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Answer to Photo Quiz: Cutaneous lesions on the body

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Seabather´s Eruption
According to the clinical evolution and the complementary tests, the possibility of contact dermatitis was dismissed, as well as other sea dermatoses, and Seabather’s Eruption was stated as the suspected principal diagnosis.
Seabather’s Eruption consists of pruritic papular and erythematous lesions that appear on body areas covered by a swimsuit. Most cases reported belong to geographic areas with warm climates, mainly the Caribbean.1
Clinically, lesions can be urticariform or maculo-papular not converging but grouped, appearing in the first hours after contact with seawater, that tend to resolve themselves spontaneously, but may persist for two to 14 days after initial appearance.

Etiology of these lesions is still uncertain. Scientific literature appoints to the larvae of different species of coelenterate (jellyfish, sea anemone, coral and hydra) who have cells with urticating philaments (nematocistes) that deliver their venom and generate this dermatosis. Swimming suits, due to a mechanical phenomenon, perpetuate the contact between the etiopathogenic agent and the skin, leading to this typical location of the lesions.2 Histopathological studies are in general, unspecific, resembling in many cases, the sting of arthropods. The main differential diagnosis is with swimmer itch (in which uncovered parts of the body are affected after swimming in fresh water), as well as other sea dermatoses (jellyfish sting, contact dermatitis by algae, etc). Similarly, diagnosis may be difficult if symptoms are considered with contact dermatitis due to reactions with the swimsuit fabrics or dyes.
Seabather’s Eruption therapy is symptomatic based on topical corticosteroids and oral antihistamines. There is no way to prevent Seabather´s Eruption except to stay out of the water. Patients should be advised that this condition can worsen in fresh water. An emerging and alarming problem identified by the Dermatological Scientific community is climate change and an increasing number of cases of Seabather´s eruption all along the American Atlantic coast due to an increasing rise of temperatures should be emphasized;3 new cases have also occured in the last few years in the Cantabrian Sea, mainly in summer. Rising temperatures could facilitate the biology and life cycles of these larvae.4

We consider the Seabather´s Eruption knowledge of great interest, not only for the reported cases, but in anticipation of the possibility of a higher number of native cases in the coming years.


  1. Wong DE, Meinking TL, Rosen LB, Taplin D, Hogan DJ, Burnett JW. Seabather’s eruption. Clinical, histologic, and immunologic features. J Am Acad Dermatol. 1994;30:399-406.
  2. Fernández Á, Gregorio J, Ruiz Rodríguez R, Cornejo Navarro P, Acevedo Barbará A, Zomeño Gómez M. Erupción del bañista. Actas Dermo-Sifiliográficas. 1999;90:451-4.
  3. Kaffenberger BH, Shetlar D, Norton SA, Rosenbach M. The effect of climate change on skin disease in North America. J Am Acad Dermatol. 2017;76:140-7.
  4. Díez I, Muguerza N, Santolaria A, Ganzedo U, Gorostiaga JM. Seaweed assemblage changes in the eastern Cantabrian Sea and their potential relationship to climate change. Estuar Coast Shelf Sci. 2012;99:108-20.