This 42-year-old man went scuba diving in Thailand. At 5 meters he stopped to decompress but got caught in a strong under water current. He grabbed the nearby fire coral with his bare hands to stop being swept away. Minutes later he had small itchy vesicles and hives on the dorsum of his hands but not his palms. That night the lesions turned red, increased in size and became very painful. The lesions are very tender to touch. No systemic symptoms were reported. These images were taken 2 weeks after the incident at the dermatology outpatient department in Hammersmith Hospital, London . Management included topical clobetasol propionate 0.05% cream (Dermovate) for 60 days, systemic antihistamines, and analgesics.
The granulomatous lesions are thought to be due to the calcium carbonate deposited from the tentacles of fire coral which leads to a prolonged inflammatory reaction.
violaceous 5 mm-1.5 cm flat topped well demarcated papules and plaques