Got An Itch?

Paddlers are confronted with common dermatology problems which range from minor annoyances to more potentially serious conditions. How to deal with these problems can be a little confusing sometimes because of treatments advocated by word of mouth, social media and online suggestions without good supporting clinical evidence. Needless to say, the main goal is to get back in the boat as soon as possible!

First and foremost besides rashguards, it goes without saying that sunscreen application using a good water repellent product is important. Although an SPF with a minimum of 30 is the way to go, inadequate applications reduce effectiveness and reapplication when necessary pays dividends. Also with the amount of exposure on the water, it is definitely worthwhile, especially for older paddlers to have a periodic screening for possible suspicious skin lesions. Without question early detection is critical especially when it comes to the possibility of melanoma.

Reef rash or dings when getting into or out of the canoe need early effective treatment. It is especially important when paddling in areas where the water is not the cleanest. Media discussion about the hazards encountered at places like Keʻehi Lagoon have definitely been exaggerated and has caused a lot of unnecessary concern. For example,  bacterial counts obtained recently at different Oahu locations indicated higher counts at Waikiki Beach than a thoroughly cleaned Keʻehi itself. The key, no matter where the location, is good initial and subsequent skin care to decrease the chance of infection and avoid unwanted down time.

What to do? Thereʻs no substitute for good vigorous cleaning with soap and water.

A dermatologist friend is an advocate of two small towels : One to bite on for the discomfort and a second to scrub the area very well to get rid of debris and contaminants from the water! Use of an antibacterial concentrate like Hibiclens, an OTC product, is good. A thorough flush with a 50% solution of hydrogen peroxide is helpful in particular for reef encounters.  Application of a 10% solution of povidine or a betadine solution has its advocates, but there is some evidence of a relationship to delayed healing because of its effect on white blood cells in traumatized tissue. Next comes the application of a topical antibiotic and subsequent occlusive dressings with daily changes that should result in a clean wound with a much reduced chance of secondary infection.  Paddling with a dressing in place doesnʻt work very well at times and needs to be avoided for a couple of days depending on the location and size of the wound. As things improve, the off the record advice  from some ER physicians is to add a little duct tape to keep things in place!

How about jellyfish stings from our Portuguese man-of-war and box jellyfish friends?

There are a lot of first aid remedies out there so we need to address some of the commonly heard recommendations (sorry, urinating on a sting has been shown to have no beneficial effect!). Two no-noʻs are trying to wash off the sting with fresh water (just discharges more nematocysts) and applying cold compresses or ice (actually makes the pain worse). What to do? Rinse off with sea water and carefully remove any residual tentacles. Vinegar compresses help prevent further discharge and helps the pain. A paste of meat tenderizer is less effective. Recently a local researcher has extensively studied the problem with good data and  has developed a product called Sting No More which appears to be more helpful than vinegar. After the initial treatment, hot water immersion or compresses reduces the pain along with analgesics. Some individuals can experience allergy symptoms so benadryl, and lastly, a trip to a physician may be needed.

Peter Caldwell