title: Cutis Marmorata skin decompression sickness is a manifestation of brainstem bubble embolization, not of local skin bubbles.
abstract: "Cutis Marmorata" skin symptoms after diving, most frequently in the form of an itching or painful cutaneous red-bluish discoloration are commonly regarded as a mild form of decompression sickness (DCS), and treated with oxygen inhalation without reverting to hyperbaric recompression treatment. It has been observed that the occurrence of Cutis Marmorata is frequently associated with the presence of a Patent Foramen Ovale (PFO) of the heart, and indeed, with a properly executed contrast echocardiographic technique, these patients have an almost 100% prevalence of PFO. Only occasionally, Cutis Marmorata is accompanied by other symptoms of DCS. These symptoms usually are in the form of visual distortions, vertigo, or mild, vague but generalized cerebral dysfunction (such as abnormal fatigue, clumsiness, concentration problems). The pathogenesis of these other manifestations is clearly emboligenic, and we hypothesize that Cutis Marmorata is also a manifestation of gas bubbles embolizing the brain stem: the site of autonomic nervous system regulation of skin blood vessel dilation and constriction. The consequences of this hypothesis are that Cutis Marmorata skin decompression sickness should no longer be considered a mild, innocuous form but rather a serious, neurological form and treated accordingly.
authors.affiliation: Centre for Hyperbaric Oxygen Therapy, Military Hospital Brussels, Belgium; Divers Alert Network (DAN) Europe Research Division, Roseto, Italy. Electronic address: peter.germonpre@eubs.org.
authors.forename: Peter
authors.initials: P
authors.lastname: Germonpre
authors.affiliation: Divers Alert Network (DAN) Europe Research Division, Roseto, Italy; Free University of Brussels Exercise and Environmental Physiology Laboratory, Brussels, Belgium.
authors.forename: Costantino
authors.initials: C
authors.lastname: Balestra
authors.affiliation: Centre for Hyperbaric Oxygen Therapy, Military Hospital Brussels, Belgium; Military Hospital Brussels, Cardiology Department, Brussels, Belgium.
authors.forename: Georges
authors.initials: G
authors.lastname: Obeid
authors.affiliation: Centre for Hyperbaric Oxygen Therapy, Military Hospital Brussels, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Caers
mesh_terms: D000818:Animals; D001341:Autonomic Nervous System; D001933:Brain Stem / Q000503:physiopathology*; D003665:Decompression Sickness / Q000150:complications / Q000503:physiopathology*; D004242:Diving / Q000009:adverse effects*; D004452:Echocardiography; D054092:Foramen Ovale, Patent / Q000150:complications / Q000503:physiopathology; D005740:Gases; D006801:Humans; D008953:Models, Anatomic; D012867:Skin / Q000503:physiopathology; D017445:Skin Diseases, Vascular / Q000150:complications / Q000503:physiopathology*; D013116:Spinal Cord / Q000502:physiology
chemical_list: D005740:Gases