To the Editor.—
We all have examined patients who believe that "bugs" are present on or in their skin; usually we find nothing to explain the symptoms. Repeated examinations in even the more plausible cases may fail to reveal any organisms. The following example of mite infestation illustrates why simple, direct examination of the skin is not adequate to exclude arthropod parasitism. Descriptions of human bird-mite infestations are not new,1-4 but because the organisms are minute and leave the host after feeding the patient may be totally unaware of the cause of his discomfort.The patient was an anxious-appearing 23-year-old housewife complaining of scalp pruritus and the sensation of bugs crawling on her face and neck of one week's duration. Examination revealed nothing significant on the skin; her fingernails were trimmed extremely closely. A potassium hydroxide preparation from scalp debris was negative. Further questioning established that the patient's husband
Martalock DL. "BUGS". Arch Dermatol. 1971;103(3):339. doi:10.1001/archderm.1971.04000150109018
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