Contact Irritants and Toxins

SPONGES

  • Phylum porifera is the most harmless. Three species produce contact dermatitis, including the red-beard sponge (Micronia prolifera), fire sponge (Tedania ignis) and poison-bun sponge (Fibulila sp.). Of the 5000 species, only twelve are thought to be toxic.
  • Symptoms include: erythema (redness), arthralgias (joint pain), and edema (swelling).
  • Treatment: symptomatic with soothing lotions and topical steroids.

SEA ANEMONES, CORALS

  • Phylum coelenterata (Cnidaria), Class Anthozoa. These possess nematocysts with potential for envenomation but primarily cause mechanical trauma to the skin, resulting in abrasions and lacerations that can retain small particles of coral and that become easily infected.
  • Symptoms: pain, burning sensation and/or itching, erythema, edema and increased warmth. Recurrence of dermatitis weeks later.
  • Treatment: Thorough cleansing of the area involved (including debridement, if necessary). Debridement is excision of dead, avulsed tissue. Provide tetanus prophylaxis and topical antibiotics. Systemic steroids if a chronic dermatitis ensues.

JELLYFISH and HYDROIDS

  • Phylum coelenterata, Class Scyphozoa (true jellyfish, sea wasp) and Class Hydrozoa (hydroids, Man-of -War). These possess nematocytes, a stinging apparatus (nematocyst) formed within the cnidoblast and discharged on contact. Floating tentacles retain active nematocysts, which remain active even after drying. There is a wide range of toxicity, from mild to severe (Portugese Man-o-War, Physalia utriculus), and sea wasp, genera Chironex. The venom is complex, and includes proteins, enzymes, polypeptides and tetramine. Pain and local histamine release are attributed to 5-hydroxytryptamine; the nerve conduction effects are due to tetramine (similar to curare).
  • Symptoms: Rapid onset of pain, varying from mild to severe. A rash that is red, hot and swollen, usually linear. There is frequent pustule and vesicle formation. Anaphylaxis (circulatory collapse) is possible in sensitized individuals. Severe stings may cause muscle cramps, abdominal pain, fever, chills, nausea, vomiting, respiratory distress, and cardiovascular collapse. Fatalities are increased if there is pre-existing cardiac and respiratory disease. Chironex may cause death in healthy individuals in less than 15 minutes.
  • Treatment: Use topical vinegar to neutralize undischarged nematocysts and removal of remaining tentacles. Topical analgesics and steroids or IV analgesics and hydrocortisone 100 mg IV every two hours are given. (Chironex).Cardiovascular monitoring and/or support are provided. Sea wasp antivenin is available (Australia Commonwealth Serum Lab.)
  • Treatment of Severe Allergic Reaction to JellyfishRemove any remnant of allergen (i.e., jellyfish tentacles, foreign material)
    • Epinephrine injection, if available
    • Decadron injection or tablets
    • Antihistamine, if available
    • Wash out wounds or injury with alcohol, vinegar or sea water
    • Call for help and immediate transport
    • Treat for shock
    • CPR if no pulse or respirations
    • Keep warm
    • Oxygen
    • Pain relief, if available

CROWN OF THORNS

  • Phylum echinodermata, Class Asteroidea. Acanthaster planci. This is the only known venomous starfish, its arms having large spines with venom producing integument. The composition of the venom is unknown.
  • Symptoms: Rapid onset of edema, erythema and pain.
  • Cleanse the wound and apply topical antibiotics. Give tetanus protection.

SEA URCHIN

  • Phylum echinodermata, Class Echinoidea. Multiple slender spines puncture the skin and break off.
  • Symptoms: Immediate pain, joint pain, edema and numbness.
  • Treatment: Remove spines, cleanse, topical antibiotics and tetanus protection. Occasional surgical removal of spine fragments.

There are about as many treatments for sea urchin puncture wounds as there are species of sea urchins (600–800 are thought to be venomous to humans). The long-spined black sea urchin is usually the culprit, as the spines break off in the dermis, leaving a painful black spot. The black spot is only black pigment, the proteinaceous spine is the part that needs removal. (vertically).
Soaking in hot water for 60-90 minutes (see below) is said to offer relief from the pain and swelling (Paul Cianci). Others espouse magnesium sulfate pastes (Carl Edmonds). Snake bite suction cups are used by some to remove the spines while others go ahead and excise the area conservatively under local anesthesia.

Surgery is indicated for a foreign body reaction and intra-articular puncture, the latter being probably the most serious consequence of the accident.

Topical antibiotics and tetanus protection should be offered.

The following is from the Merck Manual:
Echinoderms: Pedicellariae stings are treated by washing the area and applying an antihistamine-analgesic-corticosteroid balm. Sea urchin spines should be removed immediately. A bluish discoloration at the site of entry may help in locating the spine, which may sometimes be seen by xeroradiogram. Vinegar dissolves most superficial spines, and soaking the wound in vinegar several times/day and covering the area with a wet vinegar compress may be sufficient; surgery is seldom necessary at this point. If a small incision needs to be made to extract the spine, care must be taken as it is very fragile. In time, a spine may migrate into deeper tissues and require surgical removal.”

Bill Chambers, Scuba Instructor, has the following advice for treatment of sea urchin spines:

“These days, I simply place (usually a foot) the injured part into hot (comfortably hot) vinegar (black or white) that has been warmed in a microwave oven. In less than ten minutes, the pain is gone and the spines themselves look like half dissolved granules of sand in the bottom of the container.The wound heals as if nothing more than a minor splinter had been the problem.”

Reference

Hand injuries from sea urchin spines
MB Strauss and RI MacDonald write in the journal Clin Orthop 1976 Jan-Feb;(114):216-8

“Sea urchin spine injury is usually a benign process that rarely comes to the attention of a physician. Aside from the transient episode of excruciating pain which responds dramatically to hot water soaks, there is usually no residual disability. As in any puncture wound, tetanus prophylaxis and observation for latent infection is advised. Complications arise, however, when spines are embedded over bony prominences, within joints, or in contact with nerves. Cases are associated with sea urchin injuries has not been previously reported in the literature. When such injuries necessitate exploration, aseptic surgical technique is required. “

SEA CUCUMBER

  • Phylum echinodermata, Class Holothurioidea. Some species eject a visceral liquid, causing dermatitis and blindness.
  • Symptoms: Redness, itching and pain. If eyes are involved, symptoms are similar to chemical burns.
  • Treatment: Copious irrigation of the affected area.

AUTHOR

Ernest S. Campbell, M.D., FACS

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