Environmental Dermatology

What’s Eating You? Bedbugs

Author and Disclosure Information

Bedbugs are a known household scourge that also have become an increasing problem in the corporate space. These pests have adapted to the office environment, finding new harborages in which to thrive and devising new ways to obtain blood meals during the day. Bedbugs pose a considerable public health problem, and managing the epidemic will require vigilance by health care professionals as well as patient education on prevention. We present the case of a 42-year-old man with treatment-refractory pruritic papules over the bilateral posterior arms that were attributed to a bedbug infestation at his workplace.

Practice Points

  • Bedbug exposures in the workplace are on the rise.
  • High clinical suspicion is required when atypical dermatoses are not responding to therapy and histology suggests arthropod exposure.
  • Once detected, partnership with occupational health and pest management experts is critical to eradicate bedbugs.



Bedbugs are common pests causing several health and economic consequences. With increased travel, pesticide resistance, and a lack of awareness about prevention, bedbugs have become even more difficult to control, especially within large population centers.1 The US Environmental Protection Agency considers bedbugs to be a considerable public health issue.2 Typically, they are found in private residences; however, there have been more reports of bedbugs discovered in the workplace within the last 20 years.3-5 Herein, we present a case of bedbugs presenting in this unusual environment.

Case Report

A 42-year-old man presented to our dermatology clinic with intensely itchy bumps over the bilateral posterior arms of 3 months’ duration. He had no other skin, hair, or nail concerns. Over the last 3 months prior to dermatologic evaluation, he was treated by an outside physician with topical steroids, systemic antibiotics, topical antifungals, and even systemic steroids with no improvement of the lesions or symptoms. On clinical examination at the current presentation, 8 to 10 pink dermal papules coalescing into 10-cm round patches were noted on the bilateral posterior arms (Figure 1). A punch biopsy of the posterior right arm was performed, and histologic analysis showed a dense superficial and deep infiltrate and a perivascular infiltrate of lymphocytes and eosinophils (Figure 2). No notable epidermal changes were observed.

Figure 1. Several pink, ill-defined papules coalescing into a 10-cm patch on the posterior right arm. Sutures show the punch biopsy location.

Figure 2. A, A 4-mm punch biopsy showed a dense superficial and deep infiltrate (H&E, original magnification ×2). B, A perivascular infiltrate of lymphocytes and sporadic eosinophils without epidermal change also was noted (H&E, original magnification ×20).

At this time, the patient was counseled that the most likely cause was some unknown arthropod exposure. Given the chronicity of the patient’s disease course, bedbugs were favored; however, an extensive search of the patient’s home failed to uncover any arthropods, let alone bedbugs. A few weeks later, the patient discovered insects emanating from the mesh backing of his office chair while at work (Figure 3). The location of the intruders corresponded exactly with the lesions on the posterior arms. The occupational health office at his workplace collected samples of the arthropods and confirmed they were bedbugs. The patient’s lesions resolved with topical clobetasol once eradication of the workplace was complete.

Figure 3. The patient’s office chair showed bedbugs protruding through the mesh backing.

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