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An. Bras. Dermatol. vol.86 no.4 Rio de Janeiro July/Aug. 2011
Vidal Haddad Junior
Faculdade de Medicina de Botucatu (Botucatu School of Medicine) Universidade Estadual Paulista (Sao Paulo State University) and Vital Brazil Hospital- Butantan Institute- SP
Dear Editors of the Anais Brasileiros de Dermatologia (Brazilian Annals of Dermatology):
With regard to the Iconography article titled "Comparative Dermatology: lesion caused by attack of the Portuguese Man of War", I would like to congratulate the authors for the idea of the report and beautiful image sent. However, I would like to make some observations which I think are important for readers of the journal. They are outlined as follows:
1. Genus and species of animals and plants are written in italics. Family, phylum and class are not. Therefore, phylum Cnidaria, class Hydrozoa, Physalia physalis (genus and species). The zoological nomenclature is critical to the citation and bibliographic search of the article.
2. The term "attack" could never be used to refer to accidents caused by cnidarians. It is more than obvious that the accident is provoked by the swimmer that comes into contact with the tentacles of the animal, never the opposite. Thus, one should speak of "accidents" and not "attacks".
3. There is no antivenom serum for cnidarian sting victims in Brazil. It has never existed, and production has never been contemplated, either by Ezequiel Dias, Vital Brazil or the Butantan Institute. The only antivenom serum for cnidarian stings is produced in Australia, against Chironex fleckeri, responsible for hundreds of deaths in the Indo-Pacific region. I believe this amendment should be mentioned to our fellow readers of the journal.
4. Currently, first aid and cold sea water (fresh water triggers nematocysts via osmosis) treatment is prescribed. There is no risk of using sea water. Infections are extremely rare. Vinegar baths can also be useful. There is no indication for using isopropyl alcohol, talc, baking soda, shaving cream or for rubbing the spot. Corticosteroids are not indicated in the acute phase because we are dealing with poisoning and not an allergic process. There is also no reason for using topical or systemic corticoids to minimize adverse reactions to the antidote, as there is no antidote available.
5. I suggest the dissemination and use of the educational material about treating accidents caused by cnidarians available on the website of the Brazilian Society of Dermatology for additional information and learning of concepts:
Vidal Haddad Junior
Faculdade de Medicina de Botucatu - UNESP, Instituto Butantan -SP, Brazil
Phone/fax: +55 14 3882 49 22