Flood & Skin Diseases

The flooding in December 2021 in Malaysia has affected 8 states across the country, with at least 48 casualties and 5 missing. More than tens of thousands of residents had to be evacuated from their homes and seek shelters during this unexpected natural disaster.

Image Credits: Time Magazine

The occurence of flood is due to the overflow of water expansion from hydrometeorological and geophysical disasters. Flood is one of the most common catastrophes in the world, which resulted in environmental and healthcare-related consequences including water and food contamination, chemical hazards, spreading of infectious and water-borne diseases, direct injuries, and psychological health disturbances. Complications such as flood-related skin diseases can also occur due to prolonged exposure to contaminated water and unhygienic conditions during floods. Flood-related skin diseases will be categorized into 5 groups as listed below: 

(i) Inflammatory skin diseases (e.g. irritant contact dermatitis)

(ii) Skin infections (e.g. fungal and bacterial infections)

(iii) Traumatic skin diseases

(iv) Insect bite reaction

(v) Psycho-emotion aggravated primary skin diseases

Inflammatory Skin Disease

Irritant contact dermatitis

Image Credits: DermNet NZ and MSD Manuals

Irritant contact dermatitis is a common non-allergic skin inflammation. This is caused by penetration of chemicals or physical irritants on the skin barrier, which damages the skin surface faster than the skin can repair. Flooding irritation usually occurs on the hand and foot area. Common irritants include pesticides, bleach, detergents etc from households or industries. People will usually experience redness, burning, stinging, soreness on the site of contact with irritants. Irritant contact dermatitis causes more pain than itching, and symptoms normally decrease in intensity after 1 or 2 days after there is no more exposure to the irritant.

Treatment & Prevention:

1. Irritant contact dermatitis is prevented by ideally avoiding all potential irritants. If contact does occur, you should wash off the substance immediately using soap and water.
2. Gloves and protective clothing can be helpful if there is risk of ongoing exposure.
3. You can apply barrier cream or gel that serves as a protective layer for your skin and apply moisturizer regularly to restore your skin’s outermost layer.
4. To relieve the itchy symptoms, topical corticosteroid can be applied on affected skin or by taking oral antihistamine.
5. Do make sure to maintain exposed skin dry to prevent secondary skin complications. Complications of repeated prolonged irritation may develop into secondary fungal and bacterial infection and secondary skin changes such as lichenification.

Infection

Fungal skin infection

Image Credits: Healthline and Wiley Online Library 

Fungal infections do not easily manifest in normal conditions, but stagnant water and damp air make it conductive for fungi to invade. Prolonged exposure to flood water can increase risk of fungal skin infection especially on the foot area if it is submerged under contaminated water. Symptoms of fungal skin infection include itching, scaling or flaking between the toes or fingers. These are signs of intertrigo, which is the inflammation of the skin. Fungal skin infection can be treated with antifungal ointments, creams and tablets.

Treatment & Prevention:

1. Good hygiene measures by keeping skin dry, especially areas between fingers, toes, underarms, groins and other parts where sweat can be easily trapped
2. Antifungal medications and ointments will be prescribed for those with itchy or flaky skin. Topical antifungal can be applied for at least 2 to 4 weeks to treat the fungal skin infection.
3. Avoid moist spaces and dry clothes completely to prevent fungal infections

Bacterial skin infection

Image Credit: Healthline

Our skin is a natural barrier to germs, but when the skin is broken due to cuts or grazes, the door is open for germs to enter our bodies. The risk of bacterial infection increases with open injuries and in people with underlying diseases including diabetes, chronic venous insufficiency, peripheral nerve impairment, immunosuppression. An infected wound is initially red and swelling, which will rapidly progress to vesicles or large blisters containing pus. Staphylococcal and Streptococcal organisms are the most common pathogens responsible for secondary bacterial infections. Wound infections associated with sea and fresh water contamination may also be due to Clostridium tetani (tetanus causing bacteria) and Clostridium perfringens (gas gangrene causing bacteria). If these infections are not treated properly, it may lead to long term disabilities, chronic wound or bone infection, and death.

Treatment:

1. For infected wounds, wound dressing is the most effective treatment (see below).
2. Antibiotic prophylaxis is often prescribed in cases of contaminated to dirty wounds with high risk of severe infections such as contaminated or penetrating wounds.
3. In particular cases of incomplete immunization or areas of low immunization coverage, tetanus antitoxin, toxoid, and immunoglobulin will be required.

Traumatic skin diseases

Image Credits: Healthline

Flood water can increase potential risks for traumatic injuries from concealed objects in the water including sharp objects, rocks, electrical hazards, and animals displaced from flood waters. The hands and feet are usually injured by cuts, lacerations, punctures.

First aid to prevent infection in wounds:

1. Clean your hands before and after touching a wound using antimicrobial soap and alcohol based hand sanitiser. This helps avoid infection.
2. Stop the bleeding if needed by applying gentle pressure with clean bandage or cloth, and elevate the wound until bleeding stops.
3. Clean the wound with clean running water. Apply antiseptic wash or correctly diluted antiseptic liquid.
4. Gently dry the skin around the wound.
5. Apply an antiseptic cream to kill remaining germs and bacteria.
6. Cover the wound with a bandage, rolled gauze held in place with surgical tape. Change the dressing regularly at least once a day or whenever the bandage becomes wet or dirty.
7. Get a tetanus shot if you have not had one in the past 5 years and the wound is deep or dirty.
8. If your wound will not stop bleeding and shows signs of infection including redness or swelling, seek immediate medical attention.

Insect bite reactions

Mosquitoes

Image Credits: Centers for Disease Control and Prevention (CDC)

Following flood, mosquito eggs laid in the soil results in a very large population of floodwater mosquitoes. Increased rainfall also increases hatching of mosquito eggs. As people spend more time cleaning their housing area after a flood, they may get bitten by mosquitoes. Mosquitoes' bite symptoms include puffy and reddish bumps appearing a few minutes after the bite, small blisters, dark spots that look like bruises.

Treatment & prevention:

1. Avoiding mosquito bite is the ideal prevention. You can do so by wearing long sleeved shirts and pants, using mosquito nets and insect repellents.
2. Use Environmental Protection Agency (EPA)-registered insect repellents containing either of the active ingredients: DEET, picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol, or 2-undecanone. Botanical insect repellents such as 5-15% citronella have protection time of less than 20 minutes, thus do not provide adequate protection as compared to DEET containing remedies.
3. Treat clothing and gear with 0.5% permethrin.
4. Remove standing water as mosquitoes could lay eggs. Once a week, you can empty and scrub, turn over, cover, or throw out items that hold water including tires, toys, pools, flower pot saucers, trash containers etc.
5. If bitten by mosquitoes, you can wash the area with soap and water, and apply an ice pack for 10 minutes to reduce swelling and itching. To relieve itching, you can use over the counter anti-itch or antihistamine cream in the pharmacy.

Fire ants

Image Credit: Healthline

Flood waters will not drown fire ants, but their colonies will emerge from the soil forming a loose ball, float and flow with the water until reaching a dry area or object they can crawl up on. Debris piles left from the flood waters are extremely inviting to fire ants as they seek for shelter until a mound can be re-established in the soil. Thus, ant colonies have to be dealt with quickly. Symptoms of a fire ant sting results in an intense burning sensation and white pustules will be formed at the sting site within 24 to 48 hours. If the bite is not kept clean, serious infection can occur, causing permanent scarring. In rare cases, some people may experience complications such as chest pain, nausea, dizziness, coma, or death.

Treatment & prevention:

1. Avoid contact with floating mats of fire ants
2. Spray insect repellent containing DEET onto your shoes and lower pants to prevent the ants from climbing onto your legs
3. Cleansing lesion with mild soap, applying ice pack, and avoid scratching to prevent secondary bacterial infection. Topical steroid and oral antihistamine can be used to relieve itchiness and pain. Other home remedies include ammonia, meat tenderizer (papain), tea tree oil, and camphor.

Psycho-emotional aggravated primary skin diseases

Image Credits: International Committee of the Red Cross

Disasters are unpredictable, which leaves victims in a state of shock. Home is a place of safety and security. Thus, the traumatic experiences disrupt the lives of victims as some have lost their family members, communities, homes, valuable assets and properties. Being in a denial state makes victims more vulnerable to feelings of stress, anxiety and different maladaptive reactions. Psychological stress and anxiety associated with a flooding event can lead to psycho-emotional aggravated primary skin diseases, which exacerbate pre-existing skin diseases such as atopic dermatitis, alopecia areata, psoriasis, vitiligo, and angioedema. Other factors that can also aggravate these skin diseases include poor hygienic conditions, inadequate medication compliance, and uncontrollable environmental factors. 

Ways to help flood victims in terms of mental support:

1. Counselors and social workers in training educate emotional supportive strategies and provide mental health services or psychological first aid (PFA) to flood victims
2. Provide financial and material support with proper distribution and access of resources such as food and water supply, school supplies, emergency house repair, clothes, beddings etc.
3. Telemedicine offered by DOC2US allow people to get virtual health services

A WORD FROM DOC2US

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Disclaimer: As a service to our users and general public, DOC2US provides health education contents. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.
 

Reference:

1. DermNet NZ. Irritant contact dermatitis. Available from https://dermnetnz.org/topics/irritant-contact-dermatitis
2. MSD Manual Consumer Version. Contact Dermatitis. Available from https://www.msdmanuals.com/home/skin-disorders/itching-and-dermatitis/contact-dermatitis
3. Wiley Online Library. Flood-related skin diseases: a literature review. Available from https://onlinelibrary.wiley.com/doi/10.1111/ijd.12064?saml_referrer
4. Mayo Clinic. Cuts and Scrapes: First Aid. Available from https://www.mayoclinic.org/first-aid/first-aid-cuts/basics/art-20056711
5. Centers for Disease Control and Prevention (CDC). Mosquitoes, Hurricanes, and Flooding. Available from https://www.cdc.gov/mosquitoes/mosquito-control/community/mosquitoes-and-hurricanes.html 
6. Pests in the Homes. Protect Yourself and Your Family from Fire Ants in a Flood. Available from https://pestsinthehome.extension.org/protect-yourself-and-your-family-from-fire-ants-in-a-flood/
7. PMC. Disaster and its impact on mental health: A narrative review. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857396/#:~:text=Disasters%20are%20mostly%20unpredictable%2C%20which,and%20other%20different%20maladaptive%20reactions.

Written By

Ms. Rosamund Koo Wei Xin

Reviewed By

Doc2us Medical Board