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Burrowed Tick Larvae Can Lead to Multiple Pruritic Papules

Delay in diagnosis may result if not recognized

TUESDAY, April 25 (HealthDay News) -- The larvae of ticks can burrow under the skin and lead to multiple pruritic papules, according to a case report in the April issue of the Archives of Dermatology. The diagnosis can be difficult, particularly in patients with a large number of lesions, the report indicates.

Emily J. Fisher, M.D., and colleagues from Cincinnati Children's Hospital Medical Center in Ohio, described the case of a 51-year-old woman who had hundreds of erythematous papules on her skin. Five days earlier, the patient had changed her clothes in a wooded area near a lake in southern Kentucky, leaving her clothes on the ground for a short period of time.

The patient had seen a number of physicians and had been diagnosed with a "no-see-um" infestation, bedbugs and finally public lice, and had been treated with Zyrtec and prednisone. The researchers diagnosed an infestation of larvae from the Amblyomma species, or the lone star tick, after 1 mm-sized organisms were found inside the papules, removed, examined in mineral oil and sent for species identification. The lesions resolved over the next three weeks after a single overnight application of permethrin cream.

"This case serves as a dramatic illustration of the delay in diagnosis commonly associated with larval tick attachments, and of the number of ticks that may attach to a host after a single exposure," Dirk M. Elston, M.D., of the Geisinger Medical Center in Danville, Pa., writes in an accompanying editorial.

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