Diagnostic confusion between seabather’s eruption as well as dermatophytosis and parasitic infestations

Abstract

Dear Editor:Seabather's eruption (SBE) is an acute dermatitis characterized by itchy and erythematous papules that appear during or after bathing in the sea. It is caused by contact with the larvae and adult of the jellyfish (Linuche unguiculata and L. aquila, recently found in the Philippines) and larvae of the sea anemone Edwardsiella lineata 1-3 . Limited information is available on this type of dermatitis. However, it is considered a public health concern in Brazilian coastal areas 2-7 . Here, we report two typical cases of SBE characterized by exuberant and eczematous lesions, aggravated by diagnostic confusion with dermatophytosis and parasitic infestations such as cutaneous larva migrans and scabies.Envenomations occurred in a female and male children aged 2 and 11 years, respectively, who frequently went to the coastal beaches in the state of Santa Catarina, Brazil. The children experienced a pricking sensation in the pubic, genital, and gluteal regions during sea bathing, which progressed to pruritus and intensified at night.The parents of the one child consulted a pharmacist, who diagnosed the condition as ringworm and recommended the use of topical ketoconazole. After 1 week of treatment, the manifestations had worsened. Thus, the parents sought consultation from a dermatologist. The other child was taken by his mother to a pediatric emergency department. The condition was diagnosed as cutaneous larva migrans, and topical thiabendazole was prescribed and used for 2 weeks. However, due to the aggravation of pruritus and lesions, the child returned to the hospital for consultation from the same pediatrician who changed the diagnosis to scabies. Topical permethrin was prescribed, but the mother subsequently decided to consult a dermatologist.Both dermatological examinations revealed intense pruritic and eczematous, erythematous papules located mainly in the gluteal regions (Figures 1A, B, E, and F). Dermoscopic examinations did not reveal the structures of L. unguiculata or cnidocytes, and examination of areas with exulcerated and meliceric crusting revealed nonspecific findings (Figures 1C, D, G, and H).The patients were treated with systemic antihistamines and corticosteroid creams. The condition of both the patients improved, with complete regression of the lesions and pruritus after 15 and 21 days of treatment, respectively.The occurrence of SBE among individuals living on the Brazilian coast is caused by the planulae and the scyphomedusa L. unguiculata, which is found on the Santa Catarina coast 2-8 . Limited information is available of this type of dermatitis, and its occurrence is mainly observed in individuals living on the coastlines of São Paulo and Santa Catarina 3-7 . In this study, the initial clinical manifestations, which include erythematous, itchy papules that appeared during exposure to seawater, particularly in areas covered by bathing suits, with a gradual increase in itching, were typical of SBE in children 1-7 .Clinical and epidemiological diagnoses can be made. However, the absence ...

Seabather’s eruption: description of a new clinical manifestation

“…1,2 It is manifested by erythematous and itchy papules located often in areas covered by bathing suits during or immediately after exposure to sea water. [1][2][3][4][5][6][7] We report two cases of SBE mimicking Koebner Phenomenon (KP) as envenomations caused by the hydromedusa Olindias sambaquiensis and the scyphomedusa Chrysaora lactea, some of the most common jellyfish species in S and SE Brazil.…”

“…Seabather's eruption is caused by L. unguiculata in Brazil, being frequent in the area. 1,3 The knowledge about the dermatitis is not widely disseminated and diagnostic confusions with dermatophytoses and parasitic infestations such as scabies and larva migrans were recently reported. 3 Skin lesions are different according to forms of the life cycle of L. unguiculata (ephyra, adult jellyfish and larvae).…”

“…1,3 The knowledge about the dermatitis is not widely disseminated and diagnostic confusions with dermatophytoses and parasitic infestations such as scabies and larva migrans were recently reported. 3 Skin lesions are different according to forms of the life cycle of L. unguiculata (ephyra, adult jellyfish and larvae). [1][2][3][4] The contacts or macerations of ephyra and adult medusae cause erythematous plaques according to their rounded shapes with sizes of 20-50 mm.…”

“…[1][2][3][4] The contacts or macerations of ephyra and adult medusae cause erythematous plaques according to their rounded shapes with sizes of 20-50 mm. [1][2][3][4] Most envenomations are caused by planula larvae (2-5 mm) found in the water column and when imprisoned, especially under areas covered by bathing suits, they break off activating the cnidocytes with toxins causing irregularly distributed erythematous papules. [1][2][3][4] The polyps (1.8-12 mm) ( Fig.…”

“…[1][2][3][4] Most envenomations are caused by planula larvae (2-5 mm) found in the water column and when imprisoned, especially under areas covered by bathing suits, they break off activating the cnidocytes with toxins causing irregularly distributed erythematous papules. [1][2][3][4] The polyps (1.8-12 mm) ( Fig. 2d) can produce asexually planula-like particles (planuloids) ( Fig.…”