Diagnosis: Bed Bug Bites
Description: Typical papular urticarial response
Morphology: Papules,red
Site: Arm,forearm
Sex: F
Age: 65
Type: Clinical
Submitted By: Ian McColl
Differential DiagnosisHistory:
Case from Dr 65 year old lady stayed at a popular hotel in the south west of WA. She developed itchy forearms and hands while there, and a worsening rash, which persisted for weeks. Her husband developed a mild facial itch a minor rash only. She contacted the hotel proprietor, who acknowledged she was not the first to note such a rash. Topical steroids were used to treat this papular urticaria and the local public health authority notified about the hotel's bedbugs! Good example. I had a very similar case recently. People vary in their immunological reaction to the bite. She had a much greater reaction than her husband who was also bitten at the same time. Usually a short course of oral steroids is required to rapidly shut the inflammation down. Antihistamines wont help this problem as it is a Type 4 immune reaction ie cell mediated rather than Type 1 and histamine. (Submitted By: Dr Ian McColl)
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