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Case report
Blister beetle dermatitis caused by cantharidin in South Sudan in Op TRENTON: a case series
  1. Caroline Linda Maynard-Burrows1,
  2. J V Mclennan2,3,
  3. T C Nicholson-Roberts4 and
  4. H Takano5
  1. 1 Burns unit, Royal Centre for Defence Medicine, Birmingham, UK
  2. 2 Academic Department of Military Emergency Medicine (ADMEM), Royal Centre of Defence Medicine, Birmingham, West Midlands, UK
  3. 3 Emergency Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
  4. 4 Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
  5. 5 Department of Life Sciences, Natural History Museum, London, UK
  1. Correspondence to Ms Caroline Linda Maynard-Burrows, Royal Centre for Defence Medicine, Birmingham B45 9UA, UK; cazmaybuz{at}gmail.com

Abstract

Cantharidin-producing blister beetles are found worldwide. The pathognomonic feature of their toxin is a blistering dermatitis that presents an environmental health hazard. Cutaneous exposure to cantharidin can produce blistering dermatitis, most commonly seen on exposed skin, in the Bentiu region of South Sudan. This should be treated with appropriate cleaning, debridement and regular dressing changes to cope with extensive initial exudate. The best dressing combinations found were initial treatment with povidone-iodine and hydrocolloid, followed by hydrocolloid only. Hydrocolloid dressings were found to be the most effective at staying in place with South Sudan’s high humidity. Prevention strategies should include covering exposed skin, wearing wide-brimmed hats, neck scarves and enclosed footwear, and avoidance of working under white light. Medical personnel should engage with the chain of command to include appropriate force protection education within the arrivals brief.

  • blister beetles
  • cantharidin
  • blister burns
  • cantharidin toxin
  • military personnel
  • blister beetle dermatitis

https://doi.org/10.1136/jramc-2019-001186

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    Footnotes

    • Collaborators Michael Geiser.

    • Contributors JM and CLM-B compiled the case report and researched the background and supporting information. TCN-R reviewed the case report from both a medical and entomological aspect, and provided the necessary expertise to present the beetles for identification. HT identified the specific beetle responsible for the dermatitis seen and provided information on the species habitat, life cycle and food source.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.