Coral Dermatitis

Abstract

T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 373;2 nejm.org July 9, 2015 e2 Images in Clinical MedicineA 31-year-old man presented with a 1-week history of pruritic rash on his left foot, which developed after he brushed against coral while snorkeling in the Caribbean Sea. After contact with the coral, he reported the onset of a burning sensation in the foot, which was followed 1 hour later by the development of an intensely pruritic rash. The physical examination revealed an erythematous, cerebriform plaque on the lateral aspect of the left foot. On the basis of the patient's history and cutaneous findings, a diagnosis of coral dermatitis was made. Coral dermatitis is a form of contact dermatitis that is caused by numerous species of coral that produce nematocysts, which are specialized organelles that discharge dermatologic toxins. Envenomation may result in both acute and delayed reactions. Acute reactions are thought to be forms of irritant contact dermatitis and typically present with urticarial or vesiculobullous plaques immediately or within hours after exposure. Delayed reactions are more likely to be forms of allergic contact dermatitis that are mediated by type I and type IV hypersensitivity reactions and are characterized by firm, localized papules that arise days to weeks after exposure. In rare cases, superficial epithelioid granulomas may be noted on biopsy. The patient was treated with triamcinolone ointment, and the lesion resolved after 2 weeks.

Don’t Kick the Coral!

“…1,3 The ensuing rash appears over a period of minutes to days, possibly due to a hypersensitivity reaction. 2 The pattern imprinted on the skin is random, according to the pattern of the coral, with no underlying meaning to the “S” shape observed here.…”

“…1 However, if a rash consistent with coral dermatitis develops, the treatment of choice is topical steroid. 1,2 Patients should be counseled to seek further medical attention if the initial rash worsens despite steroid therapy or does not resolve within 2 weeks, if systemic symptoms develop, or if a delayed granulomatous rash appears.…”

Curvilinear undulating erythematous plaque

“…This is the treatment of choice for coral dermatitis, reducing pruritus and resolving the rash within approximately 2 weeks. 2 In the case at hand, 10 days of treatment with clobetasol propionate cream, 0.025%, applied twice a day resulted in clearance of the erythematous plaque (Fig 3 shows the right proximal pretibial region before and after suture removal, following treatment with clobetasol propionate cream, 0.025%).…”

“…These corals have specialized organelles called nematocysts, responsible for this form of contact dermatitis. [2][3][4] C. Phytophotodermatitis e Incorrect. Phytophotodermatitis is a skin eruption occurring after skin contact with psoralens in certain plants (eg, limes, lemons, celery) and then is exposed to Ultraviolet A radiation.…”

Coral Dermatitis or Infectious Dermatitis: Report of a Case of Staphylococcus Aureus Infection of Skin After Scuba Diving

“…The skin lesions present as urticarial or vesiculo-bullous plaques, firm, and localised papules, immediately or after hours of exposure to the corals. In some people, superficial epithelioid granulomas were also noted [ 3 ].…”