History:

Severe pruritus at the sites of lesions on the leg and forearm at early morning was the chief complaint of this lady. On examination, three urticated red papules were seen on the exposed parts of the limbs. It is of interest to see central vesicles on upper arm lesions on careful inspection and a central punctum which has been exoriated by itching on knee lesion. Papular urticaria in this lady is most probably due to bed bug (Cimex loctularius) bite.