A case of coral dermatitis: NEJM case report
A 31-year-old man presented with a 1-week history of pruritic rash on his left foot, which developed after he brushed against coral while snorkeling in the Caribbean Sea. After contact with the coral, he reported the onset of a burning sensation in the foot, which was followed 1 hour later by the development of an intensely pruritic rash. The physical examination revealed an erythematous, cerebriform plaque on the lateral aspect of the left foot.

On the basis of the patient’s history and cutaneous findings, a diagnosis of coral dermatitis was made. Coral dermatitis is a form of contact dermatitis that is caused by numerous species of coral that produce nematocysts, which are specialized organelles that discharge dermatologic toxins. Envenomation may result in both acute and delayed reactions.

Acute reactions are thought to be forms of irritant contact dermatitis and typically present with urticarial or vesiculobullous plaques immediately or within hours after exposure.

Delayed reactions are more likely to be forms of allergic contact dermatitis that are mediated by type I and type IV hypersensitivity reactions and are characterized by firm, localized papules that arise days to weeks after exposure. In rare cases, superficial epithelioid granulomas may be noted on biopsy. The patient was treated with triamcinolone ointment, and the lesion resolved after 2 weeks.

Source: https://www.nejm.org/doi/full/10.1056/NEJMicm1412907
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