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Case of Targetoid Dermatose triggered by Insect Bite

By June 11, 2018April 19th, 2020No Comments

A 27 yo female patient was bitten by an insect in Taiwan in Feb 2019. There were multiple insect lesions. Was first treated with steroid injection and other medications (??) and the lesions appeared less ‘angry,’ however within 2 weeks of stopping the medicines, the lesions began looking more serious again.

She went to GP, who referred to A&E, then to the National Skin Centre. By then then lesions had spread to both her legs. Patient started on prednisolone 25mg qd around the 18th of March, and continued using it for a month, tapering off toward the end. By the time she was at the 10mg qd dose, the skin lesions started surfacing again, but disappeared with used of topical steroids. However, the lesion began appearing again on the left leg.


These targetoid lesions initially appeared to resemble erythema multiforme (EM), although closed inspection said maybe not — we do not see the three rings that are typical of EM — maybe just nummular. The location is also not typical as EM lesions are most commonly found on acral regions of face, hands and feet.

I prescribed herbs for her damp-heat in lower jiao presentation, and implemented an acupuncture protocol to reduce inflammation for the next 3 weeks. She responded well with 3 weeks of ongoing treatment, as the image below demonstrates.


She came regularly for ongoing treatment with me for another 6 weeks, while continuing her treatment through diet/nutrition with a naturopathic colleague of mine. My treatments were mostly anti-inflammatory, while the naturopathic treatments supported digestive integrity provided additional liver support. This is helpful as the she was on steroids and other medications before coming for treatment. She also opted in to eliminating dairy and wheat from her diet and to supplement with foods like salmon for Omega 3s and millet for vitamin b12. She also went on a gut repair powder, and dosed up on supplementary vitamin C to relief her of histamine-induced itch. As the patient did not have a history of atopia, she went on a stronger burdock/dandelion tea for liver support.

2 months in, she is also able to reintroduce trigger foods and not flare (she did flare once from overuse of salicylates though). Her legs looked like this in the end.