title: Multiple pruritic papules from lone star tick larvae bites.
abstract: BACKGROUND
  Ticks are the second most common vectors of human infectious diseases in the world. In addition to their role as vectors, ticks and their larvae can also produce primary skin manifestations. Infestation by the larvae of ticks is not commonly recognized, with only 3 cases reported in the literature. The presence of multiple lesions and partially burrowed 6-legged tick larvae can present a diagnostic challenge for clinicians.
  
  
  METHODS
  We describe a 51-year-old healthy woman who presented to our clinic with multiple erythematous papules and partially burrowed organisms 5 days after exposure to a wooded area in southern Kentucky. She was treated with permethrin cream and the lesions resolved over the following 3 weeks without sequelae. The organism was later identified as the larva of Amblyomma species, the lone star tick.
  
  
  CONCLUSIONS
  Multiple pruritic papules can pose a diagnostic challenge. The patient described herein had an unusually large number of pruritic papules as well as tick larvae present on her skin. Recognition of lone star tick larvae as a cause of multiple bites may be helpful in similar cases.
authors.affiliation: Division of Pediatric Dermatology and Department of Pathology, Cincinnati Children's Hospital Medical Center, OH 45267, USA. fisherem@gmail.com
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Fisher
authors.forename: Jun
authors.initials: J
authors.lastname: Mo
authors.forename: Anne W
authors.initials: AW
authors.lastname: Lucky
mesh_terms: D000279:Administration, Cutaneous; D000818:Animals; D001733:Bites and Stings / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007306:Insecticides / Q000008:administration & dosage; D007629:Kentucky; D007814:Larva; D008875:Middle Aged; D026023:Permethrin / Q000008:administration & dosage; D011537:Pruritus / Q000209:etiology; D011998:Recreation; D013987:Ticks
chemical_list: D007306:Insecticides; D026023:Permethrin