Catfish skin toxin and the venom from their dorsal and pectoral spines may cause a menacing sting. Although these stings are often innocuous, severe tissue necrosis may occur. The hand is the most common site of catfish stings. Two cases of catfish stings of the hand are presented. In one of these cases gangrene of the long and small fingers developed requiring amputation. Symptoms are caused by hemolytic, dermonecrotic, edema-promoting, vasospastic, and lethal components of the venom and skin toxins. Local or regional anesthesia is administered to relieve pain and vasospasm. Empiric intravenous antibiotics are administered to cover common aquatic organisms. Wounds with progressive worsening of erythema, swelling, pain, or cyanosis should be irrigated to wash out residual toxin, and debrided of any retained spine fragments or necrotic tissue.