Fleabite T14.-

Sting by fleas with consecutive formation of itchy wheals or papules with an accentuated (usually hemorrhagic) central puncture site.

Mainly human fleas (Pulex irritans), also dog fleas, cat fleas, see also fleas.

Since fleas are mainly found in clothes, the stitches are primarily found on clothed skin areas.

Mostly multiple, grouped(typically triple configurations of the stitches -breakfast, lunch, dinner- the flea performs test stitches before the main stitch), asymmetrically arranged wheals and itchy papules; rarely blistering. Centrally punctiform haemorrhagic punctures, easily visible under glass spatula pressure.

Urticaria; prurigo simplex acuta infantum; varicella; trombidiosis; pediculosis.

Superinfections can occur due to transmitted human pathogenic germs.

The rat flea is a carrier of Yersinia pestis.

Dog fleas/cat fleas are intermediate hosts for Dipylidium caninum (tapeworm), Francisella tularensis (tularaemia), Rickettsia (typhus).

Lotio alba possibly with addition of 2-4% polidocanol (e.g. R200)

Alternatively: 1% menthol solution.

Alternative: short-term application of topical glucocorticoids e.g. Betagalen lotio or cream.

In case of stronger local inflammatory reaction it is recommended to apply a potent glucocorticoid (e.g. Clobetasol cream) thickly on the back of a knife and to occlude with a gauze compress.

Note: The value of local antihistamines (Fenistil gel, Soventol gel) is controversial.

For severe itching antihistamines such as levocetirizine (e.g. Xusal acute) 1 time per day 10 mg p.o., desloratadine (e.g. Aerius) 1 time per day 10 mg p.o. or dimetinden (e.g. Fenistil Drg.), adults 3 times per day 1-2 mg, children > 3 years 3 times per day 1 mg p.o.

Rubbing with repellents (e.g. Autan).

It is important to clean up the environment (dogs, cats and their stores, room remediation) with substances such as permethrin, pyriproxifen, piperonyl butoxide. The most suitable are nebulisers (e.g. Indorex Fogger) or sprays available from the vet.

Wash bed linen and clothing hot (boil wash).

Possibly put on flea/tick collars (e.g. with the active ingredient dimpylate) for pets.

1. Zurita A et al (2019) Origin, evolution, phylogeny and taxonomy of Pulex irritans. Med Vet Entomol 33:296-311.