What is the treatment for Seabather's eruption?

Treatment for Seabather's Eruption

The treatment for seabather's eruption is primarily symptomatic, focusing on topical corticosteroids and oral antihistamines to manage the inflammatory response and pruritus.

Clinical Features and Etiology

Seabather's eruption (SBE) is an intensely pruritic, papulo-erythematous dermatitis that occurs predominantly in areas covered by swimwear after exposure to marine water 1. The condition is caused by the larvae of cnidarians, most commonly the thimble jellyfish (Linuche unguiculata), though other organisms may be responsible in different geographical regions 2, 3.

Key clinical characteristics include:

• Erythematous papules located almost exclusively under bathing suits 2
• Onset of symptoms within hours of ocean exposure 1
• Severe pruritus that can persist for up to 2 weeks 1
• Possible systemic symptoms, especially in children (fever, chills, headache, nausea) 1

Treatment Algorithm

First-Line Treatment

1. Topical corticosteroids:

   • Apply medium-potency topical corticosteroids to affected areas 2-3 times daily 4
   • For severe cases, consider short courses of higher-potency topical steroids 4

2. Oral antihistamines:

   • First-generation antihistamines (e.g., diphenhydramine) may be more effective due to their sedating properties, which can help with sleep disruption from pruritus 5
   • Non-sedating antihistamines can be used during daytime 5

For Moderate to Severe Cases

1. Short course of systemic corticosteroids may be necessary for severe inflammatory reactions or when systemic symptoms are present 5

2. For secondary bacterial infection:

   • Consider topical antibiotics for limited superinfection 4
   • For more extensive infection, oral antibiotics covering Staphylococcus and Streptococcus may be required 4

Supportive Measures

1. Immediate post-exposure interventions:

   • Remove swimwear as soon as possible after leaving the water 6
   • Shower with fresh water immediately after ocean exposure 6
   • Wash swimwear thoroughly before reuse 6

2. Symptomatic relief:

   • Cool compresses or oatmeal baths to soothe affected skin 4
   • Calamine lotion or other anti-pruritic preparations 4

Important Considerations

Duration and Prognosis

• The eruption typically resolves spontaneously within 1-2 weeks (average 12.5 days) 1
• Recurrence rate is approximately 4.3% 1

Differential Diagnosis

It's important to distinguish seabather's eruption from:

• Swimmer's itch (cercarial dermatitis)
• Folliculitis
• Acneiform eruptions
• Follicular larva migrans 2

Prevention

• Avoid swimming in areas with known outbreaks
• Remove swimwear and shower immediately after ocean exposure
• Apply waterproof sunscreen, which may provide some barrier protection 6

Treatment Pitfalls to Avoid

1. Misdiagnosis as bacterial infection: The papular eruption may be mistaken for folliculitis, leading to unnecessary antibiotic treatment. Correct diagnosis based on distribution pattern (under swimwear) and history of ocean exposure is crucial.

2. Inadequate symptom control: The intense pruritus can significantly impact quality of life and sleep. Don't undertreat - use appropriate potency corticosteroids and consider sedating antihistamines at night.

3. Delayed treatment: Early intervention with anti-inflammatory medications can reduce the severity and duration of symptoms.

4. Overlooking systemic symptoms: While most cases are self-limited, monitor for systemic manifestations, especially in children, which may require more aggressive treatment.

The management approach should focus on controlling inflammation and pruritus while allowing the condition to run its natural course toward resolution.