hundreds of nematocysts. Given the number of coelenterates that inhabit the oceans of the world and the
cross-reactivity of antigens, it is likely that etiologic organisms are numerous.
A swimmer who encounters the stinging forms usually complains of cutaneous discomfort soon after
contact, often while in the water or soon after exiting. Application of fresh water may intensify the sting. The
eruption occurs a few minutes to 12 hours after bathing and consists of erythematous and intensely pruritic
wheals, vesicles, or papules that persist for 2 to 14 days and then involute spontaneously. When a bathing suit
has been worn by a woman, the areas commonly involved include the buttocks, genital region, and breasts. A
person at the water's surface (commonly a person who surfaces after a dive) may suffer stings to the exposed
neck, particularly if there has been recent motorboat activity in the vicinity, which may disturb and fragment
the causative jellyfish. Nematocysts adherent to scalp hair may sting the neck as the hair hangs down.
Coalescence indicates a large inoculum. Individual lesions resemble insect bites. Surfers develop lesions on
areas that contact the surfboard (chest and anterior abdomen). The rash may also be seen under bathing caps
and swim fins or along the edge of the cuffs of wet suits, tee-shirts, or "stinger suits." In children with
extensive eruptions, fever is common. Other symptoms can include headache, chills, fatigue and malaise,
vomiting, conjunctivitis, and urethritis. Itching is often pronounced at night and awakens the victim from
sleep. Burnett and Burnett reported blurred vision and left arm weakness in a teenager stung by adult Linuche.
Persons who note a stinging sensation during the primary contact while still in the water may have a higher
incidence of previous sensitization to the antigen or antigens. Persons who wear clothing that has been
contaminated with the larvae may suffer recurrent reactions. Prior sensitization may precede prolonged (up to
6 weeks) reactions (rash and pruritus).
Elevated IgG levels specific for Linuche unguiculata can be measured by ELISA in the sera of patients
who have suffered from seabather's eruption. The extent of the cutaneous eruption or sting severity appears to
correlate with the antibody titer. In an evaluation of southeast Florida victims envenomed by L. unguiculata,
histopathologic examination of inflammatory papules demonstrated superficial and deep perivascular and
intersitital infiltrate consisting of lymphocytes, neutrophils, and eosinophils.
Field management is identical to that for any coelenterate sting (see above), with the empirical
observation that topical papain may be more effective as an initial decontaminant than vinegar, isopropyl
alcohol, or other substances. This may be more effective if applied with a mildly abrasive scrub pad. On the
basis of anecdotal reports, this approach appears to be effective field therapy for seabather's eruption. Whether
the pain relief is due to nematocyst inactivation or counter-irritation is not yet known. Substances that are felt
to be ineffective include hydrogen peroxide, garlic, antifungal spray, anti-head lice medication, petroleum
distillates, fingernail polish, and citrus juice.
The skin eruption is self-limited and usually remits within 10 days. However, in a severe envenomation, the
rash may persist for up to four weeks and leave atrophic scars. Further treatment is palliative and consists of
calamine lotion with 1% menthol. Because the lesions rarely extend into the dermis, a potent topical
corticosteroid may be helpful in mild cases, but benefit is not invariably attained. In a more severe case, an
oral or parenteral antihistamine or systemic corticosteroid may be used. A thorough soap and water scrub (not
a casual rinse) on leaving the water provides partial prophylaxis. Avoidance logically includes advice to ocean
bathe in abbreviated swimwear, to maintain tightly occlusive cuffs on dive skins and wet suits, to change
swimwear as soon as possible after leaving the water, and to use caution during high season for L. unguiculata
(April to July off south Florida) or E. lineata (August to November off Long Island) and when there are
strong onshore winds. Swimwear worn and suspected to be contaminated with nematocysts should be washed
in detergent and fresh water and dried before wearing.
As mentioned previously in the chapter, current research is directed at a specific topical jellyfish sting
inhibitor. The first such product to be commercialized is Safe Sea ("jellyfish safe sun block") by Nidaria
Technology Ltd. DermaShield (Benchmark Enterprises, Salt Lake City, Utah) is a barrier topical formulation
that contains lanolin, aloe vera, and vitamin E. According to the manufacturer, this chemically inert (1-vinyl-
2-pyrrolidione) protectant is hydrophobic (dimethicone and stearic acid) and does not wash off, but is shed as
the epithelium sloughs naturally. It has been reported anecdotally by ocean bathers to protect against the
agents of seabather's eruption. To this author's knowledge, no prospective evaluation of the use of
DermaShield to protect against any coelenterate stings has been published. Smerbeck RV et al were assigned
