RESUMO
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 ï¬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 ï¬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.