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Vesicular and bullous eruptions

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Hand, foot, and mouth disease Coxsackievirus A16 is the causative organism of this viral exanthem and systemic illness. Painful mouth ulcers followed by painful white vesicles with a surrounding erythema on the fingers, palms, toes, and soles characterize the condition. Patients usually have a low­grade fever, sore throat, and malaise for 1 to 2 days. Some develop submandibular or cervical lymphadenopathy. This is a self­limiting condition.

Insect bites Mosquito and horsefly bites can cause a common blistering reaction that is surrounded by faint erythema, central pallor if swollen, and usually a visible central punctum. The bites may be arranged in groups if they are multiple. The lesions are pruritic or sore; the condition is self­limiting. The deer tick bite causes a bull’s­eye rash at the site of the bite.

Bed bugs The bed bug, Cimex lectularius, is a pest that feeds on blood, causes itchy bites, and generally irritates their human hosts. The Environmental Protection Agency, Centers for Disease Control and Prevention, and United States Department of Agriculture all consider bed bugs a public health pest. However, bed bugs are not known to transmit or spread disease.

Bites on the skin are a poor indicator of a bed bug infestation. Bed bug bites can look like bites from other insects (e.g., mosquitoes, spiders), rashes (e.g., eczema, fungal infections), or even hives. Some people do not react to bed bug bites at all. Bed bug bites can be misidentified, which gives the bed bugs time to spread to other areas of the house.

A more accurate way to identify a possible infestation of bed bugs is to look for physical signs of the pest. For example, noting spots on bedding (about this size: •) that are bed bug excrement is one of the earliest and most accurate methods. The increase in bed bugs in the United States may be caused by more travel, lack of knowledge about preventing infestations, increased resistance of bed bugs to pesticides, and ineffective pest control practices.

Herpes simplex virus Herpes simplex virus lesions have grouped vesicles that are surrounded by an erythematous base, with discrete, well­demarcated areas that later crust. The condition is associated with soreness or pain and may be preceded by tingling. There is a predilection for lips and genitalia. Recurrences in the same location are common and usually milder.

Herpes zoster (shingles) Herpes zoster lesions present as clustered vesicles that follow a dermatome. Lesions are surrounded by an erythematous base, with discrete, well­demarcated lesions that later crust. Intense burning and pain often precede the eruption. Herpes zoster along the ophthalmic branch of the trigeminal nerve requires an immediate ophthalmology visit, as this can lead to zoster of the eye and resultant blindness.