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Combination topical agent prevents jellyfish stings.

SNOWMASS, COLO. -- The best product for preventing jellyfish stings is a combination sunscreen/topical jellyfish sting inhibitor called Safe Sea, Paul S. Auerbach, M.D., said at the annual meeting of the Wilderness Medical Society.

"I use the stuff all the time. I think it's a great thing to tell your patients about," added Dr. Auerbach, a surgeon at Stanford (Calif.) University and editor emeritus of Wilderness and Environmental Medicine.

He has conducted published studies evaluating the effectiveness of Safe Sea in blinded volunteers, using conventional sunscreens as a control (Wilderness Environ. Med. 2004;15:102-8). So far, every species of jellyfish against which Safe Sea has been tested has shown at least 90% inhibition of discharge of nematocysts, the tiny barbed venom-filled dartlike organelles that carry a skin striking force of 2-5 PSI. But Safe Sea is not a panacea.

"It will only stay on in the water effectively in a lot of surge for about an hour, so I would never, ever tell anybody to put this on and be comfortable in going into jellyfish-infested water. I would want their skin covered with something mechanical. But for all the people who go in the ocean and don't know if there's jellyfish around and are concerned about being stung, this is the best thing we've got," he continued.

Safe Sea is commercially available from Nidaria Technology Ltd. The product was developed through studies of the chemical composition of the mucus coat of clown fish, which are able to rub against stinging anemones with impunity, said Dr. Auerbach, who disclosed no financial interest in the product.

He said there are probably close to 200 species of jellyfish and other coelenterates that are dangerous to humans. Stings can range in severity from a mild dermatitis to local necrosis to multiorgan involvement. Systemic symptoms can begin immediately or several hours later.

When treating patients who've been stung, the first rule is to anticipate anaphylaxis. "The last two fatalities I was involved with from jellyfish stings were both straightforward anaphylaxis in young people," he said. He advised double-gloving when treating patients to avoid getting stung. As an initial step, the wound should be rinsed with sea water. Avoid using fresh water; it's hypotonic and will cause the remaining nematocysts to fire into the skin. For the same reason, don't let the patient rub the wound.

"There are lifeguards who say they put people under forceful streams of fresh water and that it's an effective treatment for jellyfish stings.... It may well be that the force of the stream is such that the mechanical effect exceeds the chemical effect. But I can promise you that if you take somebody who has a fresh jellyfish sting and you gently pour fresh water on them or you lay a moist ice pack on them, they're likely to just go nuts from the pain. So avoid fresh water," Dr. Auerbach continued.

The best way to interrupt envenomation is by decontamination with vinegar. Many other materials have also been used for this purpose, including ammonia, isopropyl alcohol, powdered bicarbonate, urine, citrus juice, and meat tenderizer--although that's designed to dissolve proteins in meat, so don't leave it on the skin too long or a dermatitis will result. Following decontamination, the next step is to remove any remaining nematocysts by applying shaving cream or soap, then shaving the area. Corticosteroids can then be used as needed to manage the inflammatory response.

The deadliest creature in the sea is the box jellyfish, Chironex fleckeri, which is found off northern Australia, Indonesia, and Malaysia. It is the only jellyfish for which an antivenin has been developed.

In past editions of his book "Medicine for the Outdoors," Dr. Auerbach has suggested use of a pressure-immobilization bandaging technique for sequestration of venom in victims of box-jellyfish stings, but not any longer. "No one has been able to demonstrate it works, and there are some cases where it's thought to make things worse," he said.


Denver Bureau
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Title Annotation:Dermatology
Author:Jancin, Bruce
Publication:Internal Medicine News
Geographic Code:1USA
Date:Nov 1, 2005
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