Unexplained skin lesions? Be very suspicious
The middle school student was in for his annual physical, and his mother took this opportunity to bring me up-to-date on her child's recent, prolonged and pesky, though not life-threatening, medical ordeal.
The boy had been seen by one of my colleagues several months earlier, coming to the office with numerous welty skin lesions spreading throughout his body. The condition had caused uncomfortable itching and difficulty sleeping and, at the time, appeared to be a rather clear-cut case of allergic skin rash.
The patient had been sent on to an allergist for further evaluation, but an extensive panel of blood tests came back within normal limits, ruling out a variety of medical conditions known to be linked to chronic hives. So, the unfortunate young man looked good on paper, but continued to itch.
It wasn't until the mother was reading the newspaper at the kitchen table of the family's temporary residence, a rental home, that mom and boy stumbled upon the child's elusive diagnosis. The mom spied a tiny bug crawling up her own leg, and squashed it, carefully preserving it for her son's scientific investigation. The boy, a budding entomologist, searched the web for a look-alike bug and, to his fascination and his mother's horror, discovered the answer to his itch: the common bed bug.
Specialists at the Mayo Clinic explain that since the effective but potentially toxic pesticide DDT is no longer widely used in this country, bed bugs have been experiencing a national resurgence. International travel has also helped to promote the spread of bed bugs, as tourists can return home with the little critters clinging to suitcases and articles of clothing.
The good news is that bed bugs don't spread infectious diseases to humans. The bad news is that the small insects do like to suck our blood. When bed bugs bite, they leave behind skin marks that are red and itchy and tend to occur in clusters or lines. Mayo experts report that bed bug-produced skin lesions can range from small red bumps to hive-like rashes to impressive eight-inch wheals. Skin lesions can mimic other skin conditions, at times presenting as blistery or even pus-filled lesions.
If there is no ongoing exposure, these initial bed bug bites fade away after a week or two. Mayo clinicians note that bite treatment should be directed at itch relief. Hydrocortisone or other anti-itch creams are used to manage symptoms and to prevent the scratching which can lead to skin breakdown and infection. Severe allergic skin reactions can be treated orally with antihistamines and steroids, as indicated.
Since the bed bug does not inflict pain when it bites and because it usually bites at night while we sleep, the Mayo team recommends having a high index of suspicion if your child has an unexplained, itchy body rash. Parents are advised to look for signs of bed bug infestation in the home including very small bloodstains on sheets and mattresses as well as telltale deposits of insect waste found near daytime hiding spots in household furniture and along walls. Also, make sure to sniff around, as bed bugs are known to excrete a characteristically strong, sweet-smelling oil.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.