Delayed cutaneous reaction to jellyfish

A 57-year-old woman presented with a widespread papulonodular eruption. The dermatitis had appeared about 1 week after her return from a trip to the R ed Sea, where she had come into contact with a shoal of unidentified jellyf ish; however, that contact had not been followed by cutaneous lesions and/o r symptoms. The patient also stated that she had had previous contacts with jellyfish during other trips to exotic seaside resorts. The dermatitis was characterized by papulonodular lesions, round or oval in shape, of a few millimeters in diameter, with a color ranging from pink to red to brown, and with a smooth and regular surface. The lesions were grou ped in an apparently random fashion (Fig. 1) or arranged linearly (Fig. 2). The patient complained of pruritus and burning. Histopathologic examination showed the presence of some necrotic keratinocy tes; in the upper and mid dermis, edema and a predominantly perivascular an d periadnexal lymphohistiocytic infiltrate, with numerous neutrophils and e osinophils, were observed (Fig. 3). The patient was treated with hydroxyzine (37.5 mg/day) and hydrocortisone b utyrate, which resulted in the rapid disappearance of the symptoms; however , the cutaneous lesions persisted for about 3 weeks.