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CASE IMAGE
Year : 2021  |  Volume : 1  |  Issue : 3  |  Page : 202

Abrupt onset tiny pigmented macules on soles caused by cydnidae bugs


1 Department of Dermatology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
2 Department of Pediatrics, Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal Campus, Manipal, Karnataka, India

Date of Submission09-Jun-2021
Date of Acceptance09-Aug-2021
Date of Web Publication31-Aug-2021

Correspondence Address:
Dr. Ashish Gupta
Department of Pediatrics, Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal Campus, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipcares.ipcares_174_21

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How to cite this article:
Asati DP, Gupta A. Abrupt onset tiny pigmented macules on soles caused by cydnidae bugs. Indian Pediatr Case Rep 2021;1:202

How to cite this URL:
Asati DP, Gupta A. Abrupt onset tiny pigmented macules on soles caused by cydnidae bugs. Indian Pediatr Case Rep [serial online] 2021 [cited 2021 Sep 26];1:202. Available from: http://www.ipcares.org/text.asp?2021/1/3/202/325084

A 6-year-old boy presented with the sudden appearance of multiple, small, dark brown lesions on both soles for a day. Thinking that they were due to sort of staining, the mother tried scrubbing them off with soap and water, but to no avail. They were not associated with pain, itching, abnormal sensations, discharge, or previous lesions in the same areas. There was no history of fever, joint pain, trauma, drug intake, or wearing new footwear. History of lesions elsewhere (including the mouth) or similar lesions in the past was not found. The child had a habit of roaming around inside and outside the house without footwear.

Examination revealed multiple blackish-brown macules of size ranging from 1 to 3 mm which were nonscaly and nonblanchable. The macules had sharply defined margins, irregular shapes, and no particular pattern of arrangement [Figure 1]. There was no other mucosal or skin involvement. Systemic examination was unremarkable. Complete blood counts, coagulation profile, and liver function tests were normal. Dermatitis neglecta, post-inflammatory hyperpigmentation, and lentignes were considered and disregarded due to history of daily bathing, absence of preceding lesions, and mismatch in morphological appearance. The lesions disappeared spontaneously after 4 days. Based on the characteristic onset, spontaneous resolution, absence of associated systemic features, and normal investigation reports, a diagnosis of Cydnidae pigmentation was made.
Figure 1: Freckle-like hyperpigmented macules over the sole

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Cydnidae pigmentation is the appearance of asymptomatic discoloration overexposed parts of the body (usually palms and soles) due to contact with the “Cydnidae bug” (burrowing bug) or Chilochoris assmuthi Breddin, that belongs to the order Hemiptera. These winged, low flying insects are found in the soil of vegetation-rich areas adjoining human dwellings, especially during the rainy season. They release a chemical substance from their glands which result in staining of the human skin and present as pigmented macules.[1] Pigmentation can also occur when the insect is rubbed between the index finger and thumb.[2] The stains can be removed with acetone or resolve spontaneously within a few days. Only few cases have been reported till date. We are reporting this case to increase awareness among clinicians who can reassure parents and alleviate their anxiety, as well as avoid unnecessary investigations and treatment.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient's parent has given his consent for images and other clinical information to be reported in the journal. The parent understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Agarwal R, Srinivas SM, Chandrashekar BS. Asymptomatic freckle-like hyperpigmentation of the palms: A rare pigmentation caused by Cydnidae (burrowing bug). Indian J Paediatr Dermatol 2019;20:353-4.  Back to cited text no. 1
  [Full text]  
2.
Malhotra AK, Lis JA, Ramam M. Cydnidae (burrowing bug) pigmentation: A novel arthropod dermatosis. JAMA Dermatol 2015;151:232-3.  Back to cited text no. 2
    


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