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Seabather's Eruption

      CASE PRESENTATION

      A 48-year-old hypertensive female presented with a 4-day history of intensely pruritic skin eruptions over the waist. A few days prior to onset of symptoms, she had gone ocean swimming wearing a “salwar-kameez” (a traditional Indian outfit comprising of pajama-like trousers held by a drawstring at the waist and a long shirt or tunic) in clear, waist-deep waters at a beach town overlooking the Indian Ocean. She complained of localized pruritus immediately after taking a shower without removing the affected clothing. Cutaneous examination revealed multiple erythematous papules, some excoriated, overlying the bilateral lumbar regions of abdomen (Figure). No other sites were affected. The typical history and cutaneous findings were consistent with the diagnosis of seabather's eruption. Oral levocetirizine (5 mg) and topical steroid (mometasone furoate cream) application led to complete resolution within a week.
      Seabather's eruption (SBE), also termed as sea lice, is an acute dermatitis affecting skin folds and areas covered with bathing costumes after exposure to marine water.
      • Tomchik RS
      • Russell MT
      • Szmant AM
      • et al.
      Clinical perspectives on seabather's eruption, also known as “sea lice.”.
      SBE represents a hypersensitive reaction to the immature nematocysts of larval-stage thimble jellyfish (Linuche unguiculata), sea anemones (Edwardsiella lineata), and other larval cnidarians that get entrapped within minute gaps between skin and clothing. L. unguiculata frequent the waters along the southeast coast of the United States, the Caribbean, Gulf of Mexico and Florida, but has also been reported in Brazil and Papua New Guinea. E. lineata, on the other hand, has been identified as the culprit of SBE along the east coast of United States.
      • Freudenthal AR
      • Joseph PR
      Seabather's eruption.
      These microscopic sticky organisms cause envenomation with antigenic toxins when crushed, dried out, or exposed to freshwater. This induces a host immune response.
      • Sridhar SC
      • Deo SC
      Marine and other aquatic dermatoses.
      SBE should not be confused with swimmer's itch; the latter is limited to exposed areas of the body after bathing in freshwater and has a worldwide distribution. Removal of swimwear while taking a shower after sea water exposure, and symptomatic treatment helps alleviate cutaneous complaints.
      Physicians, especially those serving in coastal areas, ought to be aware of this self-resolving, yet bothersome dermatitis to ensure prompt identification and treatment.

      References

        • Tomchik RS
        • Russell MT
        • Szmant AM
        • et al.
        Clinical perspectives on seabather's eruption, also known as “sea lice.”.
        JAMA. 1993; 269: 1669-1672
        • Freudenthal AR
        • Joseph PR
        Seabather's eruption.
        N Engl J Med. 1993; 329: 542-544
        • Sridhar SC
        • Deo SC
        Marine and other aquatic dermatoses.
        Indian J Dermatol. 2017; 62: 66-78