Cutaneous Manifestations Following Exposures to Marine Life Clinical Presentation

Updated: Jan 12, 2018
  • Author: Zoltan Trizna, MD, PhD; Chief Editor: William D James, MD  more...
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Presentation

History

Patients can usually recall the circumstances of the encounter and the immediate sequelae. The encounter is usually noted because of either sudden trauma or an immediate stinging or burning pain. Dermatitis accompanied by local pain or systemic symptoms usually follows.

Recent travels and recreational activities are relevant. Ask about preexisting wounds, which can provide a portal of entry for infections. Some professions may ignore the risk of such infections.

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Physical Examination

Examine location and characteristics of the affected areas. Certain contacts result in typical patterns and distribution (such as contact with tentacles resulting in characteristic linear eruptions on unprotected skin, seabather's eruption occurring on areas covered by clothing). Stingray injuries commonly affect the unprotected skin of the legs. Fingers are common areas for bites or injury when touching a life form that releases a toxin or inoculates microbes into the skin. Tips of sea urchin spines can break off and become embedded in the wound.

Carefully explore wounds. Look for penetrating injuries, especially over joints. Assess the wounded area for the presence of cellulitis, lymphangitis, pyogenic infections, cyanosis, and necrosis.

Some bacterial infections are typically observed on certain sites. Erysipeloid, caused by Erysipelothrix rhusiopathiae, typically affects the hands of anglers (see image below), although a diffuse cutaneous form has been described. Infection with this organism has been associated with septicemia and endocarditis. [13]

Erysipeloid. Courtesy of the Department of Dermato Erysipeloid. Courtesy of the Department of Dermatology, UTMB at Galveston, Texas.

Vibrio vulnificus infection usually manifests on the lower extremities as hemorrhagic bullae progressing to ulceration and necrosis. It may also cause life-threatening sepsis. [14]

M marinum infections may show sporotrichoid spread on the hand, wrist, and arm.

Venoms have rarely been described to cause injuries to other organs, such as acute renal failure. [15]

Delayed-type skin lesions such as erythema nodosum can occasionally be observed. [16]

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Complications

Most of the cutaneous sequelae of aqueous exposure resolve without severe long-term problems. Pigmentary changes and scarring may occur. Functional limitation and disfigurement may be observed, and these can be treated (see Surgical Care). Delayed-type reactions may require treatment.

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