“Sign of the kiss” in dermatitis caused by vesicant beetles (“potós” or Paederus sp.)* Vidal Haddad Junior1 DOI: http://dx.doi.org/10.1590/abd1806-4841.20143335 Abstract: The cosmopolitan beetles of the Paederus genus (potós) cause a severe dermatitis when the insect is crushed against the skin of exposed areas (the cervical region is the most affected). Toxins (pederin and others) from the hemolymph of the insect cause plaques and/or bizarre, linear lesions with erythema, edema, blisters, pustules, crusts and exulcerations. There may be a burning sensation and severe conjunctivitis. Lesions disap- pear after 10 days and may leave hyperchromic macules. Treatment is made with topical corticosteroids and intensive washing. Keywords: Poisonous animals, Beetles; Dermatitis; Poisons Received on 20.12.2013. Approved by the Advisory Board and accepted for publication on 08.01.2014. * Study conducted at the Botucatu Medical School, Sao Paulo State University Julio de Mesquita Filho (FMB-Unesp), Botucatu (SP), Brazil. Conflict of interest: None Financial funding: None 1 Sao Paulo State University Julio de Mesquita Filho (Unesp), Botucatu (SP), Brazil. ©2014 by Anais Brasileiros de Dermatologia s Poisonous animals can provoke envenomations humans by passive release of toxins. Some beetles (Coleoptera) may produce and/or store vesicant tox- ins, such as the genera  Epicauta,  Lytta (Spanish fly) and Paederus.1 The Paederus beetles or “potós” cause a severe dermatitis, especially in warm climate such as the Midwest and Northeast Brazil (Figure 1).2,3 These insects are cosmopolitan and were first associated with vesicular dermatitis by Pirajá da Silva in Brazil.4 The animal is crushed against the skin of exposed areas (the cervical region is the most affected) and toxins (such as pederin and others), which are present in the hemolymph of the insect, cause plaques and/or linear lesions with erythema, edema, blisters, pustules, crusts and exulcerations. There may be a burning sensation and severe conjunctivitis. 996 IMAGING IN TROPICAL DERMATOLOGY An Bras Dermatol. 2014;89(6):996-7. FIGURE 1: Paederus sp., the “potó”. This beetle is the most common vesicant beetle around the world Revista6Vol89ingles_Layout 1 10/10/14 11:08 AM Página 996 An Bras Dermatol. 2014;89(6):996-7. Distribution is bizarre. Lesions disappear after about 10 days and may leave hyperchromic macules. In skin folds, the “sign of the kiss” can occur in an area of healthy skin juxtaposed to damaged skin. Vesicant lesions are reproduced due the contact with the toxins (Figure 2). The “potó” dermatitis can be confused with herpes simplex, varicella-zoster, contact dermatitis or phytophotodermatitis.1 Dermatologists should sus- pect the dermatitis in individuals with vesicles or pus- tules, who were in hot areas near lampposts, as in this case, in which a young woman slapped her arm as she “felt an insect” crawling on it. The treatment compris- es washing with boric water, topical corticosteroids and antibiotics if bacterial infection is present.1 In severe cases with multiple contacts, systemic corticos- teroid therapy is indicated.1 q How to cite this article: Haddad Jr V. “Sign of the kiss” in dermatitis caused by vesicant beetles (Paederus sp. or “potós”). An Bras Dermatol. 2014;89(6):996-7. REFERENCES Cardoso JLC, Haddad Jr V. Acidentes por Coleópteros vesicantes e outros artrópo-1. dos. In: Cardoso JLC, França FOS, Wen FH, Malaque CMS, Haddad Jr V, editores. Animais peçonhentos no Brasil: biologia, clínica e terapêutica dos acidentes. 2. ed. São Paulo: Editora Sarvier ; 2009. p. 274-280. Pirajá da Silva M. Le Paederus columbinus est vésicant. Arch Parasitol.1912;15:429-31.2. Cardoso AEC, Lima-Filho MR. Vesicular dermatitis induced by Paederus: an outbreak3. in Northeastern Brazil. An Bras Dermatol. 1986;61:173-6. Diógenes MJN. Dermatite de contato pela pederina, estudo clínico e epidemiológico4. no Estado do Ceará, Brasil. Rev Inst Med Trop São Paulo. 1994;36:59-65. MAILING ADDRESS: Vidal Haddad Junior Caixa Postal 557 18618-970 - Botucatu – SP Brazil E-mail: haddadjr@fmb.unesp.br “Sign of the kiss” in dermatitis caused by vesicant beetles (Paederus sp. or “potós”) 997 FIGURE 2: Vesicant lesions in an area of healthy skin juxtaposed to damaged skin, which reproduces the lesions Revista6Vol89ingles_Layout 1 10/10/14 11:08 AM Página 997