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Mosquito bites cause a variety of reactions ranging from pruritic papules to severe systemic hypersensitivity reactions. The salivary glands of mosquitoes have been found to contain more than 70 different allergens. Herein, we describe the pathophysiology and clinical appearance of mosquito bite reactions as well as proper management of this condition.

Background: Appropriate use criteria (AUC) provide patient-centered physician guidance in test selection. An initial set of AUC was reported by the American Society of Dermatopathology (ASDP) in 2018. AUC reflect evidence collected at single timepoints and may be affected by evolving evidence and experience. The objective of this study was to update and expand AUC for selected tests., Methods: RAND/UCLA (RAND Corporation [Santa Monica, CA]/University of California Los Angeles) methodology used includes the following: (a) literature review; (b) review of previously rated tests and previously employed clinical scenarios; (c) selection of previously rated tests for new ratings; (d) development of new clinical scenarios; (e) selection of additional tests; (f) three rating rounds with feedback and group discussion after rounds 1 and 2., Results: For 220 clinical scenarios comprising lymphoproliferative (light chain clonality), melanocytic (comparative genomic hybridization, fluorescence in situ hybridization, reverse transcription polymerase chain reaction, telomerase reverse transcriptase promoter), vascular disorders (MYC), and inflammatory dermatoses (periodic acid-Schiff, Gömöri methenamine silver), consensus by panel raters was reached in 172 of 220 (78%) scenarios, with 103 of 148 (70%) rated "usually appropriate" or "rarely appropriate" and 45 of 148 (30%), "appropriateness uncertain.", Limitations: The study design only measures appropriateness. Cost, availability, test comparison, and additional clinical considerations are not measured. The possibility that the findings of this study may be influenced by the inherent biases of the dermatopathologists involved in the study cannot be excluded., Conclusions: AUC are reported for selected diagnostic tests in clinical scenarios that occur in dermatopathology practice. Adhering to AUC may reduce inappropriate test utilization and improve healthcare delivery., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Jellies, more commonly known as jellyfish, are a common cause of stings in oceans throughout the world. Most stings result in immediate painful skin reactions that can be treated with hot water immersion and careful removal of adherent tentacles. Rarely, certain jellyfish species can cause life-threatening systemic reactions that must be treated promptly and monitored in the acute care setting. Wearing a full-body stinger suit or applying a sting-inhibiting lotion are common strategies that may reduce the risk for jellyfish injuries. Avoidance of waters during jellyfish season is prudent in regions that harbor more dangerous species of jellyfish, particularly along the Australian and Indo-Pacific coastlines.

Caterpillar envenomation is a worldwide problem, with manifestations ranging from dermatitis to iridocyclitis and a fatal hemorrhagic diathesis. This article focuses on the diagnosis and management of dermatoses related to caterpillars.

Bloodroot (Sanguinaria canadensis) is a plant that historically has been used in medicine for its antimicrobial, antihypertensive, anti-inflammatory, and antineoplastic properties. In dermatology, bloodroot has been utilized for its cytotoxic effects; it has been marketed as black salve as an anticancer treatment, but it does not come without notable toxicities. Unwanted cosmetic outcomes and even irreversible scarring and premalignant conditions have been reported. This article aims to bring awareness to both the therapeutic potential of S canadensis as well as the potential toxicities and risks associated with this North American plant.

Background: Diagnosis of fibrous tumors can be challenging and expensive due to the use of special stains., Objective: Determine the usefulness of fluorescence microscopy in the evaluation of elastic tissue patterns on hematoxylin-eosin-stained slides., Methods: In total, 228 slides representing different fibrous tumors were evaluated for their elastic tissue patterns by fluorescence microscopy, and sensitivity and specificity were determined for relevant comparisons., Results: Fluorescence microscopy was found to be useful, especially for distinguishing dermatofibroma from dermatofibrosarcoma protuberans and dermatomyofibroma from other fibrous tumors., Limitations: In some cases, excessive background staining made patterns difficult to interpret., Conclusion: Evaluation of elastic tissue patterns by fluorescence microscopy in fibrous tumors is a cheap and efficient means to further delineate these often challenging tumors., (Copyright © 2018 American Academy of Dermatology, Inc. All rights reserved.)

Sea cucumbers are sausage-shaped aquatic creatures living on the ocean floors across the world. They are considered a food delicacy in many countries but also are known to have many beneficial pharmaceutical properties; however, sea cucumbers also contain a dangerous component called holothurin, which has been shown to have a negative impact on the health of both humans and other wildlife. In humans, exposure to holothurin can cause a painful irritant dermatitis, irritation of the mucous membranes, potential blindness, and, if ingested, even possible death. Treatment options include irrigation with seawater, soap, isopropyl alcohol, and vinegar.

Phytophotodermatitis is a cutaneous reaction that occurs after exposure to plant-derived furocoumarins and ultraviolet A light. Psoralen is the most common phototoxic furocoumarin and is present in varying levels within many different plant species. This article focuses on the diagnosis and management of psoralen-induced phytophotodermatitis along with other clinical applications., Competing Interests: The authors have no funding or conflicts of interest to declare., (Copyright © 2020 American Contact Dermatitis Society. All Rights Reserved.)

Competing Interests: None disclosed.

Sponges from the phylum Porifera exist throughout the world in marine and freshwater environments. Although many encounters with humans are benign, some may lead to local dermatologic manifestations and in rare cases can cause more severe systemic reactions. Initial decontamination is of utmost importance to diminish the severity of the reaction. As contact between humans and coastal environments increases, it is important for physicians to know how to recognize and treat sponge dermatitis.

The human flea, Pulex irritans, is an important vector in the transmission of human diseases. This flea has been identified as a vector for the bubonic plague as far back as the 14th century, causing millions of deaths. Pulex irritans also has been identified as a vector for Bartonella bacteria species, which can cause trench fever. Rickettsia species, which can cause Rocky Mountain spotted fever and Mediterranean spotted fever, also have been identified in P irritans. Flea bites present as intensely pruritic papules and can be treated with topical antipruritics and corticosteroids. The most effective form of flea control and prevention includes a combination of insecticidal products and insect growth regulators.