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Anais Brasileiros de Dermatologia

versão On-line ISSN 1806-4841

An. Bras. Dermatol. vol.89 no.1 Rio de Janeiro jan./fev. 2014

https://doi.org/10.1590/abd1806-4841.20142593 

Imaging In Tropical Dermatology

Dermoscopy as an auxiliary method in the diagnosis of social wasp (Hymenoptera, Vespidae) stings*

Luiz Gustavo Martins da Silva1 

Fred Bernardes Filho2 

Maria Victória Quaresma2 

Elaine de Souza Pinto Leite3 

Andresa de Oliveira Marteloso3 

Natália Ferreira Saldanha4 

Grabriela Gonçalves Brum4 

1Dermatologist - Private Clinic - Ituiutaba (MG), Brazil.

2Post-graduate student of Dermatology, Prof. Rubem David Azulay Institute of Dermatology - Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ) and Postgraduate Medical School at Pontifical Catholic University of Rio de Janeiro (EMPG/PUC-RJ) - Rio de Janeiro (RJ), Brazil.

3Internal Medicine Residency, Hospital Municipal da Piedade - Rio de Janeiro (RJ), Brazil.

4MD - Private Clinic - Rio de Janeiro (RJ), Brazil.


ABSTRACT

We describe the case of a 32-year-old male patient that sought medical treatment complaining of severe pain in his second and third right-hand fingers. The symptoms had started two hours before. The hypotheses of spider bite, scorpion or insect sting and injury caused by a foreign body were considered in the differential diagnoses. On dermoscopy, two foreign bodies were identified on his skin. After extraction, we concluded that they were wasp stingers.

Key words: Dermoscopy; Hemiptera; Hymenoptera; Insects; Insect bites and stings

Male patient, 32 years old, sought treatment in the emergency ward complaining of pain in his second and third right-hand fingers. While handling a stack of bricks - two hours before seeking medical treatment - he felt a stinging pain in his second righthand finger. On dermatological examination, edema of the second finger, metacarpophalangeal region, and the proximal phalanx of his third right-hand finger (Figures 1A and 1B) was observed. The hypotheses of spider bite, scorpion or insect sting and injury caused by foreign bodies were considered. Dermoscopy showed the presence of two brownish foreign bodies in his skin (Figures 1C and 1D). They were extracted and identified as two stingers measuring approximately 2mm each (Figure 2). The patient was advised to avoid moving his hand, apply ice to the affected area and use oral non-steroidal anti-inflammatory drugs. One hour after the stingers had been removed, he returned to the emergency ward bringing a wasp he had found at the site (Figure 3).

FIGURE 1 A - Edema in the patient’s second and third right-hand fingers; B - Metacarpophalangeal region showing edema; arrow and circle indicate the area where the stingers were inserted; C,D - Dermoscopy revealing the two stingers 

FIGURE 2  A,B and C - Two stingers measuring approximately 2 mm are seen on dermoscopy; (D) After removal of the stingers, the affected area is seen in detail 

FIGURE 3 A,B - Dorsal view of the insect collected by the patient; C - lateral view (D) Stingers removed from the patient’s skin 

Hornets and wasps are insects that belong to the Hymenoptera order. Only the female has a stinger, since it is a modification of the ovipositor.1 These insects' stings are painful and cause a burning sensation. In more sensitive individuals, they may cause an anaphylactic reaction, jeopardizing the performance of routine activities.2-6

REFERENCES

1. Sühs RB, Somavilla A, Putzke J, Köhler A. Pollen vector wasps (Hymenoptera, Vespidae) of Schinus terebinthifolius Raddi (Anacardiaceae). Rev Bras Biocienc. 2009;7:138-43. [ Links ]

2. Przybilla B, Ruëff F. Insect stings: clinical features and management. Dtsch Arztebl Int. 2012;109:238-48. [ Links ]

3. Singh S, Mann BK. Insect bite reactions. Indian J Dermatol Venereol Leprol. 2013;79:151-64. [ Links ]

4. Steen CJ, Carbonaro PA, Schwartz RA. Arthropods in dermatology. J Am Acad Dermatol. 2004;50:819-42 [ Links ]

5. Haddad V Jr, Cardoso JLC. Dermatosis caused by poisonous animals. An Bras Dermatol. 1999;74:441-7. [ Links ]

6. Haddad V Jr, Cardoso JL, Lupi O, Tyring SK. Tropical dermatology: Venomous arthropods and human skin: Part I. Insecta. J Am Acad Dermatol. 2012;67:331.e1-14. [ Links ]

* Work conducted at Visiaderm Clinic - Ituiutaba (MG), Brazil.

Financial funding: None

Received: March 06, 2013; Accepted: April 08, 2013

MAILING ADDRESS: Luiz Gustavo Martins da Silva, Rua nº 38, casa nº 936, Progresso. 38302-010 Ituiutaba, MG, Brazil. E-mail: luizgustavodermatologia@gmail.com

Conflict of interest: None

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.