Diving beneath the surface: Dermoscopic analysis of reaction to jellyfish sting

A 30-year-old male with no known comorbidities presented with a history of a jellyfish sting on the left hand while diving under the sea. He presented with complaints of swelling over the left forearm, sudden in onset, and progressed rapidly to two times its original size within a few hours. It was associated with redness over the area of sting, pain which was severe in intensity, stinging, and a burning sensation. The patient was managed with topical corticosteroids along with antihistamines, providing complete symptomatic relief. The patient presented to us 5 days after the episode of stinging. On examination of lesions, at the time of presentation, revealed multiple, ill-defined, coalescing, erythematous papules and plaques with a necrotic center at the site of sting over the dorsal aspect of the left hand and wrist [Figure 1a]. Dermoscopy of the lesion revealed brown dots (red circle), pinkish hue, pinpoint brown crusts (blue star), Chinese letter appearance (blue circle), erythema (brown star), and yellowish crusts (green circle) [Figure 1b]. The patient did not give consent for the biopsy required for histopathological examination. Diagnosis of a jellyfish bite is done on the basis of clinical manifestations and history of contact with jellyfish. On coming in contact with the jellyfish, the patients present with an immediate onset of vesicular lesions associated with pain and burning sensations following a linear path along the direction of the sting. Similar findings were found in our patient.^[1,2] The lesions were present over the extensor aspect as described in other studies.^[2,3] Furthermore, the dermoscopic features of brown dots, pinkish hue, Chinese letter appearance, pin pinpoint brown crusts matched with previous literature on jellyfish sting dermoscopy, which stated the presence of the above findings in lesions older than 2 days’ duration.^[4] Our study also corroborates the findings of Srinivasan et al., who mentioned four classical dermoscopy findings in the case of jellyfish sting, which include brown spots, a brown “Chinese characters” pattern, tiny brown crusts, and whitish-yellow crusts.^[5] Overall, dermoscopy is becoming an important part of emergency dermatology in marine environments and deserves more widespread integration.

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Figure 1:

(a) Multiple, ill-defined, coalescing, erythematous papules and plaques with necrotic centers at the site of sting over the dorsal aspect of the left hand and wrist. (b) Dermoscopy of the lesion revealed brown dots (red circle), pinkish hue, pinpoint brown crusts (blue star), Chinese letter appearance (blue circle), erythema (brown star), and yellowish crusts (green circle).

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