Description

A 32-year-old scuba diver was admitted to the emergency department for distinct cutaneous lesions. Following an uneventful dive, his peers suspected of several lesions over his body pertaining to decompression sickness (DCS). After his initial assessment, he was referred to the underwater and hyperbaric medicine department for consultation.

The patient was a senior diver and denied to experience any diving accident before. On that cold day, he completed his 45 min dive to 20 m with a dry diving suit. Except for a sensation of discomfort on descent, his diving profile was unremarkable. On examination, he had multiple linear lesions located over his shoulders, upper arms, abdomen and his back, appearing in various colours of bruising; dark yellow, yellow brown and dark purple (figures 1 and 2). Neurological sign and symptoms pertaining to DCS were absent. The patient was diagnosed as dry suit squeeze.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

Linear lesions located over the shoulders and upper arms.

• Download figure
• Open in new tab
• Download powerpoint

Figure 2

Linear lesions located over the shoulders, upper arm and abdomen.

Dry diving suits, compared with the wet ones, have the advantages of a superior thermal protection owing to an air-filled layer between the skin and the suit. However, during descent, this layer, unless inflated with additional gas will squeeze and cause progressive discomfort and pain.1 Further persistence in such a dive may result in the bruising of the affected skin areas. Recognising this condition helps differentiate these lesions from other scuba-diving-related cutaneous manifestations, cutis marmorata2 being the most common form, and avoids unnecessary treatment.