Dr Dharmakanta Kumbhakar
(drkdharmakanta@yahoo.com)
Most of the skin diseases during or after flood occur due to usage of damp and wet cloths, excessive exposure to contaminated water, prolonged immersion in water, friction, high humidity and unhygienic environment and Cutaneous manifestations of many flood-born communicable diseases.
Eczema is the most common skin problem during the period of the flood. Skin maceration at the web space(s) of the toes is chronic irritant dermatitis with secondary bacterial colonisation. Superficial fungal infections and bacterial skin infections are common. Most cases involve superficial fungal infections and bacterial skin infections. in most cases. Whenever skin integrity is breached, the normal flora colonising the skin can become a source of infection that causes cellulitis.
Trichophyton mentagrophytes (ringworm) infection among flood-affected people is directly related to the occlusion of the skin (causing low CO? tension on the skin surface) due to wet clothing. Schistosome cercaria is able to penetrate human skin and causes cercarial dermatitis, presenting with a skin rash. Mycobacterium marinum may form granulomatous infections with a sporotrichoid pattern. Skin abrasions, even superficial cuts, can provide a potential portal of entry for Clostridium tetani to cause tetanus. Rat bites can expose people to rare bacteria like Spirillum minus and Streptobacillus moniliformis, which are known to cause a type of skin infection called urticarial bacterial folliculitis.
Injuries to the feet from prolonged immersion in water or contact with dampness, in a range of environmental temperatures, may present as "immersion foot syndromes." Continuous immersion of the foot in water or mud of temperatures above 22°C for periods ranging from 2 to 10 days may cause tropical immersion foot, or "paddy foot". The erythema affects the dorsum of the foot but not the plantar surfaces. Papules, vesicles, or both may appear, sometimes with a haemorrhagic component. It can be prevented by 24-hour drying after each 48 hours of water exposure. Rapid-drying boots and socks may delay the onset of tropical immersion.
After one to three days of intermittent exposure to warm water or mud, Warm Water Immersion Foot, also known as "moon-boot syndrome," may occur, characterised by pain and tingling in the foot, thickened and severely wrinkled soles, and macerated changes on the sides of the foot. But they do not affect the dorsum. Shortly, however, thick portions of the sole begin to fissure and peel, shedding completely within 1 to 2 weeks. During this peeling, the stratum corneum may be more susceptible to infection via the fissures. It can be prevented by drying the feet for 6 to 8 hours (overnight) every day. Silicone grease applied to the entire foot or to the soles alone retards the development of warm water immersion foot.
Continuous immersion of the foot in water or mud below 15°C may cause skin maceration, along with infection at the web space(s) of the toes. This condition is called Trench Foot Skin Disease. Leptospirosis, Dengue Hemorrhagic Fever (DHF), meningococcal meningitis, typhoid fever and few viral haemorrhagic (VHF) fever may spread during and after flood which has skin manifestation (fever and skin rash).
Leptospirosis is a potentially serious, epidemic-prone bacterial infection transmitted directly from contaminated floodwater with rat urine. Transmission occurs through contact of the skin and mucous membranes with floodwater and damp soil contaminated with rodent urine. Those with open wounds have a higher risk of getting infected. Skin manifestations usually appear on the trunk and take the form of macules, papules, urticaria and petechiae. Erythema nodosum and Kawasaki syndrome are rare complications. Early in the disease, the skin is warm and flushed. Later in severe disease, jaundice and purpura can develop. Human cases of leptospirosis are diagnosed by serologic tests: microscopic agglutination test (MAT) or ELISAs. It can be prevented by a simple antibiotic prophylaxis-taking doxycycline 200 mg, one capsule once weekly.
The skin manifestations of DHF are caused by four types of dengue virus transmitted by A. aegypti mosquitoes are petechiae, purpura, and oozing from venipuncture and injection sites. More often, a morbilliform eruption begins on the third to fifth day on the inner surfaces of the upper arms, the lateral surface of the thorax, and in the lumbar area. The macular or scarlatiniform rash spreads to the face, neck, shoulders, and thorax. Pruritus can occur if the hands and feet are involved. In the case of dengue, skin eruptions appear in 80% of patients during the remission of fever. They may appear as centrifugal macular, maculopapular, scarlatiniform or petechial eruptions. The rash characteristically starts on the dorsum of hands and feet and spreads to the arms, legs, and torso, while the face is relatively spared. The eruption seen in dengue lasts two hours to several days.
As outbreaks of meningococcal meningitis, patients presenting with fever and rash may occur during floods. Here rash is characteristically petechial, small and irregular and is often raised with pale greyish vesicular centres. It is commonly located on the extremities and the trunk.
In case of typhoid fever, the rose spots appear as slightly raised, non-tender, pink papules that blanch on pressure. They usually appear in crops of 10 to 20 lesions and are often located between the nipple area and the umbilicus on the anterior trunk.
VHF, an acute illness due to infection by four viral families (Arenaviridae, Bunyaviridae, Filoviridae and Flaviviridae), may present with a skin rash. For patients with septicaemic plague, they may present with purpuric skin lesions, together with gangrene of acral regions, leading to the Black Death.
Never use wet and damp cloths. Use cloths after washing and drying in sunshine, once the flood is over. Stop prolonged immersion in water or contact with dampness. After exposure to water or mud, wash the feet with clean water, dry them and use antiseptic cream. One can use silicone grease on legs to avoid direct contact with floodwater. Never walk in floodwater on naked feet; use shoes. Drink pure water, wash your hands before eating, and protect yourself from mosquito bites. Wash your house, floor, walls and ceilings with antiseptic once the flood is over. Take the doctor's advice if you notice any skin problem.