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CASE REPORT
Year : 2022 | Volume
: 26
| Issue : 3 | Page : 32-34
How internet search and patient's self-diagnosis helped in the management of a case of paederus dermatitis
Shaikat Mondal1, Himel Mondal2
1 Department of Physiology, Kalna SD Hospital, Kalna, West Bengal, India
2 Department of Physiology, Fakir Mohan Medical College and Hospital, Balasore, Odisha, India
Correspondence Address:
Dr. Shaikat Mondal
Kalna SD Hospital, Kalna - 713 409, West Bengal
India
Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jdds.jdds_40_19
Searching symptoms on the internet and self-diagnosis is being criticized for its uncertainty in the diagnosis. However, it may help the patient and the doctor in the diagnosis and management of a disease. In this article, we present a case where the use of smartphone and internet search helped the patient and the doctor in the initial management and diagnosis of paederus dermatitis. A 34-year-old male, an urban inhabitant, noticed pain on the right side of his neck while he was sleeping at night. He woke up and noticed a beetle on his pillow. As the beetle was an unfamiliar one, he took pictures on his smartphone and searched about the beetle on the internet. From the results, he identified the beetle as “Nairobi fly,” self-diagnosed it as “paederus dermatitis,” and washed the area with soap and water to remove vesicant secreted by the beetle. Next day morning, he presented with severe pain and mild erythema on the right side of the neck. The diagnosis becomes obvious from the images shown by the patient. The patient was treated with a topical steroid and oral antihistaminic for 7 days. The patient recovered from dermatitis on the 10th day.
Keywords: Blister beetle dermatitis, dermatitis linearis, Nairobi fly, rove beetle, smartphone
Paederus dermatitis or dermatitis linearis is a type of irritant contact dermatitis. It is caused by contact with the vesicant from the hemolymph of the rove beetle of the genus Paederus.[1] The insect is popularly known as “acid-poka” in Bengali which means acid-secreting insect. The rove beetles are commonly found in irrigated land and grassy area.[2] However, their occasional presence in urban areas is also noticed, especially in summer and rainy seasons.[3] The lesion may vary in size and appearance according to the type and extent of the contact and lesion.[4] Paederus dermatitis shares the provisional diagnosis with thermal or chemical burn and herpes zoster. The contact with the beetle commonly occurs at night and symptoms appear 24–48 h after the contact.[1] Hence, in majority of the cases, the patient cannot provide the details of the beetle and the diagnosis depends solely on the basis of the symptoms.[2]
Nowadays, self-diagnosis from the internet is a common phenomenon. Many of the patients search their symptoms and treatment modalities before appearing at the healthcare facility.[5],[6] Although many times the use of smartphones or technology becomes an advantage in finding the diagnosis from internet,[7] many of the patients end up with the wrong diagnosis.[8],[9] Despite the uncertainty in diagnosis,[10],[11] Symptoms Checker on the internet is helping the patients in decision-making for their visit to a doctor.[12] In this article, we present a case of paederus dermatitis in a male patient whose smartphone images and internet search helped in diagnosis and initial management of the case.
Case ReportA 34-year-old male, residing on the third floor of a building in an urban area of the state of West Bengal, India, felt pain on the right side of his neck while he was sleeping on his bed at approximately 9:30 pm. He woke up suspecting a sting or bite and was searching on his bed and pillow. He found an unfamiliar beetle on his pillow and captured images of the beetle on his smartphone. Two of those images are shown in [Figure 1]a and [Figure 1]b.
He tried to know the name of the insect by searching it on Google by the option “search by image.” Uploading the image on Google from his smartphone, he got results related to fabric and knitting. This may be due to the presence of fabric of the pillow on the image. Then, he searched images on Google with the keywords “beetle neck pain” and found an image showing a similar beetle. He acquired the knowledge that the beetle is known as “Nairobi fly.” From further searches, he managed to self-diagnose the case as paederus dermatitis. He also learned that the area of the contact should be washed with soap and water and did so.
Next day morning, the patient presented (nearly 12 h after the contact) with severe pain and an erythematous skin lesion on the right side of the neck measuring approximately 9 cm × 8 cm. The diagnosis was obvious from the detailed history and images of the beetle. Treatment was started with a topical steroid and an oral antihistamine. In addition, an oral nonsteroidal anti-inflammatory drug (NSAID) was coprescribed with a proton pump inhibitor (PPI) for the management of pain. On the 4th day follow-up, the blisters started decreasing and the pain was not causing much discomfort to the patient. On the 10th day, the patient recovered from dermatitis.
The patient was requested to take a snapshot of the lesion each day on his smartphone. The images are shown chronologically in [Figure 2].
DiscussionThis report is an addition to the literature of paederus dermatitis occurring in an urban area. Here, the promptness of the patient to capture the images of the beetle helped in pinpoint diagnosis. Further, self-diagnosis from the internet helped in initial management before presenting to the treatment facility. Washing the area of contact with soap and water is the correct line of treatment. It helps in removing the vesicant substance from the skin.[13] This patient acquired information, took initial action, and waited for the next morning as he was sure what actually happened. This type of information may not pacify many of the patients, making them more anxious.[8],[9] However, neck pain without any detectable reason may also increase anxiety. It may vary from patient to patient and cannot be generalized. Hence, whether searching the symptoms on the internet and self-diagnosis is beneficial or not still remain a topic of debate.
Paederus dermatitis commonly occurs on the head, neck, face, and upper extremity.[14] The skin lesion appears as erythema followed by a course of vesiculation and then crusting.[1] The initial line of management includes removal of vesicant from the area of contact by washing the area and application of topical tincture iodine. Addition of oral antibiotic (e.g., ciprofloxacin) may help in prevention of concurrent bacterial infection.[15] Calamine lotion or topical anesthetics may also be used to reduce itching and burning sensation.[1] As the patient was suffering from severe pain, NSAID and PPI were added.[16],[17] Fourth day onward, NSAID and PPI were discontinued and there was minimal pain and the patient was otherwise productive. Hence, NSAID may be prescribed in the initial days of treatment when the patient complains about the pain associated with paederus dermatitis.
In conclusion, patient's promptness in capturing image of the rove beetle helped in the diagnosis of paederus dermatitis. In addition, self-diagnosis and internet search helped in initial self-management of the lesion. This case report is an example of proper use of the internet and smartphone in diagnosis and management of a case of paederus dermatitis. Furthermore, patient-provided chronological images of any dermatological disorder, captured by smartphone, can serve as good literary evidence.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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