In this issue of the ARCHIVES, Fisher et al1 describe a healthy 51-year-old woman who developed hundreds of erythematous pruritic papules after exposure to a wooded area in southern Kentucky. Several physicians diagnosed the lesions as insect bites, but it was not until the patient noticed tiny dark “bugs” attached to her skin that she presented to a dermatology clinic where the attached larval ticks were diagnosed. 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. In this case, the patient disrobed in a wooded area, and the clothing may have collected the larval ticks in a manner similar to the fabric “tick drags” that epidemiologists commonly use to estimate the density of tick infestation in recreational areas. Questing ticks readily attach to the fabric, providing a good estimate of the tick density. In this case, it is safe to say the density was high.
Elston DM. Human Infestation by Larval Amblyomma Ticks. Arch Dermatol. 2006;142(4):497-500. doi:10.1001/archderm.142.4.497