This bed bug was actually crawling on the patient's shirt. The patient asked, "Do you think this could be causing my itchy spots?"

BED BUGS

The bite of Cimex lectularius causes very itchy urticarial lesions. This bug comes out at night and bites the exposed skin (often of the hands, arms, and face) of the patient while s/he sleeps.

• The "eyelid sign" is the very suggestive of bedbugs. Very few other organisms bite the eyelids. They like CO2.
  
• An extensive review failed to find any reports of documented disease transmission to humans [JAAD 2016;74;1261].
• Another study found a worldwide trend of peak incidence of bites in the late summer and early fall [JAAD 2016;75;627].
  
• Adult bed bugs are about the size of an apple seed (5-7 mm in length).
• Sated adult can live without food for 12 months without another meal!
• There are bedbug snffing dogs.

Clinical

Bed bugs (Cimex lectularius) have been reported to cause papular lesions with central punctum, small grouped vesicles, giant urticarial wheals, and unilateral hemorrhagic nodular or bullous lesions of the hands and feet. The distribution of lesions depends upon the type of clothing worn to bed. The face and arms are favored sites as they are more often exposed and readily accessible at night. Bed bugs are nocturnal and are most active just before dawn. They hide in cracks and crevices--avoiding light. They respond to heat and carbon dioxide and thus are attracted to sleeping individuals. They feed on the individual's blood and inject saliva which contains an anticoagulant.

Diagnosis

The clinical history and exam (red, very itchy bumps, recent onset, occurring on arms, neck, and face) are often highly suggestive. A biopsy may be done to confirm the patient is being bitten but will not say which insect is doing the biting. Sleeping in a different room or even a different domicile/hotel may be necessary to confirm the bedroom as the source of the rash.

Ask parents, this the only person in the family affected? If yes, then make the analogy to allergy, only one in family has the allergy and only one in family allergic to bite of bug.

Treatment

• "Don't let the bed bugs bite!"

The source of exposure should be eliminated. An exterminator with specific experience in bed bugs may need to be called. Chemical control may be combined with environmental management, e.g., wash bed linens daily with hot water, vacuum clean rooms and bed linens, and steam clean furniture .

Bed Bugs and Hotel Rooms

Don't keep clothes or bags on the floor. Study the bed and the area within three feet of the bed. Bed bugs are most likely to be hiding near the headboard. They also like right angles so examine bed frames, mattress piping, drawers, and windows. Look for round brown splotches/stains (from bed bug droppings) on the mattress and other fabrics.

RegionalDerm

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