious amounts of aqueous jelly to slip them over, thus creating a nice barrier to prevent the chafing.

Problem sorted. Sort of, there’s still the hood to think of and that can cause problems on your head area. A good barrier here is maybe some light cotton. So get down your local Puff Daddy franchise and purchase a do- rag, direct from the Crips in Compton, L.A. Put it on, hood over, and babba-ding, the God of Bling, no dermatitis.

Q - We are on a diving holiday in Sharm and my poor daughter has got suncream lotion in her eyes. She has bathed them in cold water but they are still burning after about 2 hours. The name of the suncream lotion is CALYPSO SPF 35 ULTRA HIGHT PROTECTION LOTION is there anything that you can suggest that I can do. She is 16yrs old.

A - Poor little thing. It takes ages to persuade kids to apply this stuff, and when they finally get the point, this happens. Mind you it's normally me putting it into my child's eyes. "Sorry Tom, you moved your head as I was putting it on your nose", lies Daddy as he was staring at the women's beach volleyball final, Sweden vs Brazil at the crucial time of application.

In these situations, when the water doesn't get rid of all the pain, use steroid eye drops. Predsol is one brand I like, but it's scrip only, so either go prepared, or run like hell to a pharmacy if there's one close. 2-3 drops 3 hourly will keep the tears at bay.

Q - I went to my doctors the day before I flew to Egypt at the end of September. I had painful lumps under both arms and quite a bad head cold at the time. They were diagnosed as abscesses and was told that they would probably come to a head, which luckily they didn't. I was prescribed antibiotics and they did almost but not fully disappear. I still had small lumps under the skin on one arm. I was told that I could dive once I had finished the course in Sharm. I had a week of fantastic diving then on the last day the lumps reappeared. I rang my doctor as soon as I could when I got home. One arm has cleared up completely, but under the other I have what looks like a tendon or gland that is visable beneath the skin. It is painful if I lift anything too heavy or stretch my arm up too much. I have been referred to the local hospital but am waiting for an appointment. Can I still dive with this as I was told that I cant with any swelling? I look forward to hearing from you.

A - Good news. You can dive if you want.

There is no problem with what you have as regards to all the usual diving medical factors. It's just a question of how you take the pain. It can be bloody painful, having a throbbing red pussy swelling under your arm. The neoprene will rub. The BCD will too. But diving won't worsen it and the salt water may even improve it. Armpits are a notoriously good breeding ground for abscesses. Lots of hair follicles, sweat and friction. A bit of shaving if you're not German and there's the causes. It would be pertinent to check for diabetes as this can make them frequent after adolescence. If your sugars are fine then dive away and in time they will get better, making the whole experience less painful.

(other dive medical questions)


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