The patient assumed that the itchy rash was due to insect bites. The shape, size, color, and presence of 6 legs of the insect he captured were consistent with bedbugs and bedbug bites.
A 32-year-old single man who lived alone complained of an itchy rash, primarily on the legs.
Key point: The patient assumed that the rash was due to insect bites. He “captured” an insect in his bed and brought it in for evaluation. The size, shape, color, and presence of 6 legs were all consistent with a bedbug infestation and bedbug bites.
Treatment: Individual skin lesions (small red papules) were treated with as needed application of clobetasol 0.05% ointment. Lesions resolved in 1 to 2 days on this regimen. The patient was advised to seek professional assistance for the insect infestation.
Note: It is rare that the patient actually provides an example of the etiologic insect in cases of infestation!