Bite Reactions Research Articles

Bullous Insect Bite Reaction with Flame Figures

Bullous Insect Bite Reaction with Flame Figures

Immune response profiles from humans experimentally exposed to Phlebotomus duboscqi bites.

Cutaneous leishmaniasis is a neglected vector-borne parasitic disease prevalent in 92 countries with approximately one million new infections annually. Interactions between vector saliva and the human host alter the response to infection and outcome of disease. To characterize the human immunological responses developed against saliva of Phlebotomus duboscqi, a Leishmania major (L. major) vector, we repeatedly exposed the arms of 14 healthy U.S volunteers to uninfected P. duboscqi bites. Blood was collected a week after each exposure and used to assess total IgG antibodies against the proteins of P. duboscqi salivary gland homogenate (SGH) and the levels of IFN-gamma and IL-10 from peripheral blood mononuclear cells (PBMCs) stimulated with SGH or recombinant sand fly proteins. We analyzed skin punch biopsies of the human volunteer arms from the insect bite site and control skin site after multiple P. duboscqi exposures (four volunteers) using immunohistochemical staining. A variety of immediate insect bite skin reactions were observed. Late skin reactions to insect bites were characterized by macular hyperpigmentation and/or erythematous papules. Hematoxylin and eosin staining showed moderate mononuclear skin infiltrate with eosinophils in those challenged recently (within 2 months), eosinophils were not seen in biopsies with recall challenge (6 month post bites). An increase in plasma antigen-specific IgG responses to SGH was observed over time. Western Blot results showed strong plasma reactivity to five P. duboscqi salivary proteins. Importantly, volunteers developed a cellular immunity characterized by the secretion of IFN-gamma upon PBMC stimulation with P. duboscqi SGH and recombinant antigens. Our results demonstrate that humans mounted a local and systemic immune response against P. duboscqi salivary proteins. Specifically, PduM02/SP15-like and PduM73/adenosine deaminase recombinant salivary proteins triggered a Th1 type immune response that might be considered in future development of a potential Leishmania vaccine.

Efficacy and Safety of Makabuhay (Tinospora rumphii) 25% Cream Versus Hydrocortisone 1% Cream in the Management of Mosquito Bite Reactions: Randomized Double-Blind Controlled Trial.

Most insect bite reactions resolve spontaneously, but the inflammation and pruritus induced have been shown to decrease the quality of life. Previous studies have shown the potential anti-inflammatory properties of Tinospora rumphii. The aim of the study is to assess the efficacy and safety of T rumphii 25% cream versus hydrocortisone 1% cream in the management of local cutaneous reactions caused by mosquito bites. This study was a parallel-group, double-blind, randomized, placebo-controlled trial with a 1-week duration in a span of 3 months (June 2019 to August 2019). Participants were exposed to sterile noninfectious mosquitoes (Aedes aegypti) for 5-10 minutes to elicit cutaneous lesions. Tinospora 25% cream or hydrocortisone 1% cream was applied twice daily throughout the 7-day study period. Of the 70 participants screened for this study, which was approved by an institutional review board (IRB 2019-07) at the Dermatology Outpatient Department of the Research Institute for Tropical Medicine, Alabang, Muntinlupa, Philippines, 58 participants in total met the inclusion criteria and were randomized to treatment (Tinospora: n=29) and active control (hydrocortisone: n=29) groups. In total, 58 participants were randomized to receive Tinospora cream (n=29) or hydrocortisone cream (n=29). All participants completed the follow-up. There was a significant decrease in lesion size in both groups from the first 15 minutes to day 7 (P<.001). Comparing the lesion size in both groups, there was a statistically significant decrease in lesion size in the first hour (P=.003) and after 24 hours (P=.03). On day 1, 10% (n=29) of participants in the hydrocortisone group and 7% (n=29) in the Tinospora group experienced complete resolution. On day 3, all participants experienced complete resolution. No adverse effects were documented. Tinospora 25% cream is safe, effective, and comparable to hydrocortisone 1% cream as an anti-inflammatory agent for mosquito bite reactions based on the decrease in lesion size, the proportion of participants with complete resolution of wheals, and improvement in pruritus intensity score using a visual analog scale. Long-term safety studies are recommended. Philippine Health Research Registry PHRR230716-005932; https://www.herdin.ph/index.php/registry?view=research&layout=details&cid=5932.

DP22 Cutaneous lymphoid hyperplasia: clinicopathological correlation and a therapeutic option

Abstract Cutaneous reactive lymphoid hyperplasia, also known as cutaneous pseudolymphoma, is an uncommon entity in which there are skin lesions that histologically, and sometimes clinically, mimic cutaneous lymphoma but are not, both morphologically and immunohistochemically. Correlating clinical, pathological, immunohistochemical and, occasionally, molecular findings is essential for the diagnosis (Romero-Perez D, Blanes Martinez M, Encabo-Duran B. Pseudolinfomas cutaneous. Actas Dermosifiliogr 2016; 107:640–51). Although the majority of cases can be regarded as idiopathic, certain infections and inflammatory conditions can precipitate cutaneous reactive lymphoid hyperplasia, examples of which include Borrelia infection, insect bite reactions and folliculitis (Mitteldorf, C, Kempf, W. Cutaneous pseudolymphoma – a review on the spectrum and a proposal for a new classification. J Cutan Pathol 2020; 47:76–97). The first case was an 18-year-old woman who presented with deep dermal and subcutaneous nodules for the last 5 years that started on her limbs and were slightly itchy. The nodules were firm and deep, with minimal surface changes (hyperpigmentation and adherent scale) but did not ulcerate. She also had nodules involving her buccal mucosa, inner lips and soft tissue in the nasal bridge and a couple of deep nodules on the cheeks. Pathological examination showed a dense lymphocytic infiltrate with plasma cells admixed with other inflammatory cells involving the deep dermis with an extension to the dermal/subcutaneous junction. The pathological picture was in the spectrum of deep tumid lupus/lupus panniculitis overlap and cutaneous lymphoid hyperplasia. Immunohistochemical stains showed a mixture of inflammatory cells with CD3+ and CD20+ cells. Lip mucosal biopsy showed florid reactive lymphoid follicular hyperplasia. Her condition was resistant to multiple systemic treatments. Eventually, she underwent treatment with rituximab and had satisfactory results. The second patient is an elderly female who had multiple erythematous papules, plaques and nodules on her face. Pathological examination showed a dense dermal lymphocytic infiltrate with periadnexal predilection and reactive follicles that also were highlighted by CD20, with Bcl2 and CD3+ cells around germinal centres. She was diagnosed as having cutaneous reactive lymphoid hyperplasia. Topical calcineurin inhibitors were initiated, with a good response. In conclusion, this paper highlights the term cutaneous pseudolymphoma/cutaneous reactive lymphoid hyperplasia, presenting a few cases with clinicopathological correlation and exploring some uncommon treatment options.

The role of eosinophils in the differential diagnosis of inflammatory skin diseases

Eosinophils are known to be present in inflammatory skin diseases, but their diagnostic utility is not well established. Upon review of the published status of lesional eosinophils, several categories were identified. 1) Lesional eosinophils highly characteristic such that, in their absence, the pathologist may question the diagnosis. These include arthropod bite reactions and scabies, urticarial dermatitis, and other eosinophilic dermatoses. 2) Lesional eosinophils rare or absent, such that, in their presence, the pathologist may question the diagnosis. These include pityriasis lichenoides, graft versus host disease, and connective tissue disorders. 3) Lesional eosinophils variable and, while in some cases expected, are not required for diagnosis. These include drug reactions, atopic dermatitis and allergic contact dermatitis. 4) Lesional eosinophils variable and not expected but may be seen to a limited extent. These include lichen planus and psoriasis.

Delineating the Boundaries of Superficial Lymphangitis: A Retrospective Study of 11 Cases with a Review of Literature.

Lymphangitis is an inflammation of lymphatic channels caused by infectious or non-infectious agents, presenting with characteristic linear erythematous streaks draining toward regional lymph nodes. To describe the clinical characteristics and etiological factors involved in acute superficial lymphangitis in a retrospective descriptive study. Materials and Methods: Records of patients were analyzed retrospectively who presented with linear erythematous streaks, diagnosed as superficial lymphangitis, in the outpatient department of dermatology during the last 5 years (January 2018-December 2022) in a tertiary care hospital. Patients were evaluated for their demographic profile, detailed history, complete physical examination, and standard blood tests (if necessary). A total of 11 patients were found, out of which 7 (63%) were males and 4 (37%) were females. The mean/median age of these patients was 30 years (range 9-52 years). The minimum duration of development of lymphangitis was within minutes in the case of a mosquito bite reaction and around 72 hours in the case of trauma or infection induced, with a median interval of 48 hours. The site most commonly involved was the upper extremity in 8 (72%) patients, followed by the trunk in 2 (18%) and the lower extremity in 1 (9%). Arthropod bite reactions (63%) were the most common etiological agent. All patients presented with linear erythematous streaks extending towards draining lymph nodes. Lymphangitis is often considered to be a bacterial infection and is mostly treated with antibiotics; however, non-bacterial and non-infectious causes should be kept in mind while treating superficial lymphangitis to make judicious use of systemic antibiotics.

PREVALENCE OF SKIN PROBLEMS IN PAEDIATRIC GROUP BELOW THAN 12 YEARS OLD

Background:Childrens skin illnesses are a significant cause of morbidity and may be impacted by regional, racial, social, cultural, and economic variables. Despite their global prevalence, skin disorders have not played a significant role in the development of public health initiatives. Methods: The current study aimed to determine the prevalence of dermatological disorders among pediatric population at a single point of measurement as reported by parents. The most suitable design is cross-sectional study. It was descriptive and correlational study. This enables the researcher to measure the effect and the outcome at a single point of time. This study design gives reliable results with short time and less effort. The study was conducted at (place). The participants were selected during the period during October 2022. This study included children aged less than 12 years old via non-probability convenient sampling technique at a confidence level of 95% using Epi Info software equation. Results: The study included 1106 parents reporting dermatological disorders among their children. The most frequent dermatological disorders among children as reported by parents were cuts, scratches and grazes (n= 127, 11.5%). Cuts, scratches and grazes and insects bite was the most frequent combination of dermatological disorders among children (n= 108, 9.8%). There were 7% of children suffered from eczema (n= 77). Other dermatological disorders that children included in the current study suffered from are: Boils (n= 30, 2.7%), Cellulitis (= 24, 2.2%), Fifth disease (n= 12, 1.1%), Impetigo (n= 13, 1.2%), Herpes zoster (n= 12, 1.1%), Ring worm (n= 24, 2.2%), Warts (n= 10, 0.9%). The most frequent age group among children was 3-6 years (n= 357, 32.3%). Male to female ratio among children was very close and almost 1:1. There were 575 males (52%) and 531 females (48%). Conclusion:The group studied had a high frequency of skin irritation, infection, and insect bite reactions. Dermatological diseases are readily recognized, treated, and prevented. Many of the examined children had not sought medical help for the identified pathology, which may indicate a lack of access to health care. The studys strengths include its large sample size and age-focused epidemiology. Due to its methodology, this study, like many prevalence studies, cannot show causal relationships.This study reveals that its necessary to give fast access to health care services, enhance cleanliness in homes and public areas, and adopt preventive measures including complete vaccination and targeted fumigation.

Bullous arthropod bite reaction

A case of bullous arthropod bite reaction occurs following the bite of an arthropod, resulting in edema and eruption of blisters on the affected area, as it is a challenging task to differentiate it from cellulitis, especially in the early course of the reaction. So, early diagnosis is required to prevent the unnecessary use of antibiotics and no delay in managing arthropod bite reaction. The natural history of the disease begins with marked edema with erythema at the bite and surrounding sites. It is followed by single/multiple bulla formation depending upon the number of bites. Then it ruptures, and a serous fluid is released, which is then followed by the formation of granulation tissue a week or two later. Appropriate wound care with soap and water is required to prevent superimposed bacterial infection. Differential diagnoses of cellulitis and necrotizing fasciitis can be excluded by lack of systemic signs and symptoms like fever, malaise, or weakness. Treatment generally involves symptomatic relief of pain and pruritus, including nonsteroidal anti-inflammatory drugs (NSAIDs) and antihistaminic.

The Spectrum of Erythema Migrans in Early Lyme Disease: Can We Improve Its Recognition?

Background and objective Diagnosis of early Lyme disease (LD) often relies on clinical recognition of the skin lesion, erythema migrans (EM), a diagnostic sign of disease when laboratory testing is insensitive.Because EM can present in morphologically distinct forms, its recognitionby clinicians can be challenging.This study aimed to characterize the clinical spectrum of lesions in patients presenting with suspected early LD in an ambulatory care setting to identify features that might help clinicians to be better prepared to recognize EM lesions. Methods Images of lesions from 69 participants suspected to have early LD were retrospectively evaluated by a dermatologist and a family practitioner with expertise in early LD.Reviewers made determinations on the diagnoses and morphological features of lesions.Agreement between reviewers and associations among lesion types and participant demographics, symptomology, and laboratory evidence of infection were examined using the kappa statistic and contingency tables, respectively. Results Challenges in diagnosing EM were evident in our study:initial concordance between reviewers was moderate [kappa statistic (95% CI): 0.45 (0.245 - 0.657)]. The final classification included 35 lesions (51%) that were agreed to be EM; 23 lesions (30%) were considered to be possible early EM or tick bite reactions, and 11 (16%) were thought notto be EM, but rather other diagnoses, including ringworm, allergic contact dermatitis, and mosquito bites.Only two lesions (6%) were observed with a classic bull's eye or ring-within-a-ring pattern.Most EM lesions were uniform (51%), pink (74%), oval lesions (63%), with well-demarcated borders (92%).Early EM or tick bite reactions were typically <5 cm in size (74%), red (52%), round lesions (61%), with a punctum present (100%).Lesions thought notto be EM also tended to be pink or red (64%), round (55%), or uniform (45%) lesions, but also had raised (25%) or irregular borders (33%), which were not commonly observed in the reviewer-classified EM or tick bite reaction lesions.Participants with lesions classified as EM reported that they had the lesions for more days (p = 0.043) and reported more symptoms (p = 0.017) than participants with other lesions.Only 14 (20%) participants overall had positive laboratory evidence for LD; these included 13 (37%) of the participants with EM-classified lesions. Conclusions EM commonly occurs in forms that are not the classic bull's eye.Patients often present with lesions that may represent the very early stage of EM or tick bite reactions, and most patients will test negative on currently available laboratory tests, challenging clinicians in making an LD diagnosis or treatment decisions.Additional studies to further characterize the morphological features of EM and how variation in skin lesions may be perceived among clinicians would be helpful for developing guidelines onimproving clinician recognition of EM.

S2412 A Case of Idiopathic Hypereosinophilic Syndrome Involving the Gastrointestinal Tract

Introduction: Hypereosinophilia (HE) is defined by an absolute eosinophil count greater than 1.5 k/mcL taken one month apart or by histologic confirmation of eosinophilic infiltration of the tissues. Hypereosinophilic syndrome (HES) occurs when HE causes organ damage. Complications from eosinophilic gastrointestinal (GI) disease include perforation, ischemic colitis, and portal vein thrombosis. Here we present a case of idiopathic HES involving multiple organs including the GI tract. Case Description/Methods: A 39-year-old male presented to the hospital with 3 weeks of burning epigastric pain and diarrhea associated with fever; chills; fatigue; shortness of breath, and macular rash to the lower extremities. This began days after initiating a 12-day prednisone taper starting at 20 mg twice daily for presumed insect bite reaction. Eosinophils were 6.0 k/mcL on admission. Skin biopsy performed on lower extremities showed diffuse eosinophilic infiltration without evidence of vasculitis. Bronchoscopy revealed eosinophilic infiltration (92% eosinophils) without infection. ANA, anti-dsDNA, SSA, SSB, scleroderma antibody, C3, C4, RF, IgM, IgE, urine histoplasma antigen, serum coccidioides antibody, and antiphospholipid antibodies were within normal limits. With eosinophilic tissue infiltration associated with organ dysfunction and absolute eosinophil count >1.5 k/mcL, the patient met criteria for HES. Two doses of intravenous methylprednisolone 125 mg were administered before starting oral prednisone 60 mg AM and 20 mg PM for 90 days. The patient’s epigastric pain, shortness of breath, and pruritus resolved. Eosinophilia levels trended down from 9.3 k/mcL to 0.4 k/mcL within 3 days. Discussion: While HES is primarily an immunological condition, it is important for physicians to be aware of eosinophilic manifestations of the GI tract. The patient’s severe epigastric pain and diarrhea were suggestive of eosinophilic gastroenteritis. He had skin and bronchial biopsies (Figure) along with peripheral eosinophilia and multiorgan involvement meeting criteria for idiopathic HES. Esophagogastroduodenoscopy and tissue sampling from the GI tract was not obtained as the patient responded well to treatment, hence adding an extra procedure wouldn't have altered the course of management. Early recognition of our patient’s symptoms led to a minimally invasive patient experience and a rapid response to therapy.Figure 1.: Biopsy of bronchial mucosa showing dense infiltration of eosinophils beneath the bronchial epithelium (greater than 50 per high power field). The granular pink cells are the eosinophils, largely on the left-hand side of the image (400X magnification, H&E stain).

Update on mosquito bite reaction: Itch and hypersensitivity, pathophysiology, prevention, and treatment.

Mosquito bites are endured by most populations worldwide. Reactions to mosquito bites range from localized wheals and papules with associated pruritus to rare systemic reactions and anaphylaxis in certain populations. The mechanism of itch is due to introduction of mosquito saliva components into the cutaneous tissue, although the exact pathophysiology is unclear. Histamine is thought to be a key player through mosquito saliva itself or through activation of mast cells by IgE or through an IgE-independent pathway. However, other salivary proteins such as tryptase and leukotrienes may induce non-histaminergic itch. Some individuals have a genetic predisposition for mosquito bites, and people with hematologic cancers, HIV, and other conditions are susceptible to robust reactions. Prevention of mosquito bites is key with physical barriers or chemical repellents. Treatment consists of second-generation antihistamines and topical corticosteroids. Further research on topical treatments that target neural-mediated itch is needed.

What’s Eating You? Mosquitoes (Culicidae)

Mosquito bites cause a variety of reactions ranging from pruritic papules to severe systemic hypersensitivity reactions. The salivary glands of mosquitoes have been found to contain more than 70 different allergens. Herein, we describe the pathophysiology and clinical appearance of mosquito bite reactions as well as proper management of this condition.

Part II: Insect allergies—Inhalation and ingestion

Summary Background Allergies to insect stings and bites are common and were partly discussed in part I of this article series. Other mechanisms leading to allergen contact, sensitization, and potential allergy to insects or insects’ compounds can be hard to suspect and diagnose due to their sometimes-hidden character in food or dust. Aims We aim to provide an overview of allergic reactions to insects elicited by mechanisms other than sting or bite reactions. Sources A PubMed search on allergy and insects apart from bees and wasps was conducted, articles were selected and included, and a series of relevant publications and cases of our outpatient units are used as examples. Content and implications Allergies to insects following direct contact, inhalation, and accidental and deliberate ingestion are common and various insect species can elicit these allergies. Sensitization may occur transcutaneously, upon inhalation, and through ingestion. Allergic reactions to edible insects, such as grasshoppers and mealworms, as genuine allergies or as tropomyosin or other protein cross-reactivities in seafood or house dust mite allergic individuals are possible. In Europe, with the licensing of mealworms to be consumed as food and sold commercially in January 2021, allergies and cross-reactivity to insects or insect compounds as foods will become more common and relevant.

Haematologic-Related Malignancy-Induced Eosinophilic Dermatoses (He Remained): A Narrative Review.

He remained(Hematologic Related Malignancy- induced Eosinophilic dermatoses) is a new eponym introduced to describe a dermatoses previously described under several terminologies such as eosinophilic dermatoses of haematological malignancy, exaggerated arthropod bite reactions, insect bite-like reactions and T-cell papulosis associated with B-cell malignancies. This chronic relapsing remitting disease has a pleomorphic presentation mimicking a variety of dermatological conditions. The underlying pathophysiology is however poorly understood. It is a paraneoplastic phenomenon hence an underlying haematological malignancy must always be looked for. Response to conventional modalities of treatment such as oral corticosteroids is rapid and satisfactory. Other newer modalities are also in the pipeline. In this manuscript, we present a narrative review of this recently described entity with data identified via a search on 27 September, 2021 in PubMed, EMBASE and MEDLINE using the term ‘Eosinophilic dermatoses of haematological malignancy’ AND ‘Hematologic related malignancy-induced eosinophilic dermatoses’. A total of 67 cases reported in the literature from the year 2012 onward have been included. The literatures pertaining to insect bite-like reactions and exaggerated insect bite hypersensitivity have been excluded in this review.

Prevalence of skin diseases in school-age children.

The prevalence of community-based skin diseases, especially among school-age children, depends on topography, climate, and age of population. We determined the prevalence of skin diseases among community-based primary school-age children and identified demographic characteristics in relation to particular skin conditions. This was a cross-sectional descriptive survey study of a subproject school cohort in children aged 5-14 years of 2 community-based primary schools. Demographic data and whole-body skin examination were collected. The association of individual skin conditions was analysed by using bivariate and multivariable binary logistic regression. A total of 556 children were enrolled in this study. Of these, 90.2% had at least 1 skin disease. The most common skin disease was postinflammatory hyperpigmentation (PIH) (58.3%), followed by nevus/mole (40.1%), insect bite reaction (28.0%), acanthosis nigricans (20.0%), acne (13.7%), and pityriasis alba (12.9%). There was an increase of body mass index (BMI) in PIH and acanthosis nigricans with the adjusted odds ratios of 2.01 (95% confidence interval [CI] 1.40-2.87, P < 0.001) and 1.93 (95% CI 1.49-2.49, P < 0.001), respectively. Insect bite reaction was related to PIH with the adjusted odds ratio of 5.66 (95% CI 3.15-10.17, P = 0.001). The most common skin disease in community-based primary school-age children is PIH which related to acanthosis nigricans and insect bite reaction. A decrease of BMI may lower the risk for PIH and acanthosis nigricans. Education on common skin diseases is recommended for both community-based schools and school-age children.

Venomous snakebite — Significance of the bite site and local reaction

Snakebite is an environmental and occupational hazard in India. Death and disabilities due to snakebite remains a major public health challenge. For the fight against this battle a greater investment should be focused on the preventive measures. This includes understanding of the common seasons of snake bites, location and also the site of snake bite. Understanding these will help in taking better preventive measures. This is a 6-year retrospective observational study of 70 venomous snake bite cases admitted to a tertiary care center in South India. Inclusion criteria has been all confirmed case of envenomation by venomous snake bite. Chi square test was done to find the association between categorical variables. The study sample size is 70. Mean age in our study is 34.66 ± 18.57 years. 57.1% were male. 79% snake bites occurred outdoor. 57.1 % patients had local reaction along with hemotoxic/neurotoxic symptoms. 28.5% patients had only local reaction. 84% bites occurred in lower limb. 43% bites occurred in the foot. Statistically borderline significant correlation between site of bite and local reaction alone (p=0.05). We could not find a statistically significant correlation between site of bite and local reaction with hemotoxic / neurotoxic symptoms (p=0.236). 59% snake bites occurred during Monsoon season this was followed by post monsoon season. Snakebite is a neglected tropical disease and remains as an underestimated cause of accidental death in modern India. Significance of bite site along with seasonal variations in snakebites helps in formation of effective preventive strategies, which along with prompt primary treatment holds the key in reducing the impact of venomous snakebite.

A study of the pattern of dermatoses in adolescent patients in South India.

Adolescence describes the age group between 10 and 19 years. This is the transitional stage of physical and physiological human development generally occurring between puberty and adulthood. Hormonal changes occurring during puberty result in various physical and psychological changes, affecting their social relationship. At this stage, external appearance is of immense concern to them. As such, any dermatological condition can extremely affect their psychological status. This study was conducted to give an insight on the various dermatological conditions of the adolescent age groups and their incidence. Study design: Descriptive study - Cross-sectional study. Three hundred patients between the ages of 10 and 19 years, attending the tertiary care center in South India, were included in the study. A detailed history, clinical examination, and appropriate laboratory investigations were carried out. Out of 300 patients, females (52.7%) more commonly presented with dermatoses than males (47.3%). Most of the 300 patients belonged to the age group of 17-19 years (50.33%). Infections/infestations (39%) were the most predominant dermatoses followed by acne (17.67%), eczema (9.67%), insect bite reactions (IBRs) (7%), keratinization disorders (6.67%), polymorphic light eruptions (PLEs) (4.33%), urticaria (4.33%), and pigmentary disorders (4.33%). This study gives an insight of various dermatological conditions among the adolescent age groups. Females more commonly presented with dermatoses. The most common dermatoses were infections. Since very few studies regarding dermatoses in adolescents are available in the literature, this study is distinctive in this regard.

Disseminated insect bite reactions in hazelnut workers

Disseminated insect bite reactions in hazelnut workers

CLINICAL SPECTRUM OF PEDIATRIC DERMATOSES IN PATIENTS ATTENDING A TERTIARY CARE CENTER IN CENTRAL NEPAL

Background: Skin diseases are common health problem in children all over the world. How­ever, there is scarcity of epidemiological studies on pediatric dermatoses in Nepal. This study was done to identify the pattern and age variations of pediatric dermatoses in a tertiary care centre in central Nepal. Methods: All children 18 years and below with skin disease attending dermatology OPD between the period of June 15, 2019 to December 15, 2019 were included in the study. SPSS 20 was used for statistical analysis with which descriptive statistics was done. Results: A total of 2789 patients (60.1% male and 39.9% female) with 2895 diagnoses were re­corded during this period. The most common dermatoses were infections and infestations (62.8%) followed by eczema (12.1%), acne (7.5%) and urticaria (4.8%). Pigmentary disorder constituted 2.6%. Insect bite reaction was seen in 2.6%, miliaria 2 %, papulosquamous disorders 1.5% followed by disorders of hairs and nails 0.9%. Conclusions: This study revealed the most prevalent skin diseases in children in specialized der­matology clinic in a developing country such as Nepal. Fungal infection was commonest disease in adolescent and school age children whereas bacterial infection was commonest in infants, toddler and preschool children. Acne was predominantly seen in adolescent.

The Nocturnal Kissing of an Annoying Mosquito; Unusual Insect Bite Reaction, a Case Report and a Literature Review

Insects represent more than half of all known living organisms in the world. Both human beings and insects share a common biodiversity and the influence of insects on human life is enormous. They share an intimate relationship in which human beings are both benefitted and harmed. Insects inflict harm by stinging, biting or transmitting diseases. Rarely, humans are harmed by inadvertently coming in contact with the toxin of an insect. Insect dermatitis is characterized by tingling and burning within 10 minutes of contact, and sometimes the incurred dermatitis is a self-healing condition. Such cases usually happen while asleep when there is a lag time between the crush of the insect and waking up in the morning. A case while sleeping, heard the insect fly around her bare chest, in summer time, and on waving it away instinctively while sleeping, and the insect had been crushed on her bare upper chest skin, incurring a subsequent skin reaction without the typical red bite mark followed by an evolving burning ulcerative skin lesion, that took a while to subside and heal completely. Key words: insect bite, crash, skin reaction.