Papules caused by insect bites
A middle-aged Caucasian woman walking in the brush while vacationing on the eastern end of Long Island noted that there were many deer in the area. Several days after returning to New York City, the otherwise healthy patient discovered a red papule with a brown center and presented to the dermatology clinic. A brown dot on the papule was discovered to be a tick. After removal, the tick was sent to the laboratory for examination. The patient was given doxycycline 100 mg b.i.d. for 10 days, and a Lyme antibody test was performed. Labs were normal.
The patient noted a burning sensation while working in a shed during the summer in Westchester County, N.Y. Several spiders had been seen in the area. A purple bump at the site of the sensation was assumed to be an insect bite, and the patient went to the emergency department (ED). Examination revealed skin injury with tissue loss and necrosis but no system complications. Lab values (including G6PD) were normal and vital signs stable. The patient was given oral dapsone 100 mg b.i.d. for one week and topical clobestasol ointment twice a day.