Jules Lipoff, MD Profile picture
Jul 23, 2018 29 tweets 9 min read Read on X
What is biting you? A TWEETORIAL on insect bites. #meded #dermatology #bites Image
A common dermatologic complaint is BUG BITES. A patient will come in and ask, look at this bite – what do you think bit me? Image
First of all, the appearance of any one lesion (the morphology) is generally not going to be specific for any one kind of insect.
Some people will get small bumps or no mark at all, whereas other people can get huge welts. ImageImage
Some people can even get massive swelling called Well’s syndrome (eosinophilic cellulitis). Everyone is different in how they react. ImageImage
What’s more revealing is the pattern of how the bites are distributed.
Are the bites randomly scattered on the body and mostly on areas not covered by clothing? Image
Then it’s probably a flying insect like a mosquito. Image
Are the bites in groups or clusters in one part of the body? Image
Then it might be an insect that is crawling on you, taking in a meal with a bite every so often, “breakfast, lunch, and dinner” sign, like bedbugs. ImageImage
Are the bites mostly in between your fingers, or in the folds of your body? Image
Then it could be from scabies, a mite so small you can’t see it, but generally bites in the warmest areas of the body (armpits, groin, buttocks, belly button, nipples, webspaces of hands/feet). Image
Are the bites mostly on the legs? Image
Maybe it’s an insect that can’t really fly or crawl, but can jump from the ground, like fleas. Image
Is it a spider bite? Many people tell me that a spider bit them. But that is highly unlikely. Spiders do not generally bite people.
In fact, per the highly used medical resource @UpToDate, “spider bites are rare medical events” - also see ncbi.nlm.nih.gov/pubmed?term=17…
Some spiders, namely the brown recluse and the black widow, can cause real issues, but these bites are rare, and these spiders are only in certain places. ImageImageImage
But I’m so clean, I can’t be getting bitten? Cleanliness usually has nothing to do with it. You can be perfectly clean and still get bitten.
But my partner isn’t getting any bites, so how can it be bites? It’s possible that your partner is getting bites, but is just not reacting the same.
Or maybe you just taste better to the bugs than your partner does. smithsonianmag.com/science-nature…
What if you notice during the day, are you getting them at work? It can take many hours for a bite to appear, so you could be getting them overnight.
The real scare is bed bugs (Cimex lectularis). Not dangerous, but super annoying. I usually tell people, if you get one incident of a cluster of bites, no need to jump to conclusions. Image
But if you continue to get new crops of bites over and over again, it’s time to get an exterminator. Image
Bedbugs are resilient, and can fool the most astute among us. They can survive for over a year without feeding! They are attracted to carbon dioxide and dissuaded from motion, so they tend to be visible only in the middle of the night when we are asleep.
Regardless of the cause, the most effective treatment for insect bites: oral antihistamines and topical steroids.
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More from @juleslipoff

Jul 8, 2020
My rules for writing academic manuscripts: a #tweetorial

I love writing, and write with students/colleagues constantly, and yet the same issues pop up again and again.

Sharing this thread if useful. My take, everyone has a different style. #medtwitter #dermtwitter #meded
1. Communication is your number one priority.

The point of your manuscript is to tell a story or argument that the reader will receive. Your writing should easily walk the reader through your research or editorial. Never forget that.
Many people, especially students, have a “show all your work” mentality, perhaps afraid the reader won’t trust their authority. Data is important (yes, do the work), but only show as needed or you will bore the reader. You need a narrative, or you’ll lose people’s attention.
Read 26 tweets
Aug 30, 2019
I hope you brought your appetite and have a strong stomach for...

A TASTING MENU OF DERMATOLOGY

This 5 course menu is a culinary journey through food-named skin signs. Bon appetit!

#prixfixe #tweetorial #MedEd #FOAMEd #dermtwitter #dermatology #medthread h/t @AdamRodmanMD
N.B. The MENU. Skip this tweet if you prefer delightful surprises. If you're one of those people who prefers to know what's ahead, here you go.
BREAKFAST:

CAFE AU LAIT MACULES (CALMs) are light brown patches seen in neurofibromatosis types I and II ("Coast of California"-type edges) and McCune-Albright syndrome ("Coast of Maine").

For NF, a diagnostic criterium is ≥ 6 CALMs of 5mm (prepubertal), 1.5cm (postpubertal).
Read 37 tweets

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