Phytophotodermatitis: differentiation from jellyfish stings

Summertime and the patient is itchy

A 21-year-old man presented to the emergency department with a 36 h history of a painful, itchy maculopapular rash and associated vesicles to his arms and neck. He had no history of exposure to new chemicals or hygiene products and no significant medical history. His physiological observations were normal and systemic examination was unremarkable. On close inspection the rash was noted to be present only on areas of skin exposed while wearing a polo shirt. On further questioning it transpired that he had been gardening 12 h prior to the development of the rash. A diagnosis of phytophotodermatitis was made. The patient was discharged with chlorphenamine, simple analgesia and the advice to wear a long-sleeved t-shirt and sunscreen when gardening in future. Phytophotodermatitis is a cutaneous reaction caused by contact with light-sensitising compounds found in plants and exposure to ultraviolet A radiation. It is self-limiting and can be managed symptomatically.

The sunny side of lime

A 26-year-old woman was affected with a maculopapular rash because of a jellyfish sting on her right leg while surfing in Indonesia. A locally-prepared liniment was applied on the affected skin. She presented with hyperpigmented linear tracks that she noted a few days later.

[Jellyfish sting. A case report]

Jellyfish bites in Hungary are rare. Yet, from a differential diagnostic point of view this epizoonozis might gain importance given the ever-growing popularity of seaside tourism. A 10 year old female patient was stung by a jellyfish while sea-bathing in the Adriatic in the summer of 2005. A couple of minutes after the bite urticaria were formed in the contacted area accompanied by a burning and sore sensation. In a few hours the above lesions turned livid and the patient developed low-grade fever and general discomfort. In acute therapy she received thorough rinse with vinegar, antibiotic ointment and systemic calcium. General symptoms regressed within 24 hours and dermatological symptoms improved progressively. Finally, the patient grew symptomless in 4 weeks altogether due to general antihistamine and local antibiotic therapy. 3 months later the patient presented again with hyperaemic papules and an increasing itching and burning sensation in the previously jellyfish-contacted area. Histopathology showed vascular involvement and eosinophilic infiltration. The inflammatory symptoms gradually diminished to locally applied steroids in an occlusive bandage leaving behind hypopigmentation. Although bare-skin contact with the different poisonous jellyfish species usually do lead to the forming of dermatological symptoms, vascular involvement developed months after the encounter in the exposure site has seldom been published. The article covers the main potential symptoms of jellyfish stings--both local and general--going into details about the possible dermatological differential diagnoses. Furthermore, the most venomous jellyfish species, their geographical habitats, do's and don't-s of first aid, therapy and prevention are being briefly discussed by the authors.