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hallmark lesion of arthropod bite Papular urticaria
Papular urticaria: increased risk of secondary infxn
Papular urticaria usually due to: flea, mosquito, bedbug
Black widow: how often do bites cause serious rxn: 25%
R-I-C-E for spider bites: minimizes inflammation & slows enzyme activity
Scorpion sx immediate sting, followed by paresthesia
Scorpion effects systemic > local (neurotoxin)
Scabies: where prefer areas where skin is thin; if <1 yo: head/scalp/neck
AKA crusted scabies (severe) Norwegian scabies (seen in immunocompromised patients)
Scabies dx is: usually clinical (but also with mineral oil)
Uses stylostome for feeding Chiggers
Chiggers: lesions papules or hives (ankles, backs of knees, groin, axillae)
Tx chiggers hot soapy water, antihistamine, topical steroid
Possible role in rosacea: demodex mite
Tick bite: rxn local, erythema; then induration, nodular; rare tick granuloma (Lyme: erythema migrans = bullseye)
Lyme dz: cutaneous lesions lymphocytoma cutis (European); acrodermatitis chronica atrophicans; both bluish
Chevron shaped bite centipede
Millipede bite: they don’t bite; secrete oily substance, may burn or blister
This may be only sx of body lice pruritus
Head lice: pts often have: cervical adenopathy; scalp pruritus, excoriations
Head lice tx 1% permethrin; retreat in 1 wk
Pubic lice tx 5% permethrin or lindane
These cause more dz than any other arthropod flies
Bedbug lesion: classic: papular urticaria but may be vesicular, eczematous
Bedbug bites: arrangement linear arrangement in clusters (painless bites)
Erucism = caterpillar dermatitis
Lepidopterism: systemic illness with urticaria and airway hypersensitivity
Moth / Butterfly exposure Tx: oral antihistamines, topical ointments w/menthol or camphor, topical c’steroids, oral steroids for severe cases; Remove setae with adhesives
Flea bites: lesions: erythematous macules and urticarial-like papules; Excoriations and secondary infection common
Fleas: Tx for sx topical steroids, oral prednisone for severe urticarial reactions (triamcimolone), antibiotics for secondary infections; advise lesions will be around for a while
Bee/wasp rxns large reactions can develop ~ 6-24 hrs after sting and peak at 48hrs
Diff btw delayed hypersensitivity rxns from stings & cellulitis both are warm; sting: area of induration, not tender; poss slightly pruritic
Fire ant rxn immediate pain followed by wheal & flare reaction (1 hr); sensitized pts may develop striking bullous reaction in an unusual ring shape
Fire ant tx local cleansing, ice, oral antihistamine. Oral steroids for severe cases. Update tetanus if needed
Brown recluse bite: lesion = pale gray sinking macule, slightly eroded in center; halo of tender inflammation/hemo
Scabies & Pediatrics: tx NO LINDANE (KWELL). Permethrin (Elimite) is drug of choice
Scabies adult tx Permethrin ($ > lindane). lindane (some regional resistance). Alt: crotamiton 10% cream; sulfur cream; benzoyl benzoate
Created by: Adam Barnard Adam Barnard