What is the best approach for managing skin reactions after jellyfish bites?

Management of Skin Reactions After Jellyfish Stings

For jellyfish stings, the best approach is to first remove any remaining tentacles by lifting or pulling them off while avoiding direct contact with hands, followed by hot water immersion or irrigation to relieve pain. 1

Initial Assessment and Emergency Care

• Monitor for systemic reactions that require emergency services:
  • Difficulty breathing
  • Signs of shock
  • Severe pain 1
  • Facial angioedema
  • Wheezing or respiratory distress 2

Step-by-Step Management Protocol

1. Tentacle Removal

• Remove any remaining tentacles by lifting or pulling while avoiding manual contact
• Alternative: Rinse the affected area with seawater (not fresh water) to remove tentacles if mechanical removal isn't possible 1
• Never use fresh water as it can cause further nematocyst discharge 3

2. Pain Management (in order of preference)

• Primary approach: Immerse affected area in hot water (temperature as hot as tolerated, or approximately 40°C/104°F) for at least 20 minutes or until pain subsides 1
• If hot water immersion isn't possible:
  • Apply a heat source to the affected area 1
  • Use topical lidocaine cream or gel (4-5% or 10-15% formulations) 1
  • Dry hot packs may help (less effective than hot water) 1
  • Dry cold packs as a last resort (least effective option) 1

3. Prevention of Further Nematocyst Discharge

• In the 2010 guidelines, vinegar (4-6% acetic acid solution) was recommended for at least 30 seconds 1
• However, the 2024 guidelines no longer specifically mention vinegar for this purpose, suggesting a shift in recommendations based on newer evidence 1

4. Management of Persistent or Delayed Reactions

• For persistent eczematous lesions, topical treatments like pimecrolimus may be effective 4
• For systemic allergic reactions:
  • Administer subcutaneous adrenaline (0.1mg/kg)
  • Give intravenous hydrocortisone (10mg/kg) 2

What to Avoid

• Do not apply:
  • Fresh water (causes further nematocyst discharge) 3
  • Alcohol or methylated spirits (can discharge unfired nematocysts) 3
  • Pressure immobilization bandages (can cause further venom release) 1
  • Topical applications of aluminum sulfate, meat tenderizer, commercial aerosol products, or papain (less effective for pain relief) 1

Special Considerations

• Reactions may vary from mild skin rash to life-threatening symptoms 5
• Children and allergic individuals may experience more serious systemic reactions 5
• Delayed cutaneous reactions can develop days or months after the initial sting 4
• Geographic location matters - different jellyfish species may require slightly different approaches 3

Follow-up Care

• Monitor for signs of secondary infection
• Watch for development of hyperpigmentation, which may be treated with topical bleaching agents if persistent 5
• For hypertrophic scarring, follow general wound management guidelines 5

This approach prioritizes the most recent evidence-based guidelines while focusing on interventions that reduce morbidity, mortality, and improve quality of life for patients with jellyfish stings.