Blister beetle dermatitis in West Bengal

To the Editor,

This is with reference to the article entitled "Blister beetle dermatitis" published recently in the journal.[1] We wish to share our experience in this regard.

The first author (SRS) has the experience of working in North Bengal for more than a decade. The occurrence of exactly same type of this peculiar seasonal dermatitis is also noticed here. We want to mention a few additional points.

The lesions are erythematovesicular to start with, but gradually within a day or two they turn necrotic, giving rise to a burnt and charred appearance. These linear, zosteriform or bizzare patterned lesions do not spare the covered area even. Kissing ulcers are also noticed by few over apposing surfaces. It is first noticed by the patient often after getting up from the bed in the morning. Symptoms like burning, itching and pain are almost always associated. Swelling of the area with limitation of movement of that part of the body are also observed. In the subhimalayan part of West Bengal the monsoon takes a fairly long course and this type of dermatitis is encountered almost throughout the year sparing only the winter and the spring. Same type of dermatitis also occurs in southern districts of West Bengal (Burdwan, Bankura, Hoogly etc) during the rainy season as observed by the second author (KL).

Though, no patients have ever noticed any insects as such, in North Bengal this mysterious agent is popularly known as "technical bug". Histologically our findings are identical with those of the previous authors.[1],[2]In addition epidermal necrosis was observed is most of the cases.

According to our experience a potent topical steroid with antibiotic in cream base for a week or so works much better than just topical emollients. Other than post-inflammatory hyperpigmentation no other sequelae are observed. A thorough clinico-entomological study is needed to detect the offending agent.