Rainy Days Skin Blues

The rainy days have come upon us with a vengeance. The rains and its inevitable partner, the floods, present the skin with its own myriad of problems.

The skin is a wonderfully dynamic organ, quickly responding and adjusting to changes in the environment: excessive heat, sun and sweat in the summer, daily exposure to dust, smoke and soot, and dampness and soaking, during the wet season. The rainy days present the skin, particularly the feet, with the problem of prolonged soaking in water. Compound this with the fact that it is not water of the bottled variety but instead a malevolent mixture of bacteria, fungi, toxic chemicals and human and animal waste that soak or skin.

Soaked skin, particularly of the feet and legs, is prone to problems during the rainy season because of the following:

• The skin of the palms and soles, although thick, are also dry and has a low lipid/fat content. Naturally occurring lipids make up an integral part of the skin barrier, and this relative lipid deficiency renders the soles more prone to injury from soaking, since water causes further lipid removal. As such, soaking from floodwaters further depletes the barrier capacity of the skin and makes it susceptible to injury.
  
  
• The skin becomes hyper/over hydrated or water-logged. In this state, a parameter called relative humidity approaches 100%, resulting in rapid growth of bacteria producing thriving populations in a short period of time. This is made worse by the warm, occlusive “kulong/kulob” condition inside the shoes hence trapping the dirty floodwaters within the footwear and socks. It is common to find fecal coliforms ( bacteria indicating contamination from human waste) present in polluted water. In fact, health experts use the presence of these bacteria as an effective predictor of skin disease, even more effectively than gastrointestinal disease. Trench foot, mentioned in the annals of wartime history, was a disabling foot infection, brought about by the combination of soaking in wet trenches and constrictive footwear. It is written that it was a common problem among the US troops in the Vietnam war sometimes making the barefooted Vietcong more effective in the warm, wet tropical jungles. Aside from th he contaminated rainwater, other microbial sources include resident skin microorganisms normally found in areas like the toe webs, which harbor gram negative bacteria and yeast, which may overgrow and produce disabling foot infections.
  
  
• Wading in floodwaters with closed footwear may compound the problem if water is allowed to seep in. This allows increased contact of skin with the dirty floodwaters, as well as providing the moist and warm environment conducive to microbial growth. Studies have proven that absorption of water pollutants through the skin is enhanced under these conditions, increasing the risk of contact allergies, skin irritation, and absorption of toxic substances so prevalent in the present- day environment.
  
  
• Soaked skin leads to maceration. This is what the skin looks like when you spend too much time in the water and your skin becomes soft, white and wrinkled. Skin like this is prone to injury and blistering, specially if subjected to mechanical insult such as friction from shoes and socks, as occurs when wading through water or walking in soggy footwear. Needless to say, blistering opens the skin to the easy entry of microbial intruders and toxic substances.
  
  
• As you walk through rainwater or boldly wade through the floods, you are unable to see what you are going to step on. This puts you in obvious jeopardy from punctures and lacerations from sharp objects on your path. These wounds require immediate attention and prompt anti-tetanus measures. Prevention of skin injury under rainy conditions is as simple as avoiding getting our feet wet. Very often however, we have no choice in the matter as we have to go to school/work, and are at the mercy of the miserable state of the city’s drainage and garbage disposal system.

Here are some useful tips to keep in mind during the rainy days:

• Wear waterproof footwear when you have to wade in the floods. High cut boots are a good choice but make sure dirty water does not seep into them. Be sure to soap, rinse and dry dirty footwear thoroughly before wearing them again. Do the same to your feet.
  
  
• Bring an extra pair of dry footwear and socks in a waterproof bag. After washing soaked skin with an antibacterial soap and thoroughly drying your feet, specially between the toes, change into dry footwear.
  
  
• Do not brave the floodwaters if you have open wounds, existing skin infections or eczema, or have conditions which impair sensation in the limbs ( such as diabetes, leprosy, or stroke).
  
  
• Cuts, puncture wounds or lacerations require immediate medical attention. Anti-tetanus prophylaxis and antibiotic therapy are also usually required.
  
  
• Avoid obviously dirty areas that probably contain hidden hazards which may cause injury. Aside from skin injury, the rainy days may bring serious, life-threatening infections such as the rat-borne leptospirosis and mosquito-borne dengue fever.
  
  
• Dispose of your garbage and (human) wastes properly. As the slogan goes … “ ang basurang tinapon mo … babalik din sa iyo…”
  
  
• Examine your feet well. If after having been exposed, you develop wounds or lesions which become red, swollen and painful, more importantly those accompanied by fever or swollen lymph nodes (kulani), please seek immediate medical attention. A duly-accredited dermatologist will be able to help you with such a problem. Always remember that a serious disabling infection can result from exposure to polluted floodwaters if not treated promptly.