a) Coral cuts should be meticulously cleansed immediately and any foreign particles should be removed.
b) Debridement should be done if necessary.
c) Topical antiseptic or antibiotic agents should be applied.
d) Antihistamines and topical corticosteroids may help relieve pruritus.
e) Surgery may be required to repair full thickness skin burns or necrosis from some types of "fire corals."

a) HOME CRITERIA: Most patients with mild pain and/or trivial wounds from coral exposure can be managed at home with local wound care.
b) OBSERVATION CRITERIA: Patients with significant pain or wounds that require debridement should be referred to a healthcare facility for evaluation and treatment.
c) ADMISSION CRITERIA: Patients with wounds that become secondarily infected, severe burns or skin necrosis should be admitted.
d) CONSULT CRITERIA: Consult a toxinologist, medical toxicologist or poison center for severe stings or if the diagnosis is unclear. Consult a surgeon if full thickness burns or skin necrosis develops.

a) Particulate material in the wound from hard corals can cause secondary infection, if careful wound exploration and debridement is not performed.

a) Onset of pain is generally quite rapid, within 15 minutes. Skin lesions can take several weeks to resolve.

a) Sting from a jellyfish, anemone or fish, OR contact or irritant dermatitis, or zoster.

a) Toxins isolated from certain corals have been shown to have neurotoxic properties in vitro (Ne'eman et al, 1974; (Sorenson et al, 1987). Relevancy to human exposure remains speculative.

a) CASE REPORT: A 45-year-old woman developed a 5-cm area of erythema and tiny fluid-filled blisters after exposure to fire coral (Millepora species) while scuba diving. The lesion resolved over the next 7 days without treatment. Thirteen days after the initial exposure, she developed ankle edema, progressing rapidly during the next 3 days to anasarca. At this point, she developed severe dyspnea and on presentation to the ED, she was severely hypoxic from pulmonary edema (BP 160/80 mg Hg) requiring 7 days of intubation. She also developed nephrotic syndrome and acute renal failure (serum creatinine level 2.4 mg/dL (212 mcmol/L; urine protein excretion of 6.6 g/day). On the day after admission, a percutaneous renal biopsy was consistent with minimal change disease. Following supportive therapy (including prednisone), the edema resolved, and serum creatinine levels decreased. However, proteinuria (protein 6 g/d) was still present 25 days later. Ninety days after the initial exposure, she recovered completely. It is not clear if this was related to her fire coral exposure (Prasad et al, 2006).

a) Toxin from the "stinging coral" or "fire coral" Millepora tenera (actually a hydrozoan) has hemolytic properties in vitro (Wittle & Wheeler, 1974). These venoms have not caused hemolysis in humans.

a) If coral cuts are left untreated, a superficial scratch may within a few days become an ulcer with a septic sloughing base surrounded by a painful zone of erythema. The ulcer may be quite disabling and usually the pain is out of proportion to the physical signs (Auerbach & Geehr, 1983).

a) Contact with the "Fire Coral" may cause immediate pain, local erythema, swelling, and in severe cases, nausea, vomiting and collapse (Sutherland, 1983).
b) CASE REPORT: A 48-year-old woman developed immediate pain and erythema of her arm after brushing against a Catalaphyllia soft coral while feeding aquarium animals. A week later she had papules and small nodules in the area of the sting, and significant pruritus. Three weeks after the sting the eruption was more lichenoid and brownish purple. Skin biopsy showed focal epidermal necrosis, papillary dermal edema and degenerative changes, and mild dermal fibrosis. A variety of treatments were tried (antibiotics, topical steroids, NSAIDs, plastic occlusion) with limited success (Burnett & Pfau, 2002).

a) CASE SERIES: In one series of cases, contact with the fire coral resulted in pruritic, urticaria-like lesions which became erythematous and edematous within minutes. Blisters were seen within 6 hours. The blistering resolved but left papules and plaques which became shiny and lichenoid within 3 weeks. Itching persisted. Resolution took 15 weeks and left residual hyperpigmented macules (Addy, 1991).
b) CASE REPORT: A 45-year-old woman developed a 5-cm area of erythema and tiny fluid-filled blisters after exposure to fire coral (Millepora species) while scuba diving. The lesion resolved over the next 7 days without treatment (Prasad et al, 2006).

a) CASE REPORT: Contact with the "fire coral" Millepora dichomata produced gradual onset of skin necrosis leading to a full thickness burn on the leg of a 20-year-old woman. Contact occurred while diving in the Red Sea. Surgical excision and closure were required (Sagi et al, 1987).

a) Another potential problem of coral cuts is infection by an atypical acid-fast bacillus, Mycobacterium marinum, which produces an anaerobic granulomatous lesion.
b) M. marinum looks like M. tuberculosum, but when cultured, grows at 2 degrees C lower than body temperature (37 degrees C).
c) M. marinum is sensitive to rifampin therapy (Williams & Riordan, 1973).

a) CASE REPORT: A 23-year-old woman cut her left foot on a coral reef, subsequently developing local edema. The patient did not experience any systemic symptoms including fever. Following topical application of a steroid, the cut healed with scarring 7 days later. Two weeks after the cut occurred, the patient began to experience pruritic hives on any location on her body where she scratched herself. The hives would spontaneously resolve 30 to 45 minutes later. A scratch challenge was positive, confirming a diagnosis of dermatographism. The patient was prescribed cetirizine as needed, and on follow-up, 1 year later, the dermatographism had completely resolved (Wu et al, 2006). It is believed that the dermatographism either occurred secondary to the toxins of the coral or to a subclinical infection by an organism associated with corals.