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 Red Sea, where she had come into contact with a shoal of unidentified jellyfish; however, that contact had not been followed by cutaneous lesions and/or 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 grouped in an apparently random fashion ( Fig. 1 ) or arranged linearly ( Fig. 2 ). The patient complained of pruritus and burning. Grouped papulonodular lesions image Papulonodular lesions linearly arranged image Histopathologic examination showed the presence of some necrotic keratinocytes; in the upper and mid dermis, edema and a predominantly perivascular and periadnexal lymphohistiocytic infiltrate, with numerous neutrophils and eosinophils, were observed ( Fig. 3 ). Epidermal erosion, covered by a crust, at the center of the lesion. Dermoepidermal detachment, edema, and lymphohistiocytic infiltrate, with numerous neutrophils and eosinophils in the upper and mid dermis (hematoxylin and eosin, ×12.5) image The patient was treated with hydroxyzine (37.5 mg/day) and hydrocortisone butyrate, which resulted in the rapid disappearance of the symptoms; however, the cutaneous lesions persisted for about 3 weeks.