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IndianJournalofDermatology,VenereologyandLeprology(IJDVL):Paederusdermatitis:<b>GurcharanSingh,SyedYousufAli</b>

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Year:2007|Volume:73|Issue:1|Page:1315

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Paederusdermatitis
GurcharanSingh,SyedYousufAli
DepartmentofDermatologyandSTD,SriDevarajUrsMedicalCollege,Kolar,Karnataka,India
CorrespondenceAddress:
GurcharanSingh
108A,JalVayuVihar,Kammanhalli,Bangalore560043
India

Howtocitethisarticle:
SinghG,YousufAliS.Paederusdermatitis.IndianJDermatolVenereolLeprol200773:1315

HowtocitethisURL:
SinghG,YousufAliS.Paederusdermatitis.IndianJDermatolVenereolLeprol[serialonline]2007[cited2016Jan12
]73:1315
Availablefrom:http://www.ijdvl.com/text.asp?2007/73/1/13/30644

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Introduction

Paederusdermatitis,alsoknownasdermatitislinearisorblisterbeetledermatitisisapeculiarirritant
contactdermatitischaracterizedbyerythematousandbullouslesionsofsuddenonsetonexposedareasof
thebody.ThediseaseisprovokedbyaninsectbelongingtothegenusPaederus.Thisbeetledoesnotbiteor
sting,butaccidentalbrushingagainstorcrushingthebeetleovertheskinprovokesthereleaseofits
coelomicfluidwhichcontainspaederin,apotentvesicant.[3]

Etiopathogenesis

ThegenusPaederusbelongstofamilyStaphyllinidae,orderColeoptae,classInsectaandconsistsofover
622specieswhicharedistributedworldwide.[2],[4]Paederusbeetleshavebeenassociatedwithoutbreaksof
dermatitisinvariouscountriesincludingAustralia,[5]Malaysia,[6]SriLanka,[7]Nigeria,[8]Kenya,Iran,[2]
CentralAfrica,Uganda,Okinawa,SierraLeone,[9]Argentina,Brazil,France,Venezuela,EcuadorandIndia.
[10],[11],[12]
Adultsofthesebeetlesareusually710mmlongand0.5mmwide,havingthesizearoundoneandhalf
timesthatofamosquito.Theyhaveablackhead,lowerabdomenandelytral(thisstructurecoversthe
wingsandfirstthreeabdominalsegments)andaredthoraxandupperabdomen.[8],[9]Paederusbeetles
liveinmoisthabitats[13]andfeedondebris.Althoughtheseinsectscanfly,theyprefertorunandare
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IndianJournalofDermatology,VenereologyandLeprology(IJDVL):Paederusdermatitis:<b>GurcharanSingh,SyedYousufAli</b>

extremelyagile.Theyhaveacharacteristichabitofcurlinguptheirabdomenwhentheyrunoraredisturbed
andthishabitallowsan"onthespot"identificationonmanyoccasions.[4]Eggsarelaidsinglyonamoist
substanceandtypicallydevelopin319daystolarvaeandadults.Paederusbeetlesarebeneficialto
agriculturebecausetheyeatcroppests.[9]
ThespeciescommonlycausingPaederusdermatitisarePaederusmelampusinIndia,Paederusbrasilensisin
SouthAmerica,commonlyknownaspodo,PaederuscolombiusinVenezuela,PaederusfusipesinTaiwan
andPaederusperegrinusinIndonesia.[13]
Paederusarenocturnalandattractedbyincandescentandfluorescentlightsandasaresult,inadvertently
comeintocontactwithhumans.[9]Hemolymphofthebeetlecontainspaederine(latigaza)[14]whichis
releasedoncrushingoftheinsectontotheskinduetothereflexofbrushingawaytheinsect.Paederin(C
25H45O9N)isanamidewithtwotetrahydropyranringsandmakesupapproximately0.025%ofan
insect'sweight(forP.fusipes).
Recently,ithasbeendemonstratedthattheproductionofpaederinreliesontheactivitiesofan
endosymbiont(Pseudomonasspecies)withinPaederus.Themanufactureofpaederinislargelyconfinedto
adultfemalebeetles.Larvaeandmalesonlystorepaederinacquiredmaternally(i.e.,througheggs)orby
ingestion.[15]Itisavesicantandblocksmitosisatlevelsaslowas1ng/mlapparentlybyinhibitingprotein
andDNAsynthesiswithoutaffectingRNAsynthesis.[9]Acantholysisisprobablycausedbythereleaseof
epidermalproteases.[2]

Clinicalfeatures

Thedermatitismayaffectpersonsofeithersex,allages,racesorsocialconditions,sinceitdependsonthe
patient'sactivitiesandinsecthabitat.Theexposedareasareaffectedwithagreaterfrequency.The
incidenceofcasesisreportedtobegreaterduringthelastquarteroftheyear,theperiodthatimmediately
followstherainyseason.[4]Thelesionsareerythematousandedematouswhichmaybelinear,givinga
whiplashappearance.Thevesiclesgenerallyappeartowardsthecenteroftheplaque.Thevesiclesturninto
pustulesquitefrequently.Thesignsappearafter24to48hofcontactandtakeaweekormoretodisappear.
[4],[8]Astrikingfeatureisthepresenceof"kissinglesions"thatoccurwheneverappositionofdamaged
areastopreviouslyintactskinispossible,e.g.,flexureoftheelbow,adjacentsurfacesofthethighs.[4]
Diffuseerythematousanddesquamativelesionswhichpredominantlyoccurontheupperbodyandface
havebeenreportedandseveralpossiblecausesforthisatypicalvariantofpaederusdermatitis[2]are:
ContactwithadifferentspeciesofPaederus.Recurrentcontactduringashortperiodoftime.Theexistenceof
underlyingdisorderssuchasatopicdermatitis.Theuseofheavilyinfestednaturalsourceofwaterfor
washing.Animmunologicphenomenonresultinginaneczematizedreactionpattern.
Complicationsincludepostinflammatoryhyperpigmentation,secondaryinfections,andextensiveexfoliating
andulceratingdermatitisrequiringhospitalization.[2],[5],[9]
Ocularandgenitalinvolvementisrelativelycommonitoccurssecondarytotransferofthetoxicchemical
fromelsewhereontheskinbyfingers.However,ocularareamaybetheonlysiteofinvolvement.Ocular
involvementusuallypresentswithunilateralperiorbitaldermatitis,orkeratoconjunctivitis,whichhasbeen
namedtheNairobieye.[2]

Histopathology

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Earlylesionsshowneutrophilicspongiosisleadingtovesiculationandeventualreticulardegenerationofthe
epidermis.Thisisfollowedbyconfluentepidermalnecrosis,usuallywithasurvivinglayerofsuprabasalcells.
Scatteredacantholyticcellsmaybepresent.Thelargenumberofintraepidermalneutrophils,combinedwith
areasofconfluentnecrosisandreticulardegeneration,arecharacteristic.Olderlesionsshowirregular
acanthosisandpallorofsuperficialkeratinocytes,withoverlyingparakeratoticscalecontaininganeutrophilic
exudate.[16]
Intheearlyvesicularstage,thereareintraepidermalvesicles.Thetopofthevesicleisusuallyformedbythe
hornylayerorbyoneortworowsofflattenedcells.Thefloorconsistsofthebasalcelllayerandsometimes
oneormorestrataofthemalpighianlayer.Insidethevesiclethereisfluidandaweft,formedby
degeneratedepithelialcells("ghosts").Thereisalwayssomeadmixtureofpolymorphonuclearcells.The
basalcelllayermaybeintactorindistinctandtheremayevenbedestructionofthedermoepidermal
junction.
Inthedermisthereisaperivascularinfiltrate,moremarkedinthepapillaeandtheupperreticulardermis.It
consistsmainlyofmononuclearcells,butsomepolymorphonuclearcellsarealsopresent.Theremaybe
edema,moremarkedatthepapillae.Inthefullblownpustularstage,thehistopathologicalcharacteristics
mentionedaboveareexaggerated.Thevesicleschangeintopustules,fullofneutrophils,whichareseen
migratingthroughtheneighboringareasoftheepidermisaswellasthepapillae.Theperivascularinfiltrate
andtheedemaaremoreintense.Thepapillaryedemamaygiveafalseimpressionofasubepidermalvesicle.
Duringhealing,thepustuleispushedupwardsbymaturingnewkeratinocytesandthenmayresemblethe
spongiformpustuleofKogoj.Finally,allthatremainarecrust,someacanthosisandmildperivascular
infiltrate.[4]
Directimmunofluorescenceisnegativefordepositionofimmunoglobulins(IgG,IgMandIgA)andC3.[2]

Differentialdiagnosis

Clinicalappearanceofpaederusdermatitismaybeconfusedwithherpessimplex,herpeszoster,liquidburns,
acuteallergicorirritantcontactdermatitis,millipededermatitisandphytophotodermatitis.[2]The
characteristiclinearappearanceofthelesions,theirpredilectionforexposedareas,thepresenceofkissing
lesions,thehistopathology,appropriatepatchtestandfinallyepidemiologicalfeatures(occurrenceofsimilar
casesinagivenarea,theseasonalincidenceandidentificationoftheinsect)shouldenabletheclinicianto
arriveattherightdiagnosis.[4]

Treatment

Thecasesshouldbemanagedasirritantcontactdermatitisremovalofirritant,initialwashingwithsoapand
water,applicationofcoldwetcompressesfollowedbytopicalsteroidandantibiotic,ifsecondarilyinfected.[9]

Prevention

Preventinghumanbeetlecontactistheprimarymethodofpreventingpaederinbasedtrauma.Tacticsthat
canbeemployedtoachievethis[2],[7]include:

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Learntorecognizepaederusbeetlesandavoidhandlingorcrushingtheseinsectsagainstexposedareasof
skin.Keepdoorsclosedandputscreensondoors.Bothdoorsandwindowsshouldbekeptingoodrepairto
reducetheentryofbeetlesintobuildings.Sleepingunderabednet,preferablypermethrintreated,mayalso
reducetheprobabilityofabeetlefallingontheskinduringthenight.Anetormeshcanbetiedunderthe
lightstopreventthebeetlefromdroppingontohumans.Patientsshouldbeadvisedtoavoidcrushingthe
beetleontheskin,manipulatingprimarylesionsorrubbingtheeyesfollowingprimaryinvolvement.Ifa
beetlelandsontheskin,trytoremoveitgently(example:blowitoff,trytogetthebeetletowalkontoa
pieceofpaperandthenremoveit).Washcontactareasoftheskin.Checkareasforbeetles(especiallyon
wallsandceilingaroundthelight)beforegoingtobed.Beetle,ifpresent,shouldbekilledbyusinginsecticide
(pyrethroid)followedbysweepingupandremovalofbeetlecarcasses.Rememberthatbeetlescancause
symptoms,aliveordeadandhenceavoidhandlingthebeetledirectly.Clearexcessvegetationsfromand
aroundtheresidence,asbeetlesmayrestintheseareas.

Conclusion

Paederusdermatitisisacommoncondition.Webelievethatincreasedpublicawarenessofthisconditioncan
decreasemucocutaneousexposuretopaederin.

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