Vol. 142 No. 4, April 2006

 Observation

Multiple Pruritic Papules From Lone Star Tick Larvae Bites

Emily J. Fisher, MD; Jun Mo, MD; Anne W. Lucky, MD

Arch Dermatol. 2006;142:491-494.

Background  Ticks are the second most common vectors of human
infectious
diseases in the world. In addition to their role as vectors, ticks and
their larvae can also produce primary skin manifestations. Infestation
by the larvae of ticks is not commonly recognized, with only 3 cases
reported in the literature. The presence of multiple lesions and
partially burrowed 6-legged tick larvae can present a diagnostic
challenge for clinicians.

Observation  We describe a 51-year-old healthy woman who presented to
our clinic with multiple erythematous papules and partially burrowed
organisms 5 days after exposure to a wooded area in southern Kentucky.
She was treated with permethrin cream and the lesions resolved over the

following 3 weeks without sequelae. The organism was later identified
as
the larva of Amblyomma species, the lone star tick.

Conclusions  Multiple pruritic papules can pose a diagnostic challenge.

The patient described herein had an unusually large number of pruritic
papules as well as tick larvae present on her skin. Recognition of lone

star tick larvae as a cause of multiple bites may be helpful in similar

cases.

Author Affiliations: Division of Pediatric Dermatology (Drs Fisher and
Lucky) and Department of Pathology (Dr Mo), Cincinnati Children's
Hospital Medical Center, and Department of Dermatology, The University
of Cincinnati School of Medicine (Drs Fisher and Lucky), Cincinnati,
Ohio.

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