Bite Reactions Research Articles

Dermatological conditions in military conscripts

Published studies regarding skin conditions in the military are mainly cross-sectional studies from clinical encounters during war campaigns and military training. To determine the incidence and spectrum of dermatological conditions in a cohort of military conscripts in Singapore. Soldiers diagnosed with contact dermatitis (CD) were further analysed for body area involvement, possible occupational and/or environmental causative agent and restrictions issued. Retrospective cohort study. Subjects' diagnoses and demographic variables were extracted from electronic medical records. Medical records of CD cases were reviewed to characterize the nature of exposure and operational impact on training. The incidence of reporting of new dermatological complaints was 24.5 per 100 military conscripts per year. Dermatological conditions with the highest incidence over the period of full-time military service included fungal skin infection (6.7/100 conscripts/year), non-specific dermatitis (4.9/100 conscripts/year) and insect bite reaction (1.8/100 conscripts/year). The annual incidence of contact dermatitis over the same period was 0.4/100 conscripts. In a military population based in the tropics fungal skin infections, non-specific dermatitis and insect bite reactions were the commonest reasons for dermatological consultation. CD incidence was 0.4 per 100 conscripts per year.

Dermatologische Probleme bei Tropenrückkehrern – „banales Häufiges“ und „seltenes, aber Gefährliches“

The most frequently observed skin lesions in travellers returning from tropical countries are insect bite reactions, bacterial skin diseases, creeping eruption and allergic reactions. The article describes these most relevant diseases and their differential diagnosis focussing on the diseases, which are potentially dangerous and which should not be missed, such as resistant staphylococci, chancre of rickettsia or sleeping sickness, cutaneous leishmaniasis or worms, which are not limited to the skin.

Exaggerated Insect Bite Reaction Related to Chronic Leukemia

Exaggerated Insect Bite Reaction Related to Chronic Leukemia

URTICÁRIA PAPULAR BOLHOSA – CASO CLÍNICO E BREVE REVISÃO DA LITERATURA

A urticária papular (UP), também conhecida como prurigo estrófulo, é uma dermatose infantil relati- vamente frequente devida a hipersensibilidade à picada de mosquitos, pulgas, percevejos e outros insetos. Carac- teriza-se pelo aparecimento de pápulas e, eventualmente, vesículas e/ou bolhas, apresentando evolução crónica ou recorrente. É geralmente pruriginosa e desconfortável, e o acto de coçar resultante pode originar erosões e infeção secundária. Os doentes afetados são frequentemente mal diagnosticados e submetidos a exames auxiliares de diagnóstico desnecessários, onerosos e/ou invasivos. De forma a evitá-lo, o clínico deve saber reconhecer as lesões cutâneas de UP, possíveis exposições e a história natural da doença. Os principais desafios na abordagem da UP são: convencer os pais/doentes de que as lesões estão relacionadas com a picada de inseto, desmistificar a convicção frequente da relação com a ingestão de certos alimentos e identificar e erradicar o insecto envolvido. Neste artigo, descrevemos uma doente de 25 anos de idade com UP bolhosa e efectuamos uma breve revisão da literatura, incluindo os aspectos clínicos, a utilidade da mnemónica “SCRATCH” no diagnóstico correcto e atempado, os principais diagnósticos diferenciais e a abordagem terapêutica baseada na regra dos 3 “P’s” (Prevenção, controlo do Prurido e Paciência).PALAVRAS-CHAVE – Urticária papular; Insetos; Criança; Prurigo.

Skin disorders encountered in a Swiss pediatric emergency department

While skin disorders are commonly seen in paediatric emergency departments (PED), the exact frequency of the various dermatological conditions is unknown. Our aim was to evaluate the occurrence and spectrum of skin disorders in an urban PED and the need for a dermatological opinion. The medical records of patients attending the PED during 120 days over a 1-year period were analysed. The dermatological findings were evaluated as to incidence, demographic details, frequency of dermatological review and treatment. A questionnaire assessed the need for dermatological support. Skin findings were recorded in 1,572 (17.4%) of the 9,041 attendances. The skin problem was the primary cause of the PED visit or related to the primary complaint in 853 (54.3%) and 335 (21.3%) cases respectively. In 373 patients (23.8%) a diagnosis was only suspected or remained unknown. Inflammatory and allergic disorders were most commonly encountered (42.9%), followed by skin infections (31.8%), physically induced skin lesions (11.9%), varia/unknown (11.1%) and congenital disorders (2.3%). Viral and parainfectious exanthema was the most common diagnosis (17.6%), followed by anogenital dermatitis (7.7%), gingivostomatitis (7.1%), petechiae (6.4%), burns (6.0%), urticaria (5.0%) and insect bite reactions (5.0%). 81 (5.2%) of the patients with skin conditions were hospitalised. The PED doctors expressed the wish for a dermatological opinion in 25% of the patients with skin findings. We identified a high frequency, broad spectrum and diagnostic difficulties of paediatric skin conditions. Our data highlight the need for educational measures and close collaboration between the two specialities to improve management of these children.

Incidence and care of environmental dermatoses in the high-altitude region of Ladakh, India

Background:Low humidity, high-velocity wind, excessive ultraviolet (UV) exposure, and extreme cold temperature are the main causes of various types of environmental dermatoses in high altitudes.Materials and Methods:A retrospective study was carried out in patients visiting the lone dermatology department in Ladakh between July 2009 and June 2010. The aim was to identify the common environmental dermatoses in high altitudes so that they can be treated easily or prevented. The patients were divided into three demographic groups, namely, lowlanders, Ladakhis (native highlanders), and tourists. Data was analyzed in a tabulated fashion.Results:A total of 1,567 patients with skin ailments were seen, of whom 965 were lowlanders, 512 native Ladakhis, and 90 were tourists. The skin disorders due to UV rays, dry skin, and papular urticaria were common among all groups. The frequency of melasma (n = 42; 49.4%), chronic actinic dermatitis (CAD) (n = 18; 81.81% of total CAD cases), and actinic cheilitis (n = 3; 100%) was much higher among the native Ladakhis. The frequency of cold-related injuries was much lesser among Ladakhis (n = 1; 1.19%) than lowlanders (n = 70; 83.33%) and tourists (n = 13; 15.47%) (P < 0.05).Conclusion:Dryness of skin, tanning, acute or chronic sunburn, polymorphic light reaction, CAD, insect bite reactions, chilblain, and frostbite are common environmental dermatoses of high altitudes. Avoidance of frequent application of soap, application of adequate and suitable emollient, use of effective sunscreen, and wearing of protective clothing are important guidelines for skin care in this region.

Dermatology in the military field: What physicians should know?

In the civilian dermatological setting, the top 5 skin diseases usually seen are eczema/dermatitis, acne, benign skin tumors, viral infections and pigmentary disorders. In comparison, the top 5 skin conditions encountered in the military sector are usually fungal infections, eczema/dermatitis, insect bite reactions, bacterial infections and acne. This is not surprising as military personnel, due to the special environment and vocations they are in, are prone to getting eczema as heat, sweating and wearing of the military uniform aggravate the condition. Fungal infections are common in those who wear the army boots. Insect bite reactions are not an uncommon sight among those who have to go to the jungle regularly for outfield training. Grass allergy or intolerance, contact dermatitis or acneiform eruption due to the application of military camouflage cream on the face, contact dermatitis to insect repellents, and military uniform allergy and intolerance are amongst the commonest dermatological problems encountered in the military field, and physicians should recognize them, investigate and manage these problems accordingly. Lastly, a diagnosis not to be missed in the military field is cutaneous melioidosis, especially when a military personnel presents with a non-healing ulcer.

Insect bite reactions

Insects are a class of living creatures within the arthropods. Insect bite reactions are commonly seen in clinical practice. The present review touches upon the medically important insects and their places in the classification, the sparse literature on the epidemiology of insect bites in India, and different variables influencing the susceptibility of an individual to insect bites. Clinical features of mosquito bites, hypersensitivity to mosquito bites Epstein-Barr virus NK (HMB-EBV-NK) disease, eruptive pseudoangiomatosis, Skeeter syndrome, papular pruritic eruption of HIV/AIDS, and clinical features produced by bed bugs, Mexican chicken bugs, assassin bugs, kissing bugs, fleas, black flies, Blandford flies, louse flies, tsetse flies, midges, and thrips are discussed. Brief account is presented of the immunogenic components of mosquito and bed bug saliva. Papular urticaria is discussed including its epidemiology, the 5 stages of skin reaction, the SCRATCH principle as an aid in diagnosis, and the recent evidence supporting participation of types I, III, and IV hypersensitivity reactions in its causation is summarized. Recent developments in the treatment of pediculosis capitis including spinosad 0.9% suspension, benzyl alcohol 5% lotion, dimethicone 4% lotion, isopropyl myristate 50% rinse, and other suffocants are discussed within the context of evidence derived from randomized controlled trials and key findings of a recent systematic review. We also touch upon a non-chemical treatment of head lice and the ineffectiveness of egg-loosening products. Knockdown resistance (kdr) as the genetic mechanism making the lice nerves insensitive to permethrin is discussed along with the surprising contrary clinical evidence from Europe about efficacy of permethrin in children with head lice carrying kdr-like gene. The review also presents a brief account of insects as vectors of diseases and ends with discussion of prevention of insect bites and some serious adverse effects of mosquito coil smoke.

Epidemiological study of insect bite reactions from central India.

Introduction:The physical effects of the arthropod bites on human skin receive less attention, especially in the rural areas where the per capita income is less. Ours is a rural-based hospital, the vicinity having more of plants, trees, and forests; we undertook the study to find out the relation of insect bite dermatitis in a rural area.Materials and Methods:The study was carried out in the Dermatology outpatient department of our institute on 100 subjects of insect bite dermatitis who were questioned retrospectively about the sequence of events besides their environmental and living conditions. They were examined thoroughly and the relevant clinical findings were noted, also taking into account the prior treatment taken by them, if any.Results and Conclusions:It was found that insect bite dermatitis has no age or gender preponderance, and the protective factors for the same are use of full sleeve clothes and keeping the doors and windows closed at night. On the contrary, the risk factors are residence in areas of heavy insect infestation, use of perfumes and colognes, warm weather in spring and summer and the lack of protective measures. However, there was no direct association of atopy with increased risk of developing insect bite dermatitis.

Pattern of Pediatric Dermatoses at a Referral Centre

To determine the pattern of skin disorders seen among children attending a Medical College Hospital, Bangalore All children 18 y and below attending the Pediatric Dermatology OPD with skin diseases between the period of January 2011 and June 2011 were included in the study. A total of 1,090 new cases (boys 589; girls 501) with 1,118 dermatoses were recorded during this period. Twenty eight children had more than one dermatoses. Most of the disorders were seen between 5 and 11 y age group. The most common dermatoses was infections and infestations (32.47 %) followed by eczematous eruptions and dermatitis (20.66 %), papulosquamous and related disorders (6.08 %) and pigmentary disorders (5.81 %). Insect bite reactions and papular urticaria formed 5.1 %. Acne was seen in 5.28 % of children followed by urticaria (3.67 %), photodermatoses 2.5 % and genetic disorders (3.04 %). In the present setting bacterial infections and scabies still remained the most common pediatric dermatoses followed by molluscum contagiosum and atopic dermatitis. Childhood psoriasis contributed to major part of the study among papulosquamous disorders.

A Pediculid Case: Autosensitization Dermatitis Caused by Pediculosis Capitis

Pediculosis capitis is a worldwide infestation caused by Pediculus humanus capitis ectoparasite that only lives on the hairs of the scalp. As a result of severe itching excoriation, secondary bacterial infection, cervical and occipital lymphadenopathy are seen frequently where, sometimes bite reaction, viral exanthema mimicking hypersensitivity eruption and conjunctivitis may occur. Hereby, with the presentation of a quite rarely seen pediculid case, characterized with common autosensitization dermatitis as an -id reaction to pediculosis capitis, the importance of exploring the source of the infection and/or infestation on the patients who have presented with generalized pruritic maculopapular eruption, is emphasized.

Sweet-Like Reaction Due to Arthropod Bites

The histopathology of arthropod bite reactions is classically described as "dermal edema" with superficial and middle to deep dermal inflammation in a perivascular and wedge-shaped distribution. The composition of the infiltrate may vary, but a characteristic feature is the presence of prominent eosinophils between collagen bundles. Sweet syndrome, also known as acute febrile neutrophilic dermatosis, is characterized by dermal edema and a dense neutrophilic infiltrate, associated with a constellation of clinical and biological signs. We describe herein 2 cases of arthropod bite reactions with impressive clinical lesions and histopathological findings reminiscent of Sweet syndrome. However, the patients were lacking other criteria for Sweet syndrome and were diagnosed as Sweet-like reaction to arthropod bites. Pathologists should be careful in rendering a diagnosis of neutrophilic dermatosis, which requires clinicopathological correlation, and should consider arthropod bite reactions in the differential diagnosis.

Bullous Reactions to Bedbug Bites Reflect Cutaneous Vasculitis

BackgroundThere has been a worldwide resurgence of bedbug infestations. Bites by these insects may cause mild or severe cutaneous reactions, and anaphylaxis has been reported. Little is known about the most severe cutaneous reactions, termed bullous or complex reactions. ObjectiveTo study the time course and histopathologic findings of complex (bullous) cutaneous reactions to bedbugs in order to determine the optional treatment for them. Design, Setting, and ParticipantsWe prospectively photographed bullous reactions to observed bedbug bites at 30 minutes; 6, 12, 24, 36, 48, and 72 hours; 1, 2, 3, and 4 weeks, and biopsied reactions at 30 minutes, and 6, 12, and 24 hours. We also reviewed Internet postings and the available medical literature on bullous reactions after bedbug bites. Main Outcomes and MeasuresCorrelations between clinical and histologic findings using both routine and immunofluorescent techniques. ResultsBullous reactions to bedbugs are not rare. Of 357 photographs of bedbug bites posted on the Internet, 6% were bullous. In an individual with previous bullous reactions, experimental bedbug bites were associated with a progression of cutaneous responses at bite sites from immediate, pruritic, edematous lesions to a late-in-time macule, which evolved into bullous reactions by 24 hours. Bullous lesions eventually lysed but took weeks to heal. Histopathologic evaluation of bullous reactions showed a polymorphous picture with histologic evidence of an urticarial-like reaction early on that rapidly developed into a hybrid leukocytoclastic vasculitis. This vasculitis was initially neutrophilic but developed into a destructive, necrotizing, eosinophil-rich vasculitis with prominent infiltration of CD 68+ histiocytes and collagen necrobiosis. This histologic picture is similar to the dermal vasculitis in patients with Churg-Strauss vasculitis. ConclusionHistorically, bedbug bite reactions have been considered to be of minor medical significance. However, the findings presented here demonstrate that the not-uncommon bullous reactions to bedbug bites reflect the presence of a local, highly destructive, cutaneous vasculitis. The histologic features of these reactions resemble those occurring in the Churg-Strauss syndrome. Therefore, efforts to prevent further bites and monitor for evidence of systemic vasculitis should be made in patients with bullous reactions to bedbug bites. Topical treatment with high potency corticosteroids may be useful in the treatment of bullous reactions.

Rupatadine 10 mg in the treatment of immediate mosquito‐bite allergy

People frequently experience wealing and delayed papules from mosquito bites. Wealing is mediated by antisaliva IgE antibodies and histamine. Rupatadine is a new antihistamine effective in allergic rhinitis and urticaria, but the effect on mosquito-bite allergy is not known. To determine the effectiveness of rupatadine in inmediate mosquito-bite allergy-confirmed adult patients. A double-blind, placebo-controlled, cross-over study was performed with rupatadine 10 mg and matched placebo in 30 mosquito-bite-sensitive adults. The mean age was 37 years and the subjects had suffered from harmful mosquito bites for a mean of 15 years. Either rupatadine or placebo was taken at 08:00 am for 4 days, followed by a 5 day wash out period and then alternative treatment was given for 4 days. On day 3, in both drug periods the subjects received two Aedes aegypti mosquito-bites on the forearm. The size of lesions and intensity of pruritus [visual analogue scale (VAS)] were measured after 15 min bite reaction. Twenty-six subjects were analysed for efficacy. The size of the 15 min bite reaction under placebo was of 106 mm2 and under rupatadine, of 55 mm2. This is a significant decrease (48%; P=0.0003). The accompanying pruritus decreased from 60 (VAS; median) under placebo to 47.5 under rupatadine, which also is a significant (P=0.019) difference. There was no significant (P=0.263) difference in adverse events under rupatadine and placebo. The present placebo-controlled study in mosquito-bite-sensitive adults shows that rupatadine 10 mg prophylactically given is an effective treatment for the mosquito-bite wealing and skin pruritus.

Bull’s-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans

Introduction. Lyme disease is an emerging worldwide infectious disease with major foci of endemicity in North America and regions of temperate Eurasia. The erythema migrans rash associated with early infection is found in approximately 80% of patients and can have a range of appearances including the classic target bull's-eye lesion and nontarget appearing lesions. Methods. A survey was designed to assess the ability of the general public to distinguish various appearances of erythema migrans from non-Lyme rashes. Participants were solicited from individuals who visited an educational website about Lyme disease. Results. Of 3,104 people who accessed a rash identification survey, 72.7% of participants correctly identified the classic target erythema migrans commonly associated with Lyme disease. A mean of 20.5% of participants was able to correctly identify the four nonclassic erythema migrans. 24.2% of participants incorrectly identified a tick bite reaction in the skin as erythema migrans. Conclusions. Participants were most familiar with the classic target erythema migrans of Lyme disease but were unlikely to correctly identify the nonclassic erythema migrans. These results identify an opportunity for educational intervention to improve early recognition of Lyme disease and to increase the patient's appropriate use of medical services for early Lyme disease diagnosis.

A human case of black fly bite caused by Simulium quinquestriatum (Shiraki, 1935)

The first report of a human case of black fly bite caused by Simulium quinquestriatum (Shiraki, 1935) in Japan is described. The author (49 years old, male) as a volunteer observed the blood-sucking female black fly of S. quinquestriatum and the course of dermatitis induced by the black fly bite. An erythematous macule with itching and edema developed at the next day and the inflammatory reaction was severe in 2 to 3 days after the bite. The skin symptoms gradually improved and almost disappeared by one month. This indicates that delayed-type hypersensitivity to components of saliva takes part in the black fly bite reaction.

Clinical and histopathological study of Simulium (blackfly) dermatitis from North‐Eastern India – a report

Simulium dermatitis is a common problem in humans and animals in areas where Simulium species occur. It is characterized by chronic eruptions of pruritic papules, vesicles, and erythematous wheals resulting from a hypersensitivity reaction to biting of simuliids or blackflies. It can result in severe skin complications where the man-biting species of Simulium are available. We report two clinical cases of Simulium dermatitis from the North-Eastern region of India. Histopathological study was carried out in one of the cases and the other one was successfully treated with medication. Clinical features like intense itching, which accompanies the eruption, resulting in excoriations, scarring, and permanent hyperpigmentation were reported. Histopathological study revealed the characteristic features of Simulium bite reaction, such as vesicles filled with serous fluid, dermal edema, and perivascular infiltrates rich in eosinophils and lymphocytes. The clinical manifestations and severity of Simulium dermatitis are serious matters of concern in hypersensitive persons.

Adult-onset cutaneous mastocytosis in monozygotic twins

To the Editor: A 36-year-old white man was evaluated for multiple pruritic skin lesions of 15 years duration. He had a history of symptomatic extrasystole during physical or emotional stress, sporadic flushing, anaphylaxis after an insect bite reaction, and endoscopic diagnosis of chronic gastritis with a positive culture for Helicobacter pylori. His monozygotic twin brother, who had suffered from asthma since early childhood, had developed similar cutaneous lesions on his trunk in the past few years.

A patient who developed toe necrosis due to poor blood circulation after an interdigital tick bite

A 71-year-old female had worked on a farm in the mountains and noticed itching of the left 3rd toe. She visited a local hospital due to a color change to purple in this area. Attachment of a tick was observed between the left 2nd and 3rd toes, and it was extracted. However, due to persistent pain, she was referred to our department of cardiovascular medicine for close examination and treatment. Lower extremity angiography showed that vascular visualization was poor in the area supplied by the arteries distal to the tick bite site, but the other blood vessels of the toe were clearly visualized. Toe amputation was performed and pathological examination of a surgical specimen revealed that most blood vessels near the necrosis were occluded by thrombi. We speculated that tick bite reactions were associated with thrombogenic vasculopathy. This report shows a patient who developed toe necrosis due to poor blood circulation after an interdigital tick bite.

Miliary and agminated-type primary cutaneous follicle center lymphoma: Report of 18 cases

Primary cutaneous follicle center lymphoma (PCFCL) presents usually with reddish nodules, plaques, and tumors on the head and neck area, particularly the scalp, and on the back. We sought to describe a peculiar clinical variant of PCFCL. We report a series of 18 patients (male:female= 7:11; median age 52 years; mean age 50.8 years; age range 27-75 years) with a clinical variant of PCFCL characterized clinically by multiple, miliary, or agminated papules predominantly on the head and neck. All patients presented with multiple erythematous, firm papules arranged in a manner that resembled millet seeds or collected together in small clusters. Lesions were located on the entire face in one patient (5.6%), the forehead in 8 (44.4%), the cheeks in 3 (16.7%), the preauricular region in two (11.1%), and multiple regions on the head and neck area in 3 (16.7%). The last patient had miliary papules on the entire face, back, upper aspect of arms, and scattered on the front of the chest. The initial diagnosis was never cutaneous lymphoma, and all patients had been treated unsuccessfully for different skin conditions including mainly rosacea, lupus miliaris disseminatus faciei, and persistent arthropod bite reaction. Microscopic examination confirmed the diagnosis of PCFCL in all patients. Small number of cases and retrospective study are limitations. This peculiar clinical presentation of PCFCL is unusual and represents a pitfall in the clinical diagnosis. Dermatologists should be aware of this variant of PCFCL so as to treat patients timely and properly.