Seabather's Eruption Research Articles

Aquatic Antagonists: Marine Rashes (Seabather's Eruption and Diver's Dermatitis).

When treating marine rashes, it is imperative to properly diagnose the root cause to guide appropriate treatment. Two of the most common rashes experienced after ocean contact are known colloquially as seabather's eruption and diver's dermatitis. In many cases, a thorough history and physical examination can aid in elucidating the responsible organism. Understanding the etiology of rashes obtained in marine environments can improve patient education on precautionary measures that can be taken to avoid exposure. Reasons for further research in this area include development of more effective treatments, as current therapies are limited to symptom management.

Marine and Other Aquatic Dermatoses.

Occupational and recreational aquatic activity predisposes our population to a wide variety of dermatoses. Sunburn, urticaria, jellyfish stings, and contact dermatitis to rubber equipment are common allergies that are encountered in the aquatic environment. Among the infections, tinea versicolor, intertrigo, and verruca vulgaris are widespread. Swimmer's itch may occur due to skin penetration by schistosome cercariae, while free-floating nematocysts of marine coelenterates may precipitate seabather's eruption. “Suit squeeze” due to cutaneous barotrauma and lymphoedematous peau d’orange due to decompression are rare, described entities. This review serves as a ready reckoner for Indian dermatologists and medical practitioners to identify and manage these conditions.

Seabather's eruption: report of fourteen cases.

Seabather's eruption is a papulo-pruritic dermatitis caused by the nematocysts of the larvae of the jellyfish Linuche unguiculata retained in the clothing fibers. Previously reported in Brazil, this work describes fourteen cases that occurred in the State of Santa Catarina, in southern Brazil. The new cases observed over a short period of time (the first half of January, 2012), at the height of the summer season, should alert health teams to possible epidemics on the coast of the state of Santa Catarina.

Seabather's eruption: report of case in northeast region of Brazil

Seabather's eruption is characterized by the occurrence of intensely itchy erythematous papules observed mainly in the region covered by swimwear. The dermatitis occurs due to the contact of planula larvae of scyphomedusae Linuche unguiculata with the skin. The swimsuit pressure triggers the action of the poisonous stinging structures carried by the larvae. The case described occurred in a child who, while bathing in the ocean waters of the Northeast coast of Bessa's Beach located in the city of Joao Pessoa, state of Paraiba, showed typical clinical signs of the disease. It was concluded that the report of the case showed clinical and therapeutic implications for doctors working in all of the Brazilian coastal areas.

Seabather's eruption: a clinical and epidemiological study of 38 cases in Santa Catarina State, Brazil

Seabather's eruption (SBE) is an intensely itchy, papule-erythematous dermatitis that occurs predominantly in regions of the body covered by bathing costumes, after exposure to marine water. The planulae larvae of Linuche unguiculata scyphomedusae (thimble jellyfish) are the etiologic agent of the dermatitis, which is frequent in waters of Caribbean, Gulf of Mexico and Florida. The authors report 38 cases of SBE in the State of Santa Catarina (Southern region of Brazil), with emphasis on their clinical and epidemiological aspects, such as profile of victim, topography of the papules and conditions predisposing to the accident.

Medical Illnesses and Injuries Encountered During Surfing

Surfing is an exciting sport enjoyed in many coastal communities around the globe. Participants are prone to various conditions ranging from acute injuries to conditions borne from chronic environmental exposure. Lacerations, contusions, sprains, and fractures are the common types of acute traumatic injury. Injury from the rider's own surfboard is the prevailing mechanism of injury. Interaction with marine animals may lead to injury through envenomation. Although jellyfish stings are common, no definitive treatment strategy has been proven most effective in dealing with such stings. Exposure to jellyfish and other nematocyst-containing larvae can cause a reaction known as seabather's eruption. Stingrays and coral reefs present further hazards to the surfboard rider. Infection of wounds is often seen and should be treated with fluoroquinolones or third-generation cephalosporins to cover Vibrio species, along with Staphylococcus and Streptococcus species. Otologic sequelae of surfing include auditory exostoses, ruptured tympanic membrane, and otitis externa.

A Randomized, Controlled Field Trial for the Prevention of Jellyfish Stings With a Topical Sting Inhibitor

Jellyfish stings are a common occurrence among ocean goers worldwide with an estimated 150 million envenomations annually. Fatalities and hospitalizations occur annually, particularly in the Indo-Pacific regions. A new topical jellyfish sting inhibitor based on the mucous coating of the clown fish prevents 85% of jellyfish stings in laboratory settings. The field effectiveness is unknown. The objective is to evaluate the field efficacy of the jellyfish sting inhibitor, Safe Sea. A double-blind, randomized, placebo-controlled trial occurred at the Dry Tortugas National Park, FL, USA and Sapodilla Cayes, Belize. Participants were healthy volunteers planning to snorkel for 30 to 45 minutes. Ten minutes prior to swimming, each participant was directly observed applying a blinded sample of Safe Sea (Nidaria Technology Ltd, Jordan Valley, Israel) to one side of their body and a blinded sample of Coppertone (Schering-Plough, Kenilworth, NJ, USA) to the contralateral side as placebo control. Masked 26 g samples of both Safe Sea SPF15 and Coppertone SPF15 were provided in identical containers to achieve 2 mg/cm(2) coverage. Sides were randomly chosen by participants. The incidence of jellyfish stings was the main outcome measure. This was assessed by participant interview and examination as subjects exited the water. A total of 82 observed water exposures occurred. Thirteen jellyfish stings occurred during the study period for a 16% incidence. Eleven jellyfish stings occurred with placebo, two with the sting inhibitor, resulting in a relative risk reduction of 82% (95% confidence interval: 21%-96%; p= 0.02). No seabather's eruption or side effects occurred. Safe Sea is a topical barrier cream effective at preventing >80% jellyfish stings under real-world conditions.

Holiday hazards: common stings from New World visits

An otherwise idyllic vacation can be abruptly marred by contact with stinging organisms. In addition to discomfort, stings from many organisms can have serious medical consequences. This review outlines three hazards commonly encountered by holiday makers to North America: jellyfish stings, seabather's eruption, and fire ant stings. Ocean bound travellers should be aware of the three medically important orders of free swimming jellyfish: the common jellyfish also referred to as ‘sea nettles’; the Portuguese Man‐o‐War (MOW) or ‘blue‐bottle’; and the box‐type (cubozoan) jellyfish which are commonly referred to as ‘sea wasps’. Common to all of these organisms is the nematocyst, a specialized, contact‐triggered stinging apparatus used by jellyfish to inject toxins into their prey.1 The common jellyfish, which consists of more than 200 species, has wide distribution and can range in size from less than 1 cm to over 100 feet. Clinically lesions develop 30–60 min after contact and present as a whip‐like, zigzag pattern (Fig. 1) of painful welts where the tentacles made contact with skin. They are primarily a nuisance; systemic symptoms rarely develop. When brave volunteers were experimentally stung with jellyfish nematocyst, pain, erythema and wheal developed within 3–4 min and resolved in 1–3 days. After 1–2 weeks, linear erythema, papulovesicles and pustules developed which had a histopathology identical to that of allergic contact dermatitis. These lesions resolve completely but often leave postinflammatory hyperpigmentation.2

Skin problems related to noninfectious coastal microorganisms

While there are a number of coastal microorganisms that can cause infections of the skin, there are many that can cause skin problems that are noninfectious in nature. From cyanobacterial dermatitis to skin problems related to dinoflagellates, to skin signs of ciguatera or scombroid fish poisonings, to “sea lice”/“seabather's eruption,” to “swimmer's itch,” this article attempts to separate these entities into distinct syndromes caused by a variety of bacteria, phytoplankton and zooplankton. Treatment and prevention of these diseases are also discussed.

Dermatologic Disorders of the Athlete

The most common injuries afflicting the athlete affect the skin. The list of sports-related dermatoses is vast and includes infections, inflammatory conditions, traumatic entities, environmental encounters, and neoplasms. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete. Infections probably cause the most disruption to individual and team activities. Herpes gladiatorum, tinea corporis gladiatorum, impetigo, and furunculosis are sometimes found in epidemic proportions in athletes. Vigilant surveillance and early treatment help teams avoid these epidemics. Fortunately, several recent studies suggest that pharmacotherapeutic prevention may be effective for some of these sports-related infections. Inflammatory cutaneous conditions may be banal or potentially life threatening as in the case of exercise-induced anaphylaxis. Athletes who develop exercise-induced anaphylaxis may prevent outbreaks by avoiding food before exercise and extreme temperatures while they exercise. Almost all sports enthusiasts are at risk of developing traumatic entities such as nail dystrophies, calluses and blisters. Other more unusual traumatic skin conditions, such as talon noire, jogger's nipples and mogul's palm, occur in specific sports. Several techniques and special clothing exist to help prevent traumatic skin conditions in athletes. Almost all athletes, to some degree, interact with the environment. Winter sport athletes may develop frostbite and swimmers in both fresh and saltwater may develop swimmer's itch or seabather's eruption, respectively. Swimmers with fair skin and light hair may also present with unusual green hair that results from the deposition of copper within the hair. Finally, athletes are at risk of developing both benign and malignant neoplasms. Hockey players, surfers, boxers and football players can develop athlete's nodules. Outdoor sports enthusiasts are at greater risk of developing melanoma and non-melanoma skin cancer. Athletes spend a great deal of time outdoors, typically during peak hours of ultraviolet exposure. The frequent use of sunscreens and protective clothing will decrease the athlete's sun exposure. It is critical that the sports physician recognises common and uncommon skin disorders of the athlete. Knowledge of the treatment and prevention of various sports-related dermatoses results in prompt and appropriate care of the athlete.

One Linuche mystery solved: All 3 stages of the coronate scyphomedusa Linuche unguiculata cause seabather's eruption

Background: Seabather's eruption (SBE) is a highly pruritic dermatosis affecting swimmers and divers in marine waters off Florida, in the Gulf of Mexico, and the Caribbean Sea. Its cause has been attributed to various organisms but recently to the larvae of the schyphomedusa, Linuche unguiculata. Objective: We attempted to determine whether immature and adult Linuche cause SBE. Methods: Episodes of SBE in the Cancun and Cozumel area of the Mexican Caribbean were evaluated during the season of high tourism (January-June). This time corresponds to the moments in the life cycle when the three swimming stages of L unguiculata—ephyrae, medusae, and larvae—can be sequentially observed. Our methods include (1) observations by divers, biologists, and students coinciding with stinging outbreaks and the onset of SBE; (2) serologic evaluation of individuals stung by L unguiculata; and (3) the demonstration of Linuche nematocysts on the affected skin. Results: All 3 swimming Linuche stages can cause SBE. Conclusion: The offending stages of Linuche can be identified by the cutaneous lesion's morphology and the time of year. (J Am Acad Dermatol 2001;44:624-8.)

Seabather's Eruption in Papua New Guinea

Seabather's Eruption in Papua New Guinea

Sea bather's eruption

Sea bather's eruption

The antibody response in Seabather's eruption

Thirty-six of 44 patients with seabather's eruption had specific IgG antibodies against Linuche unguilata (thimble jelly) medusae antigen. ELISA detected antibodies in serum stored for 10 years. The extent of the cutaneous eruption or sting severity was correlated with antibody titer. Antibodies were detected in patients acquiring the eruption in Florida, the Bahamas and Aruba, reflecting the habitat of these jellyfish. This serological assay can be useful to confirm the clinical diagnosis.

Seabather's eruption: Clinical, histologic, and immunologic features

Seabather's eruption (SE) is a highly pruritic eruption under swimwear that occurs after bathing in the ocean. Its cause has been unknown. Few data have been collected since the classic description by Sams in 1949. Our purpose was to describe the clinical and histopathologic findings in SE and to confirm the cause. Patients with a pruritic eruption that developed after swimming were seen within 1 week of onset. Skin biopsy specimens and sera were obtained in selected cases. Water samples taken from areas of active SE outbreaks were examined for a causative organism. Sera were tested by enzyme-linked immunosorbent assay for reactivity to this organism. In southeast Florida, during a 4-month period, 70 patients with SE were seen. Inflammatory papules and pruritus were noted within hours of exposure. Eruptions were maximal in areas covered by a bathing suit. Children were more likely than adults to have systemic symptoms. The average duration of the eruption and pruritus was 12.5 days, with recurrences in 4.3% of patients. Histopathologic examination revealed a superficial and deep perivascular and interstitial infiltrate consisting of lymphocytes, neutrophils, and eosinophils. Water samples contained many cnidarian larvae, later grown to maturity and identified as Linuche unguiculata (thimble jellyfish). Enzyme-linked immunosorbent assay demonstrated in patients' sera high IgG levels specific for L. unguiculata. SE is a severely pruritic marine dermatosis that resolves spontaneously within 2 weeks. Therapy is symptomatic but often ineffective. Sera from affected persons showed specific reactivity to L. unguiculata.

Clinical perspectives on seabather's eruption, also known as “sea lice”: Tomchik RS, Russell MT, Szmant AM, Black NA. JAMA. 1993; 269:1669–1672

Clinical perspectives on seabather's eruption, also known as “sea lice”: Tomchik RS, Russell MT, Szmant AM, Black NA. JAMA. 1993; 269:1669–1672

Seabather's Eruption

Seabather's eruption is an annoying pruritic dermatitis that appears on the areas covered by the bathing suit as an erythematous macular or papular dermatitis, with or without urticaria. It occurs sporadically in Florida, the Caribbean, and as far north as Bermuda. The cause is not known. We collected information in Nassau County, Long Island, New York, about cases of all types of water-related dermatitis reported by beach personnel, health providers, and affected swimmers from 1970 through 1991. Concurrently, we surveyed all Nassau County swimming waters, especially during the summer season (June through September), for the presence of organisms capable of causing dermatitis. In 1980 a sudden epidemic of a severe, unfamiliar dermatitis in ocean bathers prompted increased surveillance of cases and waters. Planula larvae of the phylum Cnidaria were collected from the ocean and beaches and inside bathing suits. They were examined, photographed, tested on healthy subjects, and observed in the laboratory for metamorphosis. Three outbreaks of seabather's eruption have occurred on Long Island since 1975. The first, in August 1975, affected a small number of swimmers on the eastern end of Long Island. In 1980 there were thousands of cases along the entire south shore of the island, and in 1990 there were hundreds in the same area. In nonepidemic years, five or fewer cases have been reported yearly. Surveillance for larvae revealed them to be present during the swimming season in epidemic years, but in nonepidemic years they did not appear until autumn, after the swimming season. Applying larvae to the skin of healthy subjects produced a dermatitis indistinguishable from seabather's eruption. All larvae metamorphosed in the laboratory to the adult sea anemone Edwardsiella lineata. Seabather's eruption, previously reported only as sporadic cases in southern climates, has occurred sporadically and in outbreaks 1000 miles north of most previously described cases. These Long Island episodes were probably caused by the planula larvae of E. lineata.

Seabather's eruption, or "seal lice": new findings and clinical implications.

Seabather's eruption, or "seal lice": new findings and clinical implications.

Clinical Perspectives on Seabather's Eruption, Also Known as 'Sea Lice'

Seabather's eruption is usually a benign clinical syndrome that resolves spontaneously, although severe symptoms and long-term sequelae have been identified. Recent research has implicated the larvae of a jellyfish, Linuche unguiculata, as the cause of this syndrome; confirmation by serological and experimental studies is pending. Clinical signs and symptoms are consistent with this etiology. Outbreaks occur when jellyfish larvae are transported to shore by ocean currents. Treatment is symptomatic and involves use of antihistamines and steroids.

Clinical perspectives on seabather's eruption, also known as 'sea lice'

Clinical perspectives on seabather's eruption, also known as 'sea lice'