Clinico-Dermoscopic Report of Jellyfish Dermatitis (Lobonemoides Robustus)–Two Cases in the Same Family
Year: 2026
Type: article
Abstract: Dear Editor, Jellyfish belong to the phylum Cnidaria, which are ubiquitously seen along coastal areas and possess a unique cnidocyte.[1] Recent studies show a sudden surge in the jellyfish population due to water pollution, global warming, overfishing, and increased coastal development projects that eventually lead to the degradation of the marine environment.[2] The diagnosis of jellyfish stings is challenging, but non-invasive diagnostic techniques like dermoscopy can facilitate early diagnosis of these conditions. A 39-year-old man, along with his 13-year-old daughter, presented to our dermatology outpatient department with a history of reddish itchy skin lesions on the body following contact with a jellyfish along the coast of Covelong Beach, Tamil Nadu. Immediately after contact, the patients had noticed a color change at the sites of contact with a burning sensation. The jellyfish was isolated with the help of the coastguard. After 5 days of initial contact, the patient and his daughter presented to us with reddish skin lesions with intense itching and burning sensations. The examination of the father revealed a few erythematous to hyperpigmented papules in a circinate pattern, with an ulcer on the left forearm, a few erosions, and erythematous patches on the insole of the right foot [Figure 1]. Examination of the daughter revealed multiple hypopigmented and few erythematous papules on the dorsum of right hand [Figure 2]. Dermoscopy (polarised mode, Dermlite DL 5, 10× magnification) of the lesions showed multiple white globules surrounded by the reddish circles, and hemorrhagic crust surrounded by reddish-white area, on the elbow and sole lesions in the adult male, and structureless red areas with peripheral scaling and multiple scattered brown dots within, on the dorsum of right hand in the female child [Figures 1 and 2]. The isolated jellyfish had been sent for species identification to the Central Marine Fisheries Research Institute (CMFRI) and was identified as Lobonemoides robustus [Figure 3]. Both patients were treated with topical corticosteroids and antibiotic combination creams, emollients, and oral antihistamines for 2 weeks.Figure 1: (a): Few erythematous to hyperpigmented papules in a circinate pattern on the left arm and forearm with an ulcer on the left forearm. (b): Few erosions, and erythematous patches with surrounding exfoliation were noted on the insole of the right foot. (c and d): Dermoscopy of the forearm and arm lesions showing multiple white globules surrounded by reddish circles and hemorrhagic crust surrounded by reddish-white area (polarised mode, Dermlite DL 5, 10× magnification)Figure 2: (a): Multiple hypopigmented and a few erythematous papules on the dorsum of the right hand. (b) Dermoscopy of the linear patch showing structureless red areas with peripheral scaling with multiple scattered brown dots. (polarised mode, Dermlite DL 5, 10× magnification)Figure 3: Isolated jelly fish identified as Lobonemoides robustusJellyfish are marine creatures of the phylum Cnidaria, sharing the cnidocyte (stinging cell) with a nematocyst (intracellular organelle).[1] The cnidocyte discharges its nematocysts into the victim, thereby injecting venom.[1] The venom is composed of proteinaceous porins, neurotoxic peptides, bioactive lipids, and small molecules that have cytotoxic, cytolytic, hemolytic, and antigenic properties.[1] Most common Cnidarian stings are from five major classes, namely, Staurozoa (Stauromedusae), Scyphozoa (true jellyfish), Hydrozoa (Portuguese Man O’ War, fire corals and hydroids), Cubozoa (box jellyfish), and Anthozoa (sea anemones and true corals).[3] Skin reactions can be acute, chronic, recurrent, and delayed. Acute lesions can be painful and reveal linear, urticarial, or vesiculopustular patterns.[4] Delayed and recurrent reactions are pruritic and usually occur weeks to months after contact. They are due to the immunological T-cell-mediated mechanisms from sequestered antigens, anti-jellyfish immunoglobulins.[4,5] Other reactions include lichen planus-like eruptions, erythema nodosum, localized hyperhidrosis, gangrene, limb necrosis, contractures, lymphadenopathy, localized fat atrophy, keloids, retractile scars, scarring, hyperpigmentation, and lichenification.[1,4] Serious complications include peripheral arterial spasm and compartment syndrome.[2] Life-threatening stings can be from Indo-Pacific box jellyfish.[2] Death can occur due to arrhythmia and electrolyte imbalances.[6] Dermoscopic features of jellyfish dermatitis are brown dots (entry point of nematocyst) connected by lines “Chinese letter pattern,” pinpoint brown crusts (deep dermal penetration of nematocyst), and red dots in a background of pinkish hue, dotted vessels, linear purpura (extravasation of erythrocytes), reticular telangiectasia, serpentine ulcers and circular milky red areas (due to the dermonecrotic effects).[1] The brown pigmentation is due to the exogenous pigment located on the “warts” in the exumbrella and from oral arms of jellyfish (P. noctiluca) or due to dispersion of epidermal melanin in the necrotic content of vesicles.[1] A cellophane tape applied to the sting site or skin scrapings suspended in saline can aid in the visualization of nematocysts.[1] Histopathology shows parakeratosis, spongiosis, intraepidermal serum crust and vesicle formation, irregular acanthosis, exocytosis of neutrophils and lymphocytes, superficial and deep perivascular and periadnexal lymphohistiocytic infiltrate, admixed with interstitial eosinophils and neutrophils.[5] The goal of therapy is to prevent further nematocyst rupture since only 10%–20% of the nematocysts are activated initially.[6] Aluminum sulfate (20%) is beneficial in the inactivation of residual nematocysts.[6] Other options include rinsing the affected area with acetic acid (4%–6% for 30 sec) or seawater. The application of warm water is beneficial for the thermolabile Portuguese man of war, due to the denaturation of proteins. Washing with drinking water (depolarization of nematocysts) and compression bandages or stockings (activation of nematocysts) should be avoided.[5,6] The treatment options include topical steroids, tacrolimus and oral antihistamines.[4] Tacrolimus is preferred for patients with prolonged granulomatous reactions.[6] Intravenous administration of anti-venom has been developed from the serum of hyperimmunized sheep for life-threatening cardiovascular reactions.[6] Histopathological examination was not performed in these patients since they did not consent to the procedure; hence, dermoscopy-histopathology correlation could not be done. Patients presented 5 days after the onset of lesions, during which the early dermoscopic findings could have changed. Since jellyfish stings have a wide clinical spectrum of presentation ranging from mild dermatitis to fatal life-threatening conditions, prompt identification, treatment, and monitoring must be ensured by clinicians. This case report highlights the need for dermoscopy in the identification of jellyfish dermatitis and distinguishing it from other contact dermatitis, even in the absence of any other supporting evidence. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Use of artificial intelligence (AI) We confirm that AI was not used in any aspect during the manuscript preparation.
Language: English
Subfield: Paleontology
Field: Earth and Planetary Sciences
Domain: Physical Sciences
Open Access status: diamond
OpenAlex ID: W7128514400