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16-21: Skeeter Syndrome

Ken Zafren; R. Jason Thurman; Ian D. Jones

Clinical Summary

Skeeter syndrome is not an envenomation. It is an allergic reaction to polypeptides in mosquito saliva. Widespread inflammation may mimic cellulitis. Initially characterized by erythema, pruritis, and warmth, the rash becomes swollen within hours. Papules, vesicles, and bullae may develop in 8 to 12 hours. Because salivary peptides vary among species, individuals may be allergic to some species of mosquitos but not others.

Management and Disposition

In mild cases, oral antihistamines and topical steroid creams are effective. In severe cases, systemic steroids are indicated.

Pearls

  1. A history of mosquito bites and the time course of the rash can help distinguish skeeter syndrome from cellulitis.

  2. Antibiotics are not indicated in the treatment of skeeter syndrome.

FIGURE 16.94

Skeeter Syndrome. This patient presented with erythema, swelling, and itching of the anterior thighs and a large bullous lesion on the left anterior thigh less than 24 hours after mosquito bites. He was wearing shorts without repellant when bitten. (Photo contributor: Simant Singh Thapa, MD.)

A patient with skeeter syndrome has a large, bullous lesion with yellow fluid and surrounding redness on the thigh.
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FIGURE 16.95

Skeeter Syndrome. The right leg of the patient in Fig. 16.94. The area was highly pruritic, and smaller vesicles and bullae were noted. He was treated with oral antihistamines and topical steroid cream with resolution of his rash in 2 weeks. (Photo contributor: Simant Singh Thapa, MD.)

The patient from the previous image after drainage of the bullous lesion and treatment. The lesion has been reduced to a small, flat, yellow mark, and minor redness.
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