Cutaneous reaction to sea urchin spines

A 35-year-old male returned from vacation in Hawaii where he went scuba diving and snorkeling. While snorkeling, he stepped on a sea urchin and sustained injuries to the dorsal aspect of his right foot. He began to swim back to shore when he felt significant pain and began removing visible spines when he reached shore. He saw a physician in Hawaii who removed remaining spines and started a treatment regimen of cephalexin 500 mg QID. Patient followed up 2 weeks later with his home dermatologist for persistent granuloma and was given 15-day course of oral doxycycline 50 mg BID with near full recovery within 2 weeks. Even physicians practicing inland need to be aware of coastal injuries and reactions as they can mimic other common skin tumors such as keratoacanthomas.