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Rev. Inst. Med. trop. S. Paulo vol.43 no.3 São Paulo May/June 2001
SEABATHER'S ERUPTION: REPORT OF FIVE CASES IN SOUTHEAST REGION OF BRAZIL
The authors report five cases of seabather's eruption, a typical dermatitis associated predominantly to the jellyfish Linuche unguiculata (Cnidaria), that causes erythematous and pruriginous papules on areas of the skin of bathers covered by swimsuits. The rash is characteristic and the eruption is commom in the Caribbean, Florida, Mexico and Gulf States of USA. The cases are the first reported in Brazil and larvae of the jellyfish are present in the waters where the accidents happened.
KEYWORDS: Dermatitis; Jellyfishes; Nematocists; Cnidaria; Marine animals.
Seabather's eruption is a dermatosis provoked by planuloid larvae of members of the phylum Cnidaria (jellyfishes, coral, Portuguese-man-of-war and sea anemones), that discharge toxic substances of the nematocists, defense structures present in the body and tentacles of the animals. When in contact with humans, especially concentrated in areas of the body covered by swimsuits, the nematocists are activated by skin contact, pressure or contact with freshwater and provoke a very characteristic dermatitis, that is common, occasionally epidemic, with onset of outbreaks in the Caribbean, Mexico, Florida and Gulf states of USA1.
Presently, there is a definite relation with the specie Linuche unguiculata, the sea thimble, a thin jellyfish of tropical and subtropical waters, fact that can be comproved by serologic tests, with demonstration of high levels of IgG specific for L. unguiculata in patient's sera5. Another organism associated with the rash is the sea anemone Edwardsiella lineata1.
The clinical aspects are typical with erythematous and pruriginous papules resembling insect bites appearing a few hours after a bath in the sea, especially on the skin covered by swimsuits2. Occasionally, low-grade fever, chills, nausea and headache can be observed in children. The eruption differs from the swimmer's itch that occurs in freshwater, in exposed areas of the body and is provoked by schistosomal cercaria5. The treatment utilize cooling lotions, antihistamines, steroids creams and, in cases of severe symptomatology, oral corticosteroids, with poor effectivity. The dermatosis resolves spontaneously within two weeks.
Case 1: male, 13 year-old. The patient noted itchy and erythematous papules one hour after a sea bath in Grande Beach, Ubatuba, São Paulo State. The lesions were concentrated on the gluteus regions (Fig. 1). He healed with application of a topical corticosteroid of high potency by two days.
Case 2: female, 54 year-old. The history of her illness was similar of the anterior patient (Fig. 2). The patient also was bathing in Grande Beach. Note the papules in regions covered by the female swimsuit.
Cases 3, 4 and 5: Females, 4, 6 and 9 year-old, sisters, that presented the typical lesions in covered areas after a sea bath in Perequê-Mirim Beach, Ubatuba, São Paulo State. There were papules in small number on exposed areas. The patients were medicated with corticosteroid cream, with improvement of the symptoms, that faded one week after the contact.
The seabather's eruption is a common dermatitis in areas of tropical and subtropical marine waters and until this communication it was not reported to occur in Brazil. The clinical aspects of the cases observed are very typical and the larvae of Linuche unguiculata can be identified and collected in the areas of Ubatuba and São Sebastião3,4, fact that enforces the probable etiology of the accidents. So, it is important to reaffirm that the dermatosis is present in Brazil, with the therapeutical and clinical implications that this fact will bring to physicians of coastal areas of the country.
Dermatite do traje de banho: relato de cinco casos na região sudeste do Brasil
Os autores relatam cinco acidentes de "seabather's eruption" ou prurido do traje de banho, uma erupção típica associada na maioria das vezes à água-viva Linuche unguiculata (Cnidaria), que causa um "rash" pápulo-eritematoso extremamente pruriginoso em áreas cobertas por trajes de banho. O quadro cutâneo é característico e a erupção é comum no Caribe, Flórida, México e estados americanos do Golfo. Os casos são os primeiros relatados no Brasil e larvas de Linuche unguiculata estão presentes nas águas onde ocorreram os acidentes.
1. FREUDENTHAL, A.R. & JOSEPH, P.R. - Seabather's eruption. New Engl. J. Med., 329: 542-544, 1993. [ Links ]
2. HADDAD JR, V. - Atlas de animais aquáticos perigosos do Brasil: guia médico de identificação e tratamento. São Paulo, Editora Roca, 2000. [ Links ]
3. SILVEIRA, F.L. da & MORANDINI, A.C. - Asexual reproduction in Linuche unguiculata (Swartz, 1788) (Scyphozoa: Coronatea) by planuloid formation through strobilation and segmentation. Proc. biol. Soc. Washington, 111: 781-794, 1998. [ Links ]
4. SILVEIRA, F.L. da & MORANDINI, A.C. - New observations on dormancy mechanisms in Linuche unguiculata (Swartz, 1788) (Scyphozoa: Coronatea). Bol. Mus. nac. Nova ser. Zool. (Rio de J.), 393: 1-7, 1998. [ Links ]
5. WONG, D.E.; MEINKING, T.L.; ROSEN, L.B. et al. - Seabather's eruption: clinical, histologic and immunologic features. J. Amer. Acad. Derm., 30: 399-406, 1994. [ Links ]
Received: 02 February 2001
Accepted: 03 April 2001
(1)Departamento de Dermatologia, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
(2)Hospital Vital Brazil, Avenida Vital Brazil 1500, São Paulo, SP, Brasil
(3)Departamento de Zoologia, Instituto de Ciências Biológicas, Universidade de São Paulo, SP, Brasil
Correspondence to: Vidal Haddad Júnior, Caixa Postal 557, 18618-000 Botucatu, São Paulo, Brasil