Case and research letters
Jellyfish Sting or Tattoo?
Medusa, ¿picadura o tatuaje?
C. Abellaneda
, R. Navarra, M.T. Martín-Urda, M. Gómez
Autor para correspondencia
Servicio de Dermatología, Hospital Municipal de Badalona, Barcelona, Spain
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"tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "243" "paginaFinal" => "244" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. Abellaneda, R. Navarra, M.T. Martín-Urda, M. Gómez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "Abellaneda" "email" => array:1 [ 0 => "cabellaneda@comb.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Navarra" ] 2 => array:2 [ "nombre" => "M.T." "apellidos" => "Martín-Urda" ] 3 => array:2 [ "nombre" => "M." "apellidos" => "Gómez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Municipal de Badalona, Barcelona, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Medusa, ¿picadura o tatuaje?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 75707 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Inflammatory plaque on the leg in the shape of the jellyfish that caused the sting.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Jellyfish are marine invertebrates. They are divided into 4 groups: Hydrozoa (e.g., the Portuguese man-of-war), Scyphozoa (true jellyfish), Cubozoa (e.g., <span class="elsevierStyleItalic">Chironex fleckeri</span> or the sea wasp, considered the most toxic), and Anthozoa (sea anemones and corals).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Jellyfish are the main cause of marine envenomation. Their tentacles have stinging cells, or nematocysts, which they use to capture prey and to defend themselves. These cells contain a capsule with a thread that injects the venom on contact with the prey. The toxicity of the jellyfish sting varies according to the species: most jellyfish stings cause a painful burning sensation but the symptoms are usually short-lasting. However, bathers are advised to leave the water immediately because of the risk of anaphylactic shock and drowning.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 46-year-old woman with no relevant personal history who presented with a skin lesion on the right leg that had appeared 24<span class="elsevierStyleHsp" style=""></span>hours earlier after bathing in the sea. The patient stated that the symptoms had begun as a sharp burning pain and within minutes the signs of inflammation had appeared. She came to the clinic because the symptoms were progressively worsening.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed confluent erythematous papules in the shape of a jellyfish and a slight inflammation of the surrounding and underlying tissue (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The rest of the physical examination was normal. With an initial diagnosis of uncomplicated jellyfish sting, moderately potent corticosteroid cream and oral antihistamines were prescribed. However, the inflammation continued to progress until it caused secondary cellulitis covering almost the entire leg, making it necessary to prescribe systemic antibiotics and anti-inflammatory drugs. After 15 days the inflammation had resolved, leaving a slight residual hyperpigmentation that disappeared spontaneously over the following months.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Reactions that occur after jellyfish envenomation are divided into 3 groups: immediate allergic reactions, immediate toxic reactions, and delayed allergic reactions.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Death from stinging occurs through a hypersensitivity mechanism or through the effect of several toxins on the cardiovascular or respiratory systems or on the liver.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Immediate local reactions are characterized by burning and itching of varying intensity according to the species of jellyfish that caused the sting. Involvement of surrounding soft tissue is common. The disease frequently presents as whiplash-like erythematous papules and papulovesicular lesions.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Vascular reactions (ischemia from vasospasm and thrombophlebitis of the underlying vessels) and regional lymph node reactions (inflammation of locoregional lymph nodes) have also been reported.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Other less commonly reported reactions include angioedema, recurrent reactions, contact dermatitis, and papular urticaria.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Delayed and persistent reactions, though little known, are not uncommon.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Medical treatment depends on the type of reaction. Patients with uncomplicated skin reactions are treated symptomatically with topical corticosteroids and oral antihistamines and show a good response in a few days.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The most important advice for the first-aid management of jellyfish envenomation is to take measures to avoid release of the venom toxins: to wash the area with sea water rather than fresh water, to apply ice in packs rather than directly, to avoid rubbing the affected area, and to avoid applying urine or alcoholic drinks, which can change the pH and activate the nematocysts. Depending on the species of jellyfish that causes the sting, it can be useful to apply vinegar, a 1:1 aqueous solution of sodium bicarbonate, or a saturated solution of magnesium sulfate in a solution of sodium chloride.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Jellyfish sting reactions are very common on the Spanish coast in summer. Therefore, although these reactions tend to be local and short-lasting, we consider it important to know how to deal with them and to be aware of the less common reactions in order to diagnose them correctly and provide early treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Abellaneda C, et al. Medusa, ¿picadura o tatuaje? Actas Dermosifiliogr. 2012;103:243–4.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 713 "Ancho" => 950 "Tamanyo" => 75707 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Inflammatory plaque on the leg in the shape of the jellyfish that caused the sting.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Cheng D, Dattaro JA, Yakobi R. Jellyfish stings. emedicine. [Consulted 29.04.10]. Available at: <a class="elsevierStyleInterRef" href="http://www.emedicine.com/derm,/topic199.htm">http://www.emedicine.com/derm,/topic199.htm</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Sintuu C, Richard AJ. Coelenterate and jellyfish envenomations. emedicine. [Consulted 29.04.10]. Available at: <a class="elsevierStyleInterRef" href="http://www.emedicine.com/emerg,/topic199.htm">http://www.emedicine.com/emerg,/topic199.htm</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Jellyfish envenomation syndromes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.W. Burnett" 1 => "G.J. Calton" 2 => "H.W. Burnett" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1986" "volumen" => "14" "paginaInicial" => "100" "paginaFinal" => "106" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2869072" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed and persistent cutaneous reactions to coelenterates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.M. Reed" 1 => "B.R. Bronstein" 2 => "H.P. Baden" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Dermatol" "fecha" => "1984" "volumen" => "10" "paginaInicial" => "462" "paginaFinal" => "466" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6144703" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delayed cutaneous reaction to jellyfish" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Veraldi" 1 => "C. Carrera" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "In J Dermatol" "fecha" => "2000" "volumen" => "39" "paginaInicial" => "28" "paginaFinal" => "29" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010300000003/v1_201304241257/S1578219012001102/v1_201304241257/en/main.assets" "Apartado" => array:4 [ "identificador" => "6169" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Cases and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010300000003/v1_201304241257/S1578219012001102/v1_201304241257/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012001102?idApp=UINPBA000044" ]
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| 2019 Abril | 4 | 52 | 56 |
| 2019 Marzo | 4 | 9 | 13 |
| 2019 Febrero | 0 | 11 | 11 |
| 2019 Enero | 4 | 8 | 12 |
| 2018 Diciembre | 2 | 0 | 2 |
| 2018 Noviembre | 3 | 0 | 3 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 3 | 3 | 6 |
| 2018 Agosto | 0 | 7 | 7 |
| 2018 Julio | 0 | 8 | 8 |
| 2018 Mayo | 0 | 5 | 5 |
| 2018 Abril | 0 | 2 | 2 |
| 2018 Marzo | 8 | 2 | 10 |
| 2018 Febrero | 92 | 3 | 95 |
| 2018 Enero | 125 | 13 | 138 |
| 2017 Diciembre | 109 | 10 | 119 |
| 2017 Noviembre | 121 | 7 | 128 |
| 2017 Octubre | 80 | 7 | 87 |
| 2017 Septiembre | 96 | 11 | 107 |
| 2017 Agosto | 145 | 19 | 164 |
| 2017 Julio | 85 | 18 | 103 |
| 2017 Junio | 72 | 19 | 91 |
| 2017 Mayo | 68 | 17 | 85 |
| 2017 Abril | 51 | 20 | 71 |
| 2017 Marzo | 92 | 48 | 140 |
| 2017 Febrero | 132 | 13 | 145 |
| 2017 Enero | 45 | 24 | 69 |
| 2016 Diciembre | 63 | 14 | 77 |
| 2016 Noviembre | 77 | 15 | 92 |
| 2016 Octubre | 124 | 22 | 146 |
| 2016 Septiembre | 189 | 18 | 207 |
| 2016 Agosto | 220 | 20 | 240 |
| 2016 Julio | 84 | 17 | 101 |
| 2016 Junio | 13 | 16 | 29 |
| 2016 Mayo | 9 | 30 | 39 |
| 2016 Abril | 4 | 26 | 30 |
| 2016 Marzo | 14 | 20 | 34 |
| 2016 Febrero | 5 | 17 | 22 |
| 2016 Enero | 9 | 2 | 11 |
| 2015 Diciembre | 10 | 12 | 22 |
| 2015 Noviembre | 33 | 16 | 49 |
| 2015 Octubre | 42 | 3 | 45 |
| 2015 Septiembre | 17 | 9 | 26 |
| 2015 Agosto | 11 | 6 | 17 |
| 2015 Julio | 202 | 10 | 212 |
| 2015 Junio | 76 | 13 | 89 |
| 2015 Mayo | 97 | 27 | 124 |
| 2015 Abril | 99 | 17 | 116 |
| 2015 Marzo | 209 | 21 | 230 |
| 2015 Febrero | 152 | 8 | 160 |
| 2015 Enero | 308 | 17 | 325 |
| 2014 Diciembre | 104 | 9 | 113 |
| 2014 Noviembre | 109 | 14 | 123 |
| 2014 Octubre | 145 | 14 | 159 |
| 2014 Septiembre | 124 | 16 | 140 |
| 2014 Agosto | 191 | 21 | 212 |
| 2014 Julio | 183 | 30 | 213 |
| 2014 Junio | 148 | 18 | 166 |
| 2014 Mayo | 157 | 18 | 175 |
| 2014 Abril | 107 | 12 | 119 |
| 2014 Marzo | 61 | 8 | 69 |
| 2014 Febrero | 57 | 6 | 63 |
| 2014 Enero | 56 | 12 | 68 |
| 2013 Diciembre | 52 | 12 | 64 |
| 2013 Noviembre | 59 | 24 | 83 |
| 2013 Octubre | 34 | 11 | 45 |
| 2013 Septiembre | 52 | 7 | 59 |
| 2013 Agosto | 33 | 24 | 57 |
| 2013 Julio | 20 | 15 | 35 |
| 2013 Junio | 23 | 15 | 38 |
| 2013 Mayo | 17 | 16 | 33 |
| 2013 Abril | 22 | 16 | 38 |
| 2013 Marzo | 27 | 18 | 45 |
| 2013 Febrero | 35 | 9 | 44 |
| 2013 Enero | 73 | 4 | 77 |
| 2012 Diciembre | 35 | 5 | 40 |
| 2012 Agosto | 1 | 0 | 1 |
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