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