A 52-year-old woman was concerned about the recent appearance of multiple itchy papules on her feet and lower legs. Her husband was experiencing the same phenomenon. While old lesions readily resolved following application of a mid-potency topical steroid, new lesions were appearing every morning. The patient brought in some “bugs” wrapped in a bandana, and wondered whether they might be responsible.
The vast majority of the time, when a patient brings in “bugs” suspected to be responsible for cutaneous signs or symptoms, they are merely presenting debris. Such patients may suffer from delusions of parasitic infestation. However, it is always wise to give the patient the benefit of the doubt and examine their “specimens.”
What is this specimen and did it cause of the patient’s symptoms?
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