Preventing Skin Infections. People who visit the tropics or developing regions are at risk for a number of skin disorders, including infections with fungi and other organisms. Cleanliness is essential. Bathing or showering is very beneficial, but if there are no facilities, simply washing with soap and water (even if cold) is still helpful. (Note: Taking multiple daily showers can remove protective oils and is not recommended.)

The skin should also be kept dry in order to prevent fungal infections, which thrive in damp, warm climates. Take special care to clean and keep dry certain skin areas where infections are most likely to occur. They include creases in the skin, the armpits, the groin, buttocks, and areas between the toes. Use talcum powder in these areas. Keep socks dry.

Precautions when Traveling to High Altitudes

Acute high altitude illness, or mountain sickness, can affect the brain (cerebral edema), the lungs (pulmonary edema), or both. Studies suggest that about 25% of mountain climbers experienced symptoms at 7,000 - 9,000 feet, and 42% of them have symptoms at 10,000 feet. Rapid ascension to high altitude, such as arrival by airplane, increases the risk. In most cases the condition is mild. Severe lack of oxygen at high altitudes, however, can cause serious problems in some people.

• Acute Mountain Sickness. This syndrome is defined as headache and at least one other relevant symptom when a person travels to about 8,000 feet. Other symptoms include upset stomach, dizziness, weakness, fatigue, and difficulty sleeping. It typically develops in the first 12 hours, and may resolve spontaneously if the traveler remains at the same altitude.
• High Altitude Cerebral Edema (HACE). HACE is a life-threatening brain swelling and the severe endpoint of acute mountain sickness. Symptoms include altered consciousness, loss of coordination, difficulty concentrating, and lethargy. In extreme cases, it can lead to coma and death.
• High Altitude Pulmonary Edema (HAPE). HAPE is the occurrence of fluid in the lungs, which in rare cases can be severe. In one study, about 75% of mountain climbers who ascended to 15,000 feet had some mild form of HAPE. Worse performance and a dry cough suggest the onset of HAPE. In extreme cases it can cause severe lung deterioration. (If it is going to develop at all, HAPE usually occurs in the first 2 days and rarely after 4 days at a given altitude.)

Luckily, symptoms of the more severe complications come on slowly, are easily recognized, and resolve when returning to a lower altitude.

Risk Factors for High Altitude Sickness. The risk for high altitude sickness is determined by certain characteristics: The rate at which a person ascends; the altitude reached; altitude during sleep; and individual physiology. People who live yearlong at low altitudes are much more likely to be ill at greater heights. Being physically stronger is not protective. Certain common conditions (heart disease, diabetes, hypertension, mild emphysema, and pregnancy) play no role in a person's risk for high altitude sickness. (Upper respiratory infections, however, do increase the risk for HAPE.)

Precautions against Mountain Sickness. Acclimatization by staying several days at increasingly higher altitudes is recommended. If you take high blood pressure medication, ask your doctor about increasing dosage if traveling to high altitudes. And anyone with a chronic medical condition should check with his or her doctor.

The following are some measures for preventing mountain sickness.

• As a rule, ascend no more than 1,000 feet per day at altitudes of 8,000 feet and above. Drink 6 - 8 glasses of water or juice a day and avoid alcohol.
• Stop climbing when experiencing any symptoms of acute mountain sickness. Descend if symptoms worsen. Also descend immediately if you have any symptoms of HACE or HAPE.
• Supplementary oxygen may be required for people who show signs of these conditions.
• People who are hiking to very high altitudes may consider an inflatable chamber (Gamow bag and others). Such devices enclose a person, and when pumped up they simulate air pressure found at low altitudes.

Medications Preventing and Managing Mountain Sickness. Some medications are available for prevention or treatment of acute mountain sickness.

• Ibuprofen (Advil) may be sufficient to manage headache associated with acute mountain sickness.
• Acetazolamide (Ak-Zol, Diamox) taken one day before, and continued during initial exposure to high altitude, can reduce symptoms of acute mountain sickness, improve exercise performance and sleep, and reduce muscle and body fat loss. It may be used to treat minor symptoms of acute mountain sickness, but if symptoms persist, the traveler should descend to a lower altitude.
• Dexamethasone (Decadron Phosphate, Dexasone, Hexadrol Phosphate) is used to treat acute mountain sickness and cerebral edema (HACE). Dexamethasone is not recommended for prevention, however, because of potentially dangerous side effects.
• Nifedipine (Adalat) is used to treat pulmonary edema (HAPE) and may be used for prevention in people who know they are at high risk for HAPE.
• Preventive use of salmeterol (Serevent), a long-acting inhaled asthma drug known as a beta-adrenergic agonist, may reduce the risk for HAPE by over 50%.

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Review Date: 01/30/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)