Cutaneous manifestations of the Hemiscorpius lepturus sting: a clinical study

BACKGROUND AND DESIGN: Scorpion stings are a serious problem in Khuzestan, a southwestern province of Iran. In around 5 years, 36,463 patients with scorpion stings have been seen. Most of the patients had no cutaneous findings, but a small group of patients developed various local and generalized skin manifestations. Patients were evaluated in terms of cutaneous findings early in and during the course of their illness. The correlation between the site of the sting and the severity of the cutaneous and systemic problems is discussed. RESULTS: Hemiscorpion (Hemiscorpius) lepturus (HL), which is responsible for more than 10% of the scorpion stings in this area, was found to be the only scorpion with related cutaneous findings. Different species of the Buthidae family, which were responsible for the remaining 90% of scorpion stings, have a neurotropic and noncytotoxic venom and, as a result, induce no cutaneous reaction. CONCLUSIONS: HL venom is cytotoxic, and HL is the only scorpion whose venom induces a toxic reaction. Erythema, purpuric changes, bullae, necrosis, and ulcers, or a combination of these, may be seen at different stages. The site and the severity of the cutaneous reaction may aid in the prediction of the clinical outcome for the patients and in estimating the interval between the sting and presentation.