Health Library Marine Stings and ScrapesFrom Healthwise

Walking on a beach or swimming in the ocean can be fun and relaxing. But just like any other activities, accidents can happen. This topic will help you determine the next steps to take if you have a jellyfish or Portuguese man-of-war sting, seabather's eruption, or a coral scrape.

Stings

Jellyfish and Portuguese man-of-wars are members of a large group of venomous marine animals that also includes fire coral and sea anemones. They are present all over the world and cause injury and illness through the release of venom when their tentacles come in contact with skin (stinging). While the sting of a jellyfish or Portuguese man-of-war can cause severe illness and extreme pain, documented deaths are rare.

Jellyfish are often present in coastal waters, having been brought ashore by winds or ocean currents. They are most common in warm ocean waters, especially along the Atlantic coast of the United States. Stings result from contact with the tentacles, which trail from the jellyfish's see-through body. Jellyfish swimming in the water are often hard to see. Beached jellyfish, which may look like the cellophane wrapper from a cigarette pack, can sting if touched.

Jellyfish stings cause immediate, intense pain and burning that can last for several hours. Raised, red welts develop along the site of the sting, which may look as if you have been hit with a whip. The welts may last for 1 to 2 weeks, and itchy skin rashes may appear 1 to 4 weeks after the sting. Fortunately, most jellyfish stings are not severe. Extensive stings, allergic reactions, or severe toxic reactions are not common but do occur. To avoid the risk of drowning, swimmers should get out of the water as soon as they realize they have been stung.

The box jellyfish, which is found in the Indian Ocean and South Pacific, can cause a fatal reaction. It is the only jellyfish for which a specific antidote (antivenin) exists. Administration of this antivenin may be lifesaving.

Seabather's eruption is a rash that develops from the stings of jellyfish or sea anemone larvae. The rash can be quite itchy and annoying, but usually goes away without medical treatment in 10 to 14 days.

Portuguese man-of-wars (hydrozoans) live in warm seas throughout the world but are most common in the tropical and subtropical regions of the Pacific and Indian oceans and in the Gulf Stream of the North Atlantic Ocean. They float on the surface of the water with their long, stinging tentacles trailing in the water below. Detached tentacles that wash up on the beach may remain dangerous for months.

Portuguese man-of-war stings produce immediate burning pain and redness where the tentacles touched the skin. The affected area develops a red line with small white lesions. In severe cases, blisters and welts that look like a string of beads may appear. Stings that involve the eye may cause pain, swelling, excessive tears, blurred vision, or increased sensitivity to light. Severe reactions are most likely to occur in children and small adults. Severe toxic reactions to the venom can also occur.

Coral scrapes

Coral scrapes and cuts are common injuries that may occur when you walk on a beach or swim, snorkel, or dive in warm water. Coral polyps, the soft living material that covers the surface of coral, can be easily torn away from the rigid and abrasive structure underneath if you touch, bump, or fall on coral. A skin infection may develop when small pieces of coral, other debris, and bacteria get inside the wound. Scrapes and cuts from sharp-edged coral may take weeks or even months to heal.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a doctor.

• Unconsciousness occurs.
• Shock occurs:
  • In children.
  • In adults and older children.
• Moderate to severe difficulty breathing occurs:
  • In children.
  • In adults and older children.
• An uncontrolled jerking of muscles (seizure) occurs. Note: Protect the person from harm during the seizure.
• Inability to move an arm or leg (paralysis) occurs.
• Rapid swelling of the throat or tongue occurs, causing difficulty swallowing or the feeling of a lump in the throat.
• The person had a severe allergic reaction (anaphylaxis) from a sting in the past, and similar symptoms are developing.

Note:

Use an allergy kit prescribed by your doctor if: Your symptoms are severe. You have a kit immediately available. You have been instructed how and when to use an allergy kit. You have had a severe reaction from a jellyfish or Portuguese man-of-war sting in the past, and you are beginning to have symptoms of a similar reaction.

Note: Do not use the kit if you do not have any symptoms of an allergic reaction now even if you had a severe reaction in the past.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

	Yes	Are you having a serious reaction to a jellyfish or Portuguese man-of-war sting?
When to See a Doctor See significance of a serious reaction to a sting if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have mild difficulty breathing or wheezing that is getting worse? Yes Do you have severe pain? Yes Are you having trouble walking or standing? Yes Do you feel weak all over? Yes Do you feel very sleepy or are you having a hard time staying awake? Yes Do you have a fever of 104 °F (40 °C) or higher? Yes Do you think that you have a high fever, but you are unable to measure your temperature? Yes Have you had sudden swelling that is rapidly increasing at the site of the sting or anywhere else, such as swelling across 2 large joints? Call your health professional today if you answer "Yes" to any of the following questions. Yes Have you vomited 3 or more times within 1 hour of being stung? Yes Do you have a fever? Yes Do you have moderate pain? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had vomited 3 or more times in 24 hours, but you are still able to keep down some fluids or food? Yes Have you had vomiting that comes and goes for longer than 48 hours and is getting worse? Yes Have you had mild pain for 48 hours or longer? Yes Have you had muscle spasms, muscle cramps, joint pain, or aching all over for 48 hours or longer? Yes Have you had symptoms of mild dehydration for 48 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you been stung in the eye?
When to See a Doctor See significance of eye symptoms following a sting in the eye if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have any eye symptoms that have lasted for more than 30 minutes after being stung in the eye? Call your health professional today if you answer "Yes" to the following question. Yes Have you been stung in the eye, but you do not have symptoms of blurred vision or eye pain? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have a skin infection at the site of the sting or coral scrape?
When to See a Doctor See significance of a skin infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease or take medicine that causes problems with your immune system? Yes Do you have red streaks extending from the site of the sting or scrape? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased pain, swelling, redness, or warmth around the site of the sting or scrape? Yes Is the area around your wound increasingly tender to the touch? Yes Do you have pus in or around the site of the sting or scrape? Yes Do you know or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around the site of the sting or scrape for 48 hours or longer? Yes Have you had swollen lymph nodes in the neck, armpit, or groin for 1 week or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you developed an itchy rash or deep sores after a jellyfish or Portuguese man-of-war sting or after swimming in the ocean with jellyfish?
When to See a Doctor See significance of an itchy rash and deep sores if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have severe itching? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild to moderate itching for 48 hours or longer? Yes Have you had a rash or deep sores from a sting for 1 week or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot after getting a scrape or sting?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Are you worried that the scrape or sting area has gotten dirty and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment can help ease your discomfort and prevent other problems.

Jellyfish and Portuguese man-of-war stings

• Do not rub the tentacles with your hands, a towel, sand, or clothing.
• Soak a compress in household vinegar (5% acetic acid solution) and hot water. Apply to the affected area to prevent further stings.
• If vinegar is not available, rinse the area with large amounts of salt water. Do not use fresh water; this may cause the tentacles to release venom. Do not use urine, gasoline, kerosene, or turpentine.
• Rinse eye stings with a saline solution, such as Artificial Tears. Do not put vinegar, alcohol, or any other "stinger solution" in the eyes. The skin around the eye can be dabbed with a cloth soaked in vinegar, but you must be extremely careful not to get any of the solution in the eye.
• If vinegar is not available, unseasoned meat tenderizer, baking soda, or one-quarter-strength household ammonia may be useful for treating jellyfish stings. Be careful not to get these products in your eyes. Meat tenderizer or baking soda may be sprinkled directly onto the affected area or made into a paste by adding water and then applied to the skin. Apply meat tenderizer to the skin for no longer than 15 minutes. Soak a cloth in ¼ cup (60 mL) ammonia mixed with ¾ cup (180 mL) water and apply it to the affected area.
• After decontamination, pick off tentacles with a stick or your hand protected by a towel or glove. Be very careful not to rub or press the tentacles.
• If it is available, apply a lather of shaving cream or soap, or a paste of baking soda, flour, or talc to the skin. The stinging cells will stick to the shaving cream or paste and can then be easily scraped off with a safety razor, a knife edge, or the edge of a credit card.
• Take an antihistamine, such as diphenhydramine or chlorpheniramine, or apply 1% hydrocortisone cream to help control itching. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area in children younger than age 12 unless your doctor tells you to. Also, don't give antihistamines to your child unless you've checked with the doctor first.
• Use an ice pack to help relieve pain.
• Clean any open sores 3 times per day, apply an antiseptic ointment, such as bacitracin, and cover with a light bandage.

Seabather's eruption

• Do not rub your skin. If larvae are on your skin, rubbing will cause them to sting.
• Remove your swimsuit as soon as possible. Since larvae can become trapped in the fabric of your suit, it is important to remove a contaminated suit to prevent more stings.
• If available, rinse in household vinegar (5% acetic acid solution) or rubbing alcohol (40%–70% isopropyl alcohol).
• Shower with fresh water. Apply soap and vigorously scrub your skin. Do not shower with a contaminated suit on. If larvae are trapped in the fabric of a suit, a freshwater shower will cause the larvae to sting.
• Take an antihistamine, such as diphenhydramine or chlorpheniramine, or apply 1% hydrocortisone cream cream to help control itching. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area in children younger than age 12 unless your doctor tells you to. Also, don't give antihistamines to your child unless you've checked with the doctor first.
• Use an ice pack to help relieve pain.
• Wash the rash with soap and water daily.

Coral scrapes and cuts

Most minor coral scrapes or cuts can be treated at home.

• Wash the wound for 5 minutes with a soft brush or towel and large amounts of warm water and soap (mild dishwashing soap, such as Ivory, works well). Cleaning the wound as soon as possible may reduce the risk of infection, scarring, and tattooing of the skin from coral material left in the wound. See how to clean a wound.
• After washing, rinse the wound with a large amount of fresh water.
• After rinsing with fresh water, rinse the wound again with a solution of one-half hydrogen peroxide and one-half water.
• After rinsing with a solution of one-half hydrogen peroxide and one-half water, rinse again with fresh water.
• Stop mild bleeding with direct pressure to the wound. See how to stop bleeding.
• Use an antibiotic ointment, such as polymyxin B sulfate (for example, Polysporin) or bacitracin. Put the ointment lightly on the wound. The ointment will keep a bandage from sticking to the wound. Be sure to read the product label about skin sensitivity. If a skin rash or itching under the bandage develops, stop using the ointment. The rash may mean you had an allergic reaction to the ointment. Antibiotic ointments that contain neomycin may have an increased risk of causing an allergic reaction.
• Consider bandaging the wound. You may need to protect your wound from getting dirty or irritated. If available, use a nonstick dressing. Be sure to read the product label for correct use.
  • Clean the wound thoroughly before bandaging it to reduce the risk of infection occurring under the bandage.
  • Apply a clean bandage when it gets wet or soiled to further help prevent infection.
  • If a bandage is stuck to a scab, soak it in warm water to soften the scab and make the bandage easier to remove.
• Watch for symptoms of a skin infection.
• Be patient. Coral scrapes and cuts may take weeks and sometimes even months to heal completely.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate the symptoms if any of the following occur during home treatment:

• Lips, tongue, or throat swell.
• Symptoms of a severe reaction develop.
• Symptoms of a skin infection develop.
• A rash develops.
• Symptoms become more severe or frequent.

You can limit your risk of being injured by jellyfish, a Portuguese man-of-war, or coral.

• Be familiar with the likely marine risks in the area where you plan to swim, snorkel, or dive. If you are traveling, obtain information about the local conditions.
• Be prepared with first aid supplies that might be needed for a injury.
• Watch for warning signs that are posted when there is a jellyfish or Portuguese man-of-war invasion.
• Do not touch jellyfish, Portuguese man-of-wars, or coral.
• Watch out for jellyfish and Portuguese man-of-wars in the water, particularly when there are strong onshore winds.
• Stay out of the water when jellyfish and Portuguese man-of-wars are present. Look out for the bluish floats of the Portuguese man-of-war, and avoid the poisonous trailing tentacles.
• Watch for beached jellyfish and Portuguese man-of-wars. Their tentacles may still sting.
• Do not rely on clothing or on coating the skin with petroleum jelly (such as Vaseline) to prevent stings. Wear a wet suit to reduce your risk of getting stung.
• Wear protective shoes when walking on the beach. Avoid stepping on marine life.
• Avoid swimming or snorkeling in swallow water, where touching or bumping into coral might occur.
• Wash your swimsuit with detergent and heat-dry after use. This will kill the stinging larvae that cause seabather's eruption.
• Talk to your doctor about carrying an allergy kit if you have had any sort of allergic reaction or toxic reaction to a marine sting in the past.
• Consider using a topical jellyfish sting inhibitor lotion, such as Safe Sea.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• What are your main symptoms?
• When did your symptoms begin? How have your symptoms developed, progressed, or changed since the sting?
• Do you know what you were stung by? Can you describe what stung you? Note: Bring a sample of the stinging organism with you if you can safely do so. A sample may help your doctor plan your treatment.
• When were you stung? How many times were you stung?
• Where were you when you were stung?
• Have you ever had an allergic reaction or a severe (toxic) reaction to a similar sting?
• What steps have you tried at home to take care of this problem? Did they help?
• Do you have any health risks?

Author:	Jan Nissl, RN, BS	Last Updated: September 24, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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