Blister Beetle Dermatitis

C R V Narasimhalu

Blister beetle dermatitis or paederus dermatitis is an irritant contact dermatitis due to accidental crush of insects
belonging to paederus family on the skin. The characteristic features of blister beetle dermatitis are linear
erythematous itchy vesicles over the exposed parts of body and kissing lesions. This condition is commonly seen
during or after rainy season. The treatment is removal of irritant by gentle washing and topical steroids. It is often
misdiagnosed and causes significant morbidity among the rural population.

It will be a baffling experience for the medical practitioners when they come across patients saying .Doctor, I was
alright when I went to bed, but when I got up in the morning I noticed a linear red itchy and burning skin lesion..
Doctors may console them by saying not to worry and it might be due to insect bite. To add up the confusion patient
will say, .Doctor, I never noticed an insect biting me and my bed is quite clean without any insects.. Alas, both are
wrong, it is not due to the insect bite, it is due to the crush of the insects called blister beetle, which comes into the
humans habitat attracted by the light. We are sharing our six months experience in this paper.

CASE REPORTS

Within a period of six months a total of 83 clinically diagnosed cases of beetle dermatitis were seen in our hospital.
They were in the age group of 18-25 years residing in the same locality. Majority of them were males. All of them
presented with red, burning or itching linear skin lesions with blisters (Figs 1 & 2). There were no systemic
manifestations or fever or lymphadenopathy. Most of them went to sleep uneventfully, next day morning they
noticed sudden eruption of skin lesions.

Examination . Lesions were more common over the exposed parts of the body like hands, face, neck and upper back.
In some cases there were kissing lesions on the skin folds. On retrospective leading questions to the patients they
were able to recall that they had noticed some insects were flying near the fluorescent lamps of their residing places.

Treatment . All were treated with mild topical steroids and antihistamines. All have recovered without any sequelae.

DISCUSSION

Blister beetle dermatitis is also known as dermatitis linearis or paederus dermatitis. It is an irritant contact dermatitis
which occurs due to the accidental crushing of the beetle of genus paederus over the skin that in turn releases the
secretion containing a vesicant called pederin causing blisters in the skin. The genus paederus belongs to family
staphylinidae, orders coleoptae, class insecta and consists of over 622 species which are distributed worldwide1,2.
There have been many case reports of Paederus dermatitis in various countries with Different species3-8.

Adults of these beetles are longer than mosquito, 7-10 mm long and 0.5 mm wide having a black head, red thorax
and abdomen6,9. Paederus beetles live in moist habitats and feed on debris. These insects can fly but they prefer to
run and are extremely agile. They Are identified with their habit of curling up their abdomen when they run or are
disturbed2. Paederus are nocturnal and attracted by incandescent and fluorescent lights and as a result, accidentally
come into contact with humans9. Haemolymph of the beetle contains pederin which is released on the skin when it is
brushed away during contact8.

Anybody can be affected with blister beetle dermatitis irrespective of sex, age, race or social conditions, since it
depends on the patient.s activities and insect habitat8. The exposed areas are affected with a greater frequency.
Usually it occurs in clusters and seen during and after rainy season2. The lesions are erythematous and oedematous
which may be linear, giving a whiplash appearance. The vesicles generally appear towards the centre of the plaque.
The vesicles turn into pustules quite frequently. The signs appear after 24 to 48 hours of contact and take a week or
more to disappear2,6.

A striking feature is the presence of .kissing lesions. That occur whenever apposition of damaged areas to previously
intact skin is possible eg, flexures of the elbow, adjacent surface of the thighs2. The reason for the linearity of the
lesions is due to the fact that the beetle tries to escape from getting completely crushed out. On its way of escape it
pours out pederin containing fluid which causes the linear lesions.

Common complications of blister beetle dermatitis include postinflammatory hyperpigmentation, secondary infections,
and extensive exfoliating and ulcerating dermatitis requiring hospitalisation1,3,9. Ocular and genital involvement can
also be seen and it is due to transfer of the toxic chemical from elsewhere on the Skin by fingers. Only ocular
involvement usually presents with unilateral peri-orbital dermatitis, or keratoconjunctivitis, which has been named as
Nairobi eye1.

The differential diagnoses for paederus dermatitis are herpes simplex, herpes zoster, liquid burns, acute allergic or
irritant contact dermatitis, millipede dermatitis and phytophotodermatitis1. The characteristic linear appearance of
the lesions, their predilection for exposed areas, the presence of kissing lesions and epidemiological features
(occurrence of similar cases in a given area, the seasonal incidence and identification of the insect) should enable the
clinician to arrive at the right diagnosis2.

The cases should be managed as irritant contact dermatitis- removal of irritant, initial washing with soap and water,
application of cold wet compresses followed by topical steroid and antibiotic, if secondarily infected9. This dermatitis
is prevented by avoiding handling and crushing of the insect, careful removal of the insect landed on the body, using
different source of light, use of nets and spraying of insecticide1,5.

REFERENCES

1 Zargari O, Asadi AK, Fathalikhani F, Panahi M Paederus dermatitis in northern Iran: a report of 156 cases. Int J
Dermatol 2003; 42: 608-12

2 Vegas FK, Yahr MG, Venezuela C Paederus dermatitis. Arch Dermatol 1996; 94: 175-83.

3 Todd RE, Guthridge SL, Montgomery BL Evacuation of an Aboriginal community in response to an outbreak of
blistering dermatitis induced by a beetle (Paederus australis). Med J Aust 1996; 164: 238-40.

4 Mokhtar N, Singh R, Ghazali W Paederus dermatitis among medical students in USM, Kelatan. Med J Malaysia
1993; 48: 403-6.

5 Kamaladasa SD, Pereea WDH, Weeratunge L An outbreak of Paederus dermatitis in a suburban hospital in
Srilanka. Int J Dermatol 1997; 36: 34.

6 George AO, Hart PD Outbreak of Paederus dermatitis in southern Nigeria: Epidemiology and dermatology. Int J
Dermatol 1990; 29: 500-1.

7 Handa F, Pradeep S, Sudarshan G Beetle dermatitis in Punjab. Indian J Dermatol Venerol Leprol 1985; 51: 208-
12.

8 Singh G, Yousuf Ali S Paederus dermatitis. Indian J Dermatol Venereol Leprol 2007; 73: 13-5.

9 Frank JH, Kanamitsu K Paederus, sensu lato (Coleoptera: Staphylinidae): natural history and medical
importance. J Med Entomol 1987; 24: 155-91.