Bites of fleas, lice, and scabies produce lesions so similar that diagnosis is often difficult. Flea bites are frequently found in zigzag lines, especially on the legs and in the waist area. The lesions have hemorrhagic puncta surrounded by erythematous and urticarial patches. Pruritus is intense, and often, even after the lesions clear, dull red spots persist.
The main concern in the treatment of flea bites is the possibility of secondary infection. Children may develop impetigo as a complication. The lesions should be washed thoroughly with soap and water. Children with flea bites should have their fingernails cut short to prevent scratching. To relieve discomfort and itching, starch baths at bedtime (about 1 kg starch to a tubful of water), local application of calamine, cool soaks, and oral antihistamines may be helpful. For severe discomfort, application of a topical steroid cream or spray may be necessary. If secondary infection develops, topical or oral antibiotics may be needed.
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