Bubbles in the skin microcirculation underlying cutis marmorata in decompression sickness: Preliminary observations

Area of Science:

• Diving Medicine
• Physiology
• Ultrasound Imaging

Background:

• Cutaneous decompression sickness (DCS), presenting as cutis marmorata, is common.
• Pathophysiology debated: local bubble formation, venous bubble arterialization via shunts, or cerebral effects.
• Existing hypotheses lack direct in-vivo evidence in affected skin.

Observation:

• Ultrasound examination of skin in four divers with cutis marmorata was performed 4-5.5 hours post-rash.
• Numerous small bubbles were visualized within the skin microvasculature of affected areas.
• No bubbles were detected in adjacent normal skin regions.

Findings:

• All four divers with cutis marmorata had a significant right-to-left shunt (RLS).
• Direct visualization of bubbles in the skin microvasculature supports local bubble formation or arterialized bubble amplification.
• This is the first report of in-vivo bubble detection in cutis marmorata.

Implications:

• Findings support hypotheses involving local bubble formation and venous bubble arterialization in DCS pathophysiology.
• Ultrasound is a valuable tool for further investigation of DCS.
• Understanding bubble dynamics in cutaneous DCS can refine treatment and prevention strategies.