Return to Appendix Local Reactions Your skin may have something to say - Marine Stinging Creatures and show - when it contacts underwater
Hydroids, anemones, jellyfishes, fire corals, sponges
irritants
and worms are examples of marine stinging creatures that can cause reactions with blisters, itching and pain.
By Paul S. Auerbach M.D., M.S.
The reaction occurs only if the injured diver or swimmer is contacted by the stinging cells of the
Q Two or three days after diving, I get skin eruptions
creature, and the pattern of rash often reveals which
that are slightly painful, itchy and filled with liquid. I
stinger was involved. Thus, the long tentacle of a
usually get about 10 eruptions on my face, hands,
jellyfish often leaves a "print" pattern which is
forearms and shins. This condition occurs both with
diagnostic for the specific creature that caused the
and without a full wetsuit. My husband, who dives
sting. However, the more common situation is what we
with me, is not affected by this problem. Is this
are faced with in your inquiry: a non-specific
condition related to swimmer's itch? Is there any way
dispersion of blisters and sores that could have been
to prevent it from occurring? How should I treat it once
caused by virtually anything that floats or can be
Swimmer's Itch
A:The description you have offered portray what is likely a toxic bite or sting, followed by a local allergic
Swimmer's itch, which you suggested as a possibility, is
reaction, which indicates that you have in all
caused by the cercarial (larval worm) form of certain
probability been sensitized to the toxic substance(s) in
marine schistosomes, and is an unlikely agent for this
the past. Given your history of repeated episodes in the
rash, particularly if no one else in the water -your
Caribbean and the Florida Keys, the most likely
husband, for example - is afflicted. I believe that you
causative agent is a biting insect or marine creature
may be demonstrating your own personal sensitization
to toxin(s). Thus, whether the culprit is an insect or a marine stinger, your skin reaction seems to have an
Insect Bites
element of hypersensitivity that would account for the blistering and longer natural course until there is
Reactions similar to what you reported are commonly
seen after fire ant stings, certain bee or wasp stings, and occasionally (rarely) after mosquito bites. With regard
Seabather's Eruption
to the fact that blisters are present, bites from tiny biting midges, chiggers, flies, or common mites seem
Could this be "sea lice," which is really "seabather's
less likely, but not impossible. The beach (sand)
eruption," a cluster of stings from small thimble
environment, particularly in these regions, is often part
jellyfish or larval forms of sea anemones? Perhaps,
of, or adjacent to, breeding grounds for these noxious
although one would expect a more intense skin
insects, which are a plague to beachgoers and divers
reaction around your neck and wrists, along and under
who perform beach dives or traverse sandy or marshy
bathing suit lines, and representative of an assault by
thousands of stinging cells simultaneously. Given the pattern, I would not favor seabather's eruption. Anemone Sting
insect bites are a possibility. Unfortunately, there are no commercially available topical skin preparation
The intense redness and blisters you display in the
barriers which protect against marine stings, although
photos are reminiscent of stings by sea anemones,
at least one such product is in development. I would
particularly those which burrow in the sand, although
also advise full wetsuit or diveskin protection while in
you would most likely recollect handling the creatures.
the water. If you use your hands a lot while diving, you
Similarly, fire coral is unlikely if there is no mention of
your contact with their clearly visible calcareous pillars. Hydroids are often widespread and fragile, and
Whether or not you recognize a stinging sensation
can leave stinging fragments invisible in the water, so a
while you're in the water, it might be prudent to apply
hydroid sting is a distinct possibility.
a brief swab of household vinegar, baking soda solution, papain solution (an enzyme in papaya juice), or rubbing alcohol after each dive to the skin areas in
Photosensitive Reaction
which these stings most commonly occur, in the off chance that a subclinical (unnoticeable) sting might be
It's difficult to make precise diagnosis, because there is
no "smoking gun." Of course, we shouldn't overlook a drug eruption (rash) related to a possible interaction
In the future, dive safely, and try these suggestions.
between a medication and exposure to the sun
Hopefully, one - or a combination of them - will keep
(ultraviolet radiation). This can cause a rash similar to
that demonstrated by your photos. Additional
Paul Auerbach, M.D., M.S., is a consultant on
questions to answer include whether you take any
hazardous marine life to DAN, medical editor for Dive
medications regularly, and if you were wearing a
Training magazine, advisor to numerous medical,
protective sunscreen at the time of your injury.
recreational and scientific organizations and recognized internationally as a leading expert on the clinical
Treatment and Prevention
management of hazardous marine encounters.
After the blisters occur, treat the rash as you would a
- From Alert Diver, November/December 1998
second-degree (blistering) burn, by keeping the affected area clean, applying a thin application of non-sensitizing topical antiseptic ointment such as mupirocin (Bactroban), and observing for the onset of infection. If the rash becomes incapacitating because of pain or itching, you might want to ask a physician to examine you and determine whether a hypersensitivity (allergic) reaction exists. If so, the physician would most likely treat you with a glucocorticoid (steroid) drug. You could take this type of medication by mouth or by injection - I would not expect a topical steroid cream or ointment to be of any particular benefit, and would not recommend its use, because of the effect of decreased wound healing and possible increase in the chance for infection. If itching is severe, try a standard antihistamine, such as diphenhydramine (Benadryl®) or fexofenadine (Allegra®), although this may not work for everyone.
In terms of prevention, I would advise you to wear sunscreen and insect repellent, particularly the latter if
T h e cu rre n t iss u e a n d fu l tex t a rch iv e o f th is jo u rn a l is a v a ila b le a t Synchronicity: a post-structuralist guide to creativity and change University of Alabama, Tuscaloosa, Alabama, USA Revised January 2002Accepted January 2002 Keywords Jungian psychology, Creativity, Organizational change Abstract Synchronicity was coined by Jung in 1955 to refer to
Universitätsklinikum Heidelberg Fachweiterbildung zur Pflege und Betreuung des Tumorpatienten und schwerst-chronisch Kranken Nachqualifizierungsseminar im Rahmen der DKG-Empfehlungen „Pflege in der Onkologie“ § 23 Abs. 6 Nr. 2 Die Pflege in der pädiatrischen Onkologie im Wandel der Zeit Ruthild Korn Faberstraße 50 67063 Ludwigshafen Stellvertretende Stationsleitung