Treatment for Hydroid stings - it works!

[DandyDon]

Hey Don Donaldo,

Pretty much is, especially as regards marine envenomations.

Regards,

DocV

Thanks. I do get confused at times, but I was pretty sure you had. Stopped carrying it. It did get good at the time once when I got a sting on my forehead (scab & scar lasted a month) but that probly just the wet, cooling effect.

 

[vlkr]

had problem once on coz. put bacitration on one area and left another untreated. treated area cleared up faster.

 

[DocVikingo]

had problem once on coz. put bacitration on one area and left another untreated. treated area cleared up faster (sic)

Hi vlkr,

"Bacitracin" would not be expected to be effective as a primary treatment for marine envenomations caused by fire coral, stinging hydroids, juvenile thimble jellies and the like. Immediate flushing with copious of household vinegar (5% acetic acid solution) is the first step, followed by regular application of a steroid or antihistamine cream. However, Bacitracin could be useful in preventing infection, thus potentially resulting in a treated area "clearing up" faster than an untreated one.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[PineNut]

had problem once on coz. put bacitration on one area and left another untreated. treated area cleared up faster.

The bacitracin ointment induces more rapid healing due to its petroleum jelly base. The occlusive property of ointments promotes wound healing by keeping the skin waterproof and allow granulation tissue to grow more effectively. You would find the same result using petroleum jelly. Hydrocortisone ointment is more effective for these injuries for the same reason, where hydrocortisone cream is not effective.

The risk of using over the counter antibiotic ointments is that many individual (1 to 2%) are allergic to neosporin or bacitracin. A large number are also allergic to topical diphenhydramine (Benadryl). Petroleum jelly actually works better than topical over the counter antibiotics on skin wound (http://www.medscape.com/viewarticle/551354_4).

A good topical antibiotic is mucopuricin (Bactroban) ointment, especially now that MRSA's are quite common. Altabax is also good for skin infections, unfortunately, it is very painful and irritating to open wounds. Both are prescription only.

 

[Jaeger45]

Having just got nailed by the hydroid in Cozumel at Eagle Ray Alley, I would attest to delayed symptoms being prominent. Stinging at the moment of impact, fine days 1-5, day 6 I'm feeling some itching and irritation.

I did a little searching, and found this article....hmmmm.
First aid treatment of the sting from the hydroid <IT>Lytocarpus philippinus</IT>: the structure of, and <IT>in vitro</IT> discharge experiments with its nematocysts
Suggests that, unlike jellyfish stings, hydroid stings may be ACTIVATED by vinegar.

 

[DocVikingo]

Hi Jaeger45,

Thanks for posting the interesting article on a single type of stinging hydroid found in the tropical Indo-Pacific, Lytocarpus philippinus, and studied in a lab setting.

This piece nothwithstanding, the following by Dr. Paul S. Auerbach, a recognized expert in the treatment of marine envenomations, probably represents the best lay guidelines available to date for the treatment of jellyfish and stinging hydriod run ins:

"Hot Water for Jellyfish Stings

August 15, 2009
Paul Auerbach, M.D.

There are multiple therapies recommended for field therapy (first aid) for jellyfish stings. These include topical decontaminants, such as vinegar (acetic acid), rubbing alcohol, papain, citrus juice, ammonia, and others; rapid decontamination combined with removal of nematocysts (by scraping, shaving, or abrasion); application of ice or cold packs; and application of heat. In addition, there is the consideration of therapy for an allergic reaction to jellyfish venom(s).

Application of heat, in the form of hot water "to tolerance" (non-scalding) is a relatively new therapy, in comparison to others that have been recommended for years in one form or another. The major proponents for this therapy are Australians, who have observed and evaluated this therapy clinically, predominately in victims of the Australian species of man-of-war jellyfishes. Their observations have been that this therapy is very helpful, as the victims improve clinically, particularly in showing relief from pain.

I am encouraged by this finding, and hope that it proves to be true over the long haul, and not just until it falls out of favor based upon some new recommendation. So, until further notice, here is general advice about how to manage a jellyfish sting:

The following is recommended for all unidentified jellyfish and other creatures with stinging cells, including the box jellyfish, Portuguese man-of-war (“bluebottle”), Irukandji, fire coral, stinging hydroid, sea nettle, and sea anemone:

1. If the sting is felt to be from the box jellyfish (Chironex fleckeri), immediately flood the wound with vinegar (5% acetic acid). Keep the victim as still as possible. Continually apply the vinegar until the victim can be brought to medical attention. If you are out at sea or on an isolated beach, allow the vinegar to soak the tentacles or stung skin for 10 minutes before you attempt to remove adherent tentacles or further treat the wound. In Australia, surf lifesavers (lifeguards) may carry antivenom, which is given as an intramuscular injection at the first-aid scene. There is recent discussion in the medical literature about whether or not antivenom against box jellyfish as currently administered to humans is beneficial. Until further notice, it is likely to be used by clinicians. Notably, the pressure immobilization technique is no longer recommended as a therapy for jellyfish stings.

2. For all other stings, if a topical decontaminant (vinegar or isopropyl [rubbing] alcohol) is available, pour it liberally over the skin or apply a soaked compress. Some authorities advise against the use of rubbing alcohol on the theoretical grounds that it has not been proven beyond a doubt to help. However, many clinical observations support its use. Since not all jellyfish are identical, it is extremely helpful to know ahead of time what works against the stinging creatures in your specific geographic location. For instance, vinegar may not work as well to treat sea bather’s eruption, which is commonly seen in certain Mexican coastal waters; a better agent (also subject to some differing opinions) may be a solution of papain (such as unseasoned meat tenderizer). For a fire coral sting, citrus (e.g., fresh lime) juice that contains citric, malic, or tartaric acid may be effective, with emphasis on the word "may."

Until the decontaminant is available, you can rinse the skin with seawater. Do not rinse the skin gently with fresh water or apply ice directly to the skin, as these may worsen the envenomation. A brisk freshwater stream (forceful shower) may have sufficient force to physically remove the microscopic stinging cells, but nonforceful application is more likely to cause the stinging cells to discharge, increasing the envenomation. A nonmoist ice or cold pack may be useful to diminish pain, but take care to wipe away any surface moisture (condensation) prior to its application.

As I mentioned above, observations from Australia suggest that hot (nonscalding) water application or immersion may diminish the sting of the Portuguese man-of-war from that part of the world. The generalization of this observation to treatment of other jellyfishes, particularly in North America, should not automatically be assumed, because of the fact that application of fresh water worsens certain envenomations. However, the concept is intriguing, and I intend to try it the next time I am stung if hot water is available. (How hot is hot? The upper limit of temperature should be 113 degrees Fahrenheit or 45 degrees Centigrade.) Otherwise, I will continue to use vinegar (e.g., StingMate) or another of the useful topicals.

3. Apply soaks of vinegar or rubbing alcohol for 30 minutes or until pain is relieved. Baking soda powder or paste is recommended to detoxify the sting of certain sea nettles, such as the Chesapeake Bay sea nettle. If these decontaminants are not available, apply soaks of dilute (quarter-strength) household ammonia. A paste made from unseasoned meat tenderizer (do not exceed 15 minutes of application time, particularly not upon the sensitive skin of small children) or papaya fruit may be helpful. These contain papain, which may also be quite useful to alleviate the sting from the thimble jellyfish that cause sea bather’s eruption. Do not apply any organic solvent, such as kerosene, turpentine, or gasoline. While likely not harmful, urinating on a jellyfish, or any other marine, sting has never been proven to be effective.

4. After decontamination, apply a lather of shaving cream or soap and shave the affected area with a razor. In a pinch, you can use a paste of sand or mud in seawater and a clamshell.

5. Reapply the vinegar or rubbing alcohol soak for 15 minutes.

6. Apply a thin coating of hydrocortisone lotion (0.5 to 1%) twice a day. Anesthetic ointment (such as lidocaine hydrochloride 2.5% or a benzocaine-containing spray) may provide short-term pain relief.

7. If the victim has a large area involved (an entire arm or leg, face, or genitals), is very young or very old, or shows signs of generalized illness (nausea, vomiting, weakness, shortness of breath, chest pain, and the like), seek help from a doctor. If a child has placed tentacle fragments in his mouth, have him swish and spit whatever potable liquid is available. If there is already swelling in the mouth (muffled voice, difficulty swallowing, enlarged tongue and lips), do not give anything by mouth, protect the airway, and rapidly transport the victim to a hospital."

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[DandyDon]

Having just got nailed by the hydroid in Cozumel at Eagle Ray Alley, I would attest to delayed symptoms being prominent. Stinging at the moment of impact, fine days 1-5, day 6 I'm feeling some itching and irritation.

I did a little searching, and found this article....hmmmm.
First aid treatment of the sting from the hydroid <IT>Lytocarpus philippinus</IT>: the structure of, and <IT>in vitro</IT> discharge experiments with its nematocysts
Suggests that, unlike jellyfish stings, hydroid stings may be ACTIVATED by vinegar.

There was an article in the DAN magazine a year or so ago discouraging vinegar for other than the Indo-Pacific box jelly (the Caribbean box jelly is totally different), however - their magazine articles often disagree with each other and do not reflect official DAN advice.

DocVikingo's comments are always well thot out and beneficial, so I am going to rethink the vinegar idea. My problem is I generally don't see what got me.

 

[arrowcrab]

Hi there,

If you are on this thread, sucks to be you. You've probably been stung by a hydroid. Well, join the club. I got stung about 10 days ago as the back of my hand lightly brushed a hydroid that was attached to the side of a wreck, and all the dermatologists in my area are all booked up, so I had to fend for myself. I finally found something that works, thanks to the help of this thread, and I wanted to share what I'm doing. (Before finding the solution, my hydroid rash was spreading, very red and angry, and very itchy!)

DISCLAIMER: I am not a medical professional, just a diver that got stung by a hydroid. This information is for hydroid stings only, not jellyfish stings, fire coral stings, etc. If you want to try this stuff on other types of stings, it is at your own risk.

What works:
Cleansing the area often with Hydrogen Peroxide. Anytime you are not cleansing it, it should be covered with calamine.

What DID NOT work (for me):
Plain soap & water
Vinegar
Hydrocortisone
Clobetasol Propionate Ointment (made it worse - puffier and itchier)
Ammonia
Bacitracin

My routine (AM, midday & before bed):
1. With a saturated cotton ball, cleanse area with hydrogen peroxide, let dry.
2. Repeat step 1.
3. Repeat step 1.
4. Thoroughly saturate a cotton ball with calamine lotion, apply to area. Let dry.
5. Repeat step 4, adding a second layer.
6. Wrap the area loosely with gauze from a roll, using first aid tape to secure it. It should be breathable. Why? A few reasons. First, the sting is gross-looking to people. Second, your hand (or whatever body part) is covered in calamine lotion and that will rub off onto your clothes/furniture if it's not covered, making your clothes look like they have chalk-marks on them. Plus if the calamine doesn't stay on the area, what's the point? And third, if you scratch the area, and you will try to (even absentmindedly), the gauze protects your rash from your fingernails which can spread bacteria into the irritation site. (At bedtime I skip the gauze and just put a sock on my hand)

In a nutshell, you want to use products that are going to dry out the little welts. If you are using petroleum-based stuff, lotions, etc., well, that's hydrating all those little welts and they can't shrink and dissipate if you're doing that.

Now the vinegar I would recommend at the time of the sting, as that's the recommended first aid treatment and it kills the little hydroid residuals that may be still on your skin (even if you can't see them). I was on a dive boat, so I did ask the crew member to dump white vinegar on my hand. The rash was not bad at that time, just a few little red bumps, but over time it did spread.

I'd recommend the soap & water for in between the treatments, of course. Keeping any injury clean is a great idea, and using soap & water on my hand in the shower neither made it better or worse. But at least it was clean

My sting went through a few stages: It started with a few little red bumps. Then the rash area got larger, puffier, itchier, and redder. After I found my little treatment as posted above, all the little welts shrank, became a slightly darker red (vs the angry bright red as before), eventually lightening up as they disappeared back into my skin over time.

What did it feel like when the hydroid stung me? It didn't hurt & it didn't itch. Was more of a sensation. Almost like a slight tingle? I describe it to people who ask, it's like if you've ever touched insulation - you know that little irritation-type feeling you get. It's like that.

The hydroid looked just like a plant. It was swaying in the current, tan in color, almost feathery-looking. Didn't look harmful at all. HA! Well it didn't like me. Of course I didn't touch it on purpose. I was on a wreck with a strong 3 knot current, and the current kinda pushed me back, and the back of my hand happened to brush the hydroid. And yes, I know what you guys are thinking.. and that is my fault. I forgot my gloves on the boat.

I really hope this info is helpful to you all.

Sincerely,

Arrowcrab

 

[buff]

N=1. Not a study. But whatever works!...the placebo effect is 30% of any medication. I did sit on fire coral when in Cozumel. I was wearing only a Speedo and helping a young beauty with her.....trim...IN THE WATER THAT IS....when we(I) hit bottom...more like my bottom hit the fire coral!!!...yeooow!

It is something to keep aware of. I found personally, that numerous margaritas and regae music helped ease the pain. As for the beautiful lovely...we never saw each other after that trip.....but I had the fire coral burn as a reminder of our time spent together.