What's Biting Methamphetamine Users?

I found Joe Monroe's Photoclinic case of a patient with dermatitis artefacta veryinteresting (CONSULTANT, December 2000, page 2406). The patient might havebeen exhibiting a phenomenon sometimes seen in methamphetamine users that isreferred to as "crank bug bites." Patients claim to see and/or feel bugs on theirbody and attempt to remove them or pick at them until they create open woundsand scabs (Figure).

I recently saw a patient with multiple lesions who had come to the emergencydepartment to seek treatment for what he believed were brown recluse spiderbites. He said he lived in a basement apartment and had seen several of the spidersthat bit him.

However, his lesions did not look like typical brown recluse spider bites. Thepatient admitted that he had been using methamphetamine. Laboratory findingsdemonstrated infection with hepatitis B and C viruses.

Thanks to Mr Monroe, I can now give this patient a diagnosis of "dermatitisartefacta."
-Nancy Tosone, MSN, APRN
  Omaha

Thank you for relating your experience with dermatitis artefacta. Iagree that this phenomenon is often associated with methamphetamineuse.
-Joe Monroe, PA-C
  Tulsa, Okla