Seabather’s Eruption
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Seabather’s eruption was first described in 1949 as a pruritic papular eruption occurring in bathers off the eastern coast of Florida. Seabather’s eruption is a highly pruritic, papular eruption that occurs underneath the swimsuit after extended exposure to seawater. Seabather’s eruption results from a hypersensitivity to the larval form of the thimble jellyfish, Linuche unguiculata. [1, 2] Cases have been reported in the Phillipines and have been attributed to Linuche aquila. [3] Most cases occur from March to August, but the incidence peaks in May and June. See the image below.
See Deadly Sea Envenomations, a Critical Images slideshow, to help make an accurate diagnosis.
See also the Medscape article Cutaneous Manifestations Following Exposures to Marine Life.
Seabather’s eruption is a cutaneous hypersensitivity reaction to contact with the larval form (planulae) of the thimble jellyfish, L unguiculata. The eruption typically occurs underneath the bathing garments, which are believed to trap the jellyfish larvae against the skin. Whether the discharge of venom by the trapped larvae plays an important role in the pathogenesis of the eruption remains uncertain. Factors that promote the discharge of venom by the larvae include wearing of bathing suits for prolonged periods following swimming, exposure to fresh water through showering, and mechanical stimulation.
Seabather’s eruption is caused by exposure to the larval form (planulae) of the thimble jellyfish, L unguiculata. The seasonal variation in the concentrations of thimble jellyfish larvae in endemic areas lead to the increased incidence of seabather’s eruption from May through August, with a peak in May and June.
Freudenthal and Joseph [4] reported the larvae of the sea anemone Edwardsiella lineata as the cause of an outbreak of seabather’s eruption on Long Island, New York. This organism also has nematocysts. Various species of Cnidaria larvae in other waters can likely produce similar eruptions.
United States
The incidence of seabather’s eruption is seasonal; the highest incidence occurs from May through August. This coincides with the warm gulf streams running along the Atlantic coastline of Florida and the corresponding spawn of thimble jellyfish larvae, which results in the high seasonal concentration of Linuche planulae. In 1997, Kumar et al [5] reported the occurrence of seabather’s eruption in Palm Beach saltwater swimmers in May to be 16%.
International
Seabather’s eruption has been reported in Mexico and the Caribbean and along the coast of Brazil. [6, 7, 8] Reports have occurred in the Phillipines. [3] The true prevalence of seabather’s eruption along other international coastlines remains unknown.
Seabather’s eruption occurs independent of race.
Seabather’s eruption has been noted with equal frequency in both sexes.
No correlation between age and risk for developing seabather’s eruption has been noted. The severity of symptoms, particularly the frequency of fever, is greater in children than in adults.
Cutaneous eruptions clear in 2 weeks, with or without therapy. No deaths have been attributed to exposure to thimble jellyfish larvae.
Educate patients about thimble jellyfish larvae during peak seasons in affected areas and the preventative role of showering with the bathing suit off following exposure to the seawater.
For patient education materials, see the Environmental Exposures and Injuries Center; Bites and Stings Center; and Jellyfish, Stingray, and Other Water Animal Bites/Stings Center, as well as Jellyfish Stings and Stingray Injury.
Segura Puertas L, Burnett JW, Heimer de la Cotera E. The medusa stage of the coronate scyphomedusa Linuche unguiculata (‘thimble jellyfish’) can cause seabather’s eruption. Dermatology. 1999. 198(2):171-2. [Medline].
Segura-Puertas L, Ramos ME, Aramburo C, Heimer De La Cotera EP, Burnett JW. One Linuche mystery solved: all 3 stages of the coronate scyphomedusa Linuche unguiculata cause seabather’s eruption. J Am Acad Dermatol. 2001 Apr. 44 (4):624-8. [Medline].
Guevara BEK, Dayrit JF, Haddad V Jr. Seabather’s eruption caused by the thimble jellyfish (Linuche aquila) in the Philippines. Clin Exp Dermatol. 2017 Oct. 42 (7):808-810. [Medline].
Freudenthal AR, Joseph PR. Seabather’s eruption. N Engl J Med. 1993 Aug 19. 329(8):542-4. [Medline].
Kumar S, Hlady WG, Malecki JM. Risk factors for seabather’s eruption: a prospective cohort study. Public Health Rep. 1997 Jan-Feb. 112(1):59-62. [Medline].
Rossetto AL, Da Silveira FL, Morandini AC, Haddad V, Resgalla C. Seabather’s Eruption: Report of Fourteen Cases. An Acad Bras Cience. March 2015. 87(1):431-6. [Medline].
Rossetto AL, Proença LA. Seabather’s eruption: report of case in northeast region of Brazil. An Bras Dermatol. 2012 May-Jun. 87 (3):472-4. [Medline].
Eyer-Silva WA, Pitombo FB, Silva GARD. Seabather’s eruption in Ipanema Beach, Rio de Janeiro, Brazil. Rev Soc Bras Med Trop. 2018 Jan-Feb. 51 (1):119. [Medline].
Wong DE, Meinking TL, Rosen LB, Taplin D, Hogan DJ, Burnett JW. Seabather’s eruption. Clinical, histologic, and immunologic features. J Am Acad Dermatol. 1994 Mar. 30(3):399-406. [Medline].
Clarence William Brown, Jr, MD, FAAD Chief Executive Officer, University Dermatology
Clarence William Brown, Jr, MD, FAAD is a member of the following medical societies: American Medical Association, Chicago Medical Society, Illinois State Medical Society, Chicago Dermatological Society, Illinois Dermatological Society, American Academy of Dermatology, American College of Mohs Surgery
Disclosure: Nothing to disclose.
Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society
Disclosure: Nothing to disclose.
Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology
Disclosure: Received income in an amount equal to or greater than $250 from: Lilly; Amgen <br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Allergen; Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.
William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine
William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology
Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD.
Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine
Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha
Disclosure: Nothing to disclose.
Seabather’s Eruption
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