Sea Urchin Stings
Sea urchins are present worldwide. Most sea urchin injuries result when spines break off in the skin and cause local tissue reactions. Without treatment, the spines may migrate into deeper tissues, causing a granulomatous nodular lesion, or they may wedge against bone or nerve. Joint and muscle pain and dermatitis may also occur. A few sea urchins (eg, Globiferous pedicellariae) have calcareous jaws with venom organs, enabling them to inject venom, but injuries are rare.
Diagnosis is usually obvious by history. A bluish discoloration at the entry site may help locate the spine. X-rays can help when the location is not obvious during examination.
Treatment for a sea urchin sting is immediate removal. Vinegar dissolves most superficial spines; soaking the wound in vinegar several times a day or applying a wet vinegar compress may be sufficient. Hot soaks may help relieve pain. Rarely, a small incision must be made to extract the spine; care must be taken because the spine is very fragile. A spine that has migrated into deeper tissues may require surgical removal. Once spines are removed, pain may continue for days; pain beyond 5 to 7 days should trigger suspicion of infection or a retained foreign body.
G. pedicellariae stings are treated by washing the area and applying a mentholated balm.
Tetanus prophylaxis should be given (see table Tetanus Prophylaxis in Routine Wound Management).