title: Efficacy of Topical Treatments for Chrysaora chinensis Species: A Human Model in Comparison with an In Vitro Model.
abstract: OBJECTIVE
  This study sought to create a model for testing topical treatment of jellyfish stings. It sought to determine which treatments 1) stimulate/inhibit nematocyst discharge; 2) decrease pain; and 3) decrease skin inflammation; it also sought to discover whether there is a clinical correlation between stimulated nematocyst discharge observed in vitro to the pain and erythema experienced by humans stung by a particular species of jellyfish, C chinensis.
  
  
  METHODS
  Chrysaora chinensis stung 96 human subjects, who were then treated with isopropyl alcohol, hot water, acetic acid, papain meat tenderizer, lidocaine, or sodium bicarbonate. Pain and erythema were measured. In a separate experiment, nematocysts were examined microscopically after exposure to the same topical treatments used in the human experiment.
  
  
  RESULTS
  Forearms treated with papain showed decreased mean pain over the first 30 minutes after being stung, relative to placebo, although only by a small amount. The other topical treatments tested did not reach statistical significance. Sodium bicarbonate may reduce erythema after 30 minutes of treatment; sodium bicarbonate and papain may reduce erythema at 60 minutes. The other topical treatments tested did not reach statistical significance. Nematocyst discharge in vitro occurred when tentacles of C chinensis were exposed to acetic acid or isopropyl alcohol. Sodium bicarbonate, papain, heated water, and lidocaine did not induce nematocyst discharge.
  
  
  CONCLUSIONS
  Papain-containing meat tenderizer used as a topical treatment for C chinensis stings may decrease pain. Although there is published experimental support for the concept that in vitro nematocyst discharge correlates with in vivo human pain perception, no definitive randomized controlled trial, including ours, has yet provided incontrovertible evidence of this assertion. Despite this study's limitations, it presents a viable basis for future human studies looking at the efficacy of topical treatments for jellyfish stings.
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs CeClerck, Bailey, Craig, and P. Auerbach; Ms Lin; and Ms L. Auerbach). Electronic address: mpdeclerck@gmail.com.
authors.forename: Matthieu P
authors.initials: MP
authors.lastname: DeClerck
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs CeClerck, Bailey, Craig, and P. Auerbach; Ms Lin; and Ms L. Auerbach).
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Bailey
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs CeClerck, Bailey, Craig, and P. Auerbach; Ms Lin; and Ms L. Auerbach).
authors.forename: David
authors.initials: D
authors.lastname: Craig
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs CeClerck, Bailey, Craig, and P. Auerbach; Ms Lin; and Ms L. Auerbach).
authors.forename: Michelle
authors.initials: M
authors.lastname: Lin
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs CeClerck, Bailey, Craig, and P. Auerbach; Ms Lin; and Ms L. Auerbach).
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Auerbach
authors.affiliation: Oregon Health and Science University School of Medicine, Portland, OR (Ms Linney).
authors.forename: Olivia
authors.initials: O
authors.lastname: Linney
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, CA (Mr Morrison).
authors.forename: Doug E
authors.initials: DE
authors.lastname: Morrison
authors.affiliation: Division of Husbandry, Monterey Bay Aquarium, Monterey, CA (Mr Patry).
authors.forename: Wyatt
authors.initials: W
authors.lastname: Patry
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, CA (Drs CeClerck, Bailey, Craig, and P. Auerbach; Ms Lin; and Ms L. Auerbach).
authors.forename: Paul S
authors.initials: PS
authors.lastname: Auerbach
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D001733:Bites and Stings / Q000628:therapy*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058894:Nematocyst / Q000502:physiology*; D059408:Pain Management / Q000379:methods*; D037401:Scyphozoa / Q000502:physiology*; D012867:Skin / Q000473:pathology; D013045:Species Specificity; D055815:Young Adult