ABSTRACT

Fleas, gnats and mosquitoes are the most common biting insects, with geographical and seasonal variation. Reaction depends on individual response, from none, through innocuous itchy papules, to blisters. Season and circumstance are usually sufficient to identify bites from gnats and mosquitoes. Flea and mite bites, when numerous and recurrent, can cause diagnostic difficulty and the term papular urticaria is used. Lesions are most numerous on the legs and lower trunk (491) but any area can be affected. Pruritic papules and weals may be grouped, sometimes linearly. A punctum may be seen at the centre of a lesion but this is usually obliterated by scratching because of intense itching. Bullae may occur, particularly on the legs (492). The condition is more common in children, though adults may also be affected. Cat and dog fleas are the most common pests. Bird fleas and mites can also cause problems. Secondary bacterial infection is a common complication.