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This Month in Archives of Dermatology
April 2006

This Month in Archives of Dermatology

Author Affiliations


Arch Dermatol. 2006;142(4):425. doi:10.1001/archderm.142.4.425

Patients with multiple pruritic papules that appear to be insect or arthropod bite reactions often present a clinical challenge. In addition to the “usual suspects,” Fisher et al add multiple Lone Star tick larvae bites to the list of diagnostic possibilities in this case report, highlighting the risks of tick-borne diseases as well as the role of tick bites in primary skin disorders. The diagnostic challenge in identifying ticks as the causative organism in these rare cases lies in the ability to recognize the 6-legged larval form as opposed to the 8-legged adult form.

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Actinic keratoses (AKs) are among the most common reasons for which patients consult dermatologists. In diagnostically uncertain cases, a biopsy is often performed, but only rarely is excision considered an appropriate treatment method. In this blinded, comparative, retrospective study, Sellheyer and Bergfeld analyzed differences in biopsy techniques used by dermatologists and plastic surgeons. Dermatologists performed shave biopsies of AKs in almost 9 of 10 cases. This was in sharp contrast to plastic surgeons who performed excisional biopsies in 50% of cases, with more than half located in the cosmetically important central face. These data suggest that care provided by dermatologists in the evaluation and treatment of AKs may be more cost-effective than care by plastic surgeons.