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An Urge to Scratch

  • James H. Diaz
    Corresponding author: James H. Diaz, MD, DrPH, Professor of Public Health and Preventive Medicine, School of Public Health, Louisiana State University Health, New Orleans, LA
    Professor of Public Health and Preventive Medicine, School of Public Health, Louisiana State University Health, New Orleans, LA
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      A 21-y-old man was hiking the length of the Appalachian Trail (AT) from its southern terminus at Springer Mountain, Georgia, to its northern terminus at Mount Katahdin, Maine, during the summer after college graduation. By the time he reached the North Carolina section of the AT, he had developed an intensely pruritic, papulovesicular rash with draining pustules confined to a circumferential area around his waist and hips covered by his underwear (Figure 1). He had hiked sections of the AT before as a summer camp counselor and sustained scratches and insect bites while on the trail but had never developed such an extensive and pruritic regional skin eruption. He could no longer continue his trek. He called his sister, who lived in Asheville, North Carolina, on his cell phone, requesting a ride to the nearest urgent care facility.
      Figure thumbnail gr1
      Figure 2A 6-legged larva of a trombiculid species mite (family Trombiculidae) capable of causing chiggers worldwide. The feathery anterior projection is the mite’s feeding stylostome, which is usually retracted unless feeding. Source: Wikimedia Commons. Photo by Alan R. Walker. Public domain, no copyright permission required. Available at:


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        • McClain D.
        • Dana A.N.
        • Goldenberg G.
        Mite infestations.
        Dermatol Ther. 2009; 22: 327-346
        • Hase T.
        • Roberts L.W.
        • Hildebrandt P.K.
        • Cavanaugh D.C.
        Stylostome formation by Leptotrombidium mites (Acari: Trombiculidae).
        J Parasitol. 1978; 64: 712-718
        • Smith G.A.
        • Sharma V.
        • Knapp J.F.
        • Shields B.J.
        The summer penile syndrome: seasonal acute hypersensitivity reaction caused by chigger bites on the penis.
        Pediatr Emerg Care. 1998; 14: 116-118
        • Elston D.M.
        What’s eating you? Chiggers.
        Cutis. 2006; 77: 350-352