Dermatology

A Study of Beetle Dermatitis

Asit Mittal*, Sharad Mehta**, Anubhav Garg**, Lalit Gupta*, CM Kuldeep†, Ashok Kumar Khare‡, Sarin Nistha¶

Abstract
Background: Beetle dermatitis is a common condition seen in regions with warm and tropical climate. The condition causes
significant morbidity and can be misdiagnosed. Aim: The study was conducted to know the clinical profile of beetle dermatitis
and to increase awareness among nondermatologist physicians about this condition. Methods: All clinically diagnosed cases of
beetle dermatitis were included in the study. Detailed history was taken and a thorough clinical examination was conducted
in all the cases. Clinical photographs were taken in all the cases. Results: A total of 70 cases comprising of 46 males and 24
females were studied. The age of the patients ranged from 5 to 60 years. Majority of the cases presented during the post
monsoon months (September-November), indicating a distinct seasonal trend. Morphology of lesions was mainly linear, but
kissing and bizarre lesions were also observed. Head, neck and upper extremities were the most commonly involved sites.
Fever and malaise was observed in a few cases. Conclusion: Beetle dermatitis should be included in differential diagnosis while
examining erythematous vesicular lesions of sudden onset, especially on exposed parts during rainy and post rainy season.
Awareness of this condition and its clinical features among the physicians will prevent misdiagnosis. Preventive measures can
be undertaken based on the behavioral pattern of this beetle.
Keywords: Beetle dermatitis, kissing lesion

B
eetle dermatitis is a specific form of acute irritant
contact dermatitis caused by a vesicant chemical
present in the body fluid of the beetle belonging
to the order coleopteron.1 The beetle does not bite or
sting but accidental brushing against or crushing over
the skin provokes the release of its coelomic fluid,
which is a potent vesicant.1 The disease is characterized
by sudden onset of erythematous, vesiculobullous
lesions on the exposed body parts and associated with
burning, stinging and itching.2
The dermatitis is most commonly seen in regions with
warm tropical climate3 and is common in various
parts of India, but may not be easily diagnosed by
nondermatologists due to lack of awareness and
familiarity about this condition. There have been
reports of outbreak of beetle dermatitis from various
*Associate Professor
**Assistant Professor
†Professor
‡Professor and Head
¶Dept. of Dermatology, Venereology and Leprosy
RNT Medical College, Udaipur, Rajasthan
Address for correspondence
Dr Asit Mittal
Associate Professor, Dept. of Dermatology, Venereology and Leprosy, RNT Medical
College, Udaipur, Rajasthan - 313 001
E-mail: asitmittal62@gmail.com
regions of India.3,4 We undertook this study to know
the various clinical patterns of beetle dermatitis and to
raise the awareness about this entity among medical
professionals.
Material and Methods
This study was carried out at the Dept. of Skin and
VD, RNT Medical College and Associated Group of
Hospitals, Udaipur, Rajasthan. A total of 70 cases of
beetle dermatitis were seen over a period of three
months from September to November. A detailed
history was taken regarding age, sex, occupation,
locality (rural or urban), duration, symptoms
like itching, burning, pain, fever, malaise, living
conditions, sleeping habits, history of exposure to
insects, etc. A thorough clinical examination was
done to record the sites, distribution, morphology
of lesions, residual post inflammatory pigmentary
changes and systemic features, if any. Clinical
photographs of all cases were taken.
Patients were treated according to severity of lesions.
Mild cases were treated with topical corticosteroid-
antibiotic combination and oral antihistamines.
For severe cases, oral corticosteroids were prescribed.
Where secondary infection was seen, systemic
antibiotics were also added.

714 Indian Journal of Clinical Practice, Vol. 23, No. 11 April 2013
 Dermatology

Results

A total of 70 cases of beetle dermatitis were included

in this study. Age of the patients ranged from 5 to 60
years. Out of 70 cases, 46 (65.71%) were males and rest
24 (34.29%) were females.
Duration of lesions was less than one week in 60
(85.71%) patients. Maximum number of patients 55
(78.57%) had burning and itching at the site of lesion,
while 15 (21.43%) cases were asymptomatic. Systemic
features such as fever and malaise were observed in 10
(14.29%) cases.
Face was the commonest site in 32 (45.71%) patients.
Other sites of involvement were trunk, upper extremities
Figure 1. Kissing lesion over cubital fossa.
and lower extremities (Table 1). Maximum number of
patients 40 (57.14%) showed linear pattern (Table 2).
All cases responded well to therapy; however,
residual hyperpigmentation and persistent exfoliation
(Fig. 3), which were very distressing to the patient,
were seen in a few cases.

Discussion

Beetle dermatitis is a distinctive seasonal vesico-

bullous skin disorder caused by three major families
of blister beetles of the order coleoptera: Meloidae,
edemeridae and staphylinidae. The vesicant chemical

Table 1. Sites of Involvement of Beetle Dermatitis

Sites of No. of cases % (n = 70) Figure 2. Beetle dermatitis mimicking herpes zoster.
involvement
Face 32 45.71
Upper extremities 18 25.71
Trunk 10 14.29
Lower extremities 10 14.29
Total 70 100

Table 2. Pattern of Lesions of Beetle Dermatitis

Morphology of lesions No. of cases % (n = 70)

Linear 40 57.14

Kissing (Fig.1) 12 17.14 Figure 3. Persistent exfoliation.

Bizarre 10 14.29
in both meloidae and edemeridae is cantharidin, while
Herpetiform (Fig. 2) 8 11.43 it is pederin in the third family staphylinidae, which
Total 70 100 includes the genus Paederus.1 The genus paederus
consists of more than 622 species, which are widely

Indian Journal of Clinical Practice, Vol. 23, No. 11 April 2013 715
Dermatology
distributed.2 Cantharidin dermatitis is characterized by
noninflammatory vesicle and bullae whereas, Paederus
dermatitis is characterized by vesicle and pustules
arising from intensely inflamed skin.2 Blister beetle can
fly but they prefer to run and live in moist habitats,
and may appear in large numbers following heavy
rains and hot weather.1 They are attracted to white
light at night, a feature that commonly brings them into
contact with humans.
In our study, exposed body parts such as head, neck
and upper extremities were most commonly affected.
A similar observation was made in a study on 77 cases
of beetle dermatitis in Punjab by Handa et al3 and in
a study on 54 cases at Jodhpur by Kalla et al.4 Most
common pattern of lesions seen in our study was
linear. Similar pattern has been reported in other
studies also.2-5 The lesions are commonly linear due to
crushing and whipping an insect off the skin. Mirror
image or ‘kissing lesions’ are seen in skin flexures
where an insect has been inadvertently crushed with
transfer of chemical to the opposing surface.5-7
Ocular involvement was seen in a few of our patients.
It is usually secondary to transfer of toxic chemicals by
fingers from elsewhere on skin. Ocular involvement
as a relatively common finding was also reported
by Zargari et al.2 We observed diffuse and persistent
exfoliation (desquamative lesions) as an uncommon
finding in a few of our patients. Such atypical variants
of beetle dermatitis have been reported in other studies
also.2,8
Clinically beetle dermatitis mimics many common skin
conditions like herpes simplex, herpes zoster, thermal
burns, bullous impetigo, phyto-photodermatitis and
acute allergic or irritant contact dermatitis.2,6-9 Herpes
zoster is particularly a condition often confused with
beetle dermatitis on account of symptom of burning,
pain and vesico-bullous lesions. Grouped vesicles and
bullae strictly in a dermatomal pattern is characteristic
of herpes zoster. The diagnosis of beetle dermatitis
should be suspected by the sudden onset of linear and
mirror image lesions, predominant involvement of
exposed sites and seasonal incidence.
■■■■
Umbrellas may Shield you from more than Rain: Study
If it’s streaming sunshine outdoors and the sunscreen isn’t handy, an umbrella could help shield skin from
ultraviolet (UV) rays, according to a new study by dermatologists at Emory University in Atlanta. They found
that any fully-functioning handheld umbrella can block more than three-quarters of UV light on a sunny day.
Black ones seem to do the job especially well, blocking at least 90% of rays. (Source: Medscape)
716 Indian Journal of Clinical Practice, Vol. 23, No. 11 April 2013
Conclusion
Awareness about this condition amongst the
medical practitioner will aid in early diagnosis
and prompt treatment and prevent the sequelae
of persistent hyperpigmentation, which can be
particularly distressing in some patients. Therefore,
an early diagnosis and treatment would prevent this
complication. In addition awareness among the public
at large may also help decrease the incidence of beetle
dermatitis. The patients should also be counseled about
the benign and self-limiting nature of the disease.
Various preventive measures like changing the light
source, using kerosene or petrol to kill the larva in
stagnant water and spraying pesticides and insecticides
particularly in breeding areas are often helpful.8
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Paederus dermatitis in northern Iran: a report of 156 cases.
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