A case of skin
injuries due to
stings by crown-of-thorns starfish, Acanthaster planci, in a 53-year-old Okinawan woman is reported. She went to a beach to gather shellfish on 8 April 2001 and fell to the ground with her left palm on a crown-of-thorns starfish that happened to be close to her. She hurried to the emergency section of our hospital. An emergency doctor sterilized the
wound and administered an
antibiotic, an
analgesic agent and an injection of a
tetanus antitoxin. He tried to remove the remaining spines from the palm with great difficulty. Because swelling and subcutaneous indurations of the left palm had persisted thereafter, oral and
topical administration of
corticosteroid started on 13 April. Physical examination at the dermatology section revealed approximately 10
stab wounds of the left palm with
pus, subcutaneous
bleeding and many abrasions around them. X-rays of the left hand showed
foreign bodies, 2-10 mm in size, located on the lesions. The patient was treated with a topical injection of 2 mg
triamcinolone acetonide (
Kenacort-A), diluted fivefold with 1%
Xylocaine, once a week. Some of the
foreign body granulomatous lesions improved but
pain and subcutaneous indurations persisted in most of the lesions. Because the X-ray photographs showed many remaining spines, surgical excision to remove them was performed under
local anesthesia 3 months after the injury. All the symptoms improved after the operation. Scanning electron microscopic examination of the spines revealed that their
tips had fragile lattice-like structures.