2.4.9 Flea bites

Grading & Level of Importance: B




Pruritic lesions caused by bites of from human or animal fleas.

Aetiology & Pathogenesis

Human flea (pulex irritans), various animal fleas (such as dog fleas, cat fleas, pigeon fleas, European rat fleas): flightless insects, 1-6 mm.

Signs & Symptoms

Multiple, very pruritic urticated papules with central haemorrhagic punctae. Typically present in an asymmetrical, linear or grouped distribution. Rarely can present as a bullous reaction. Can occur with more erythema in infants. 


Exposed body areas, preferentially around the ankles and lower legs.


Can occur with more erythema in infants.


Impetiginisation. Fleas can also transmit concurrent infectious diseases (for example Xenopsylla cheopis and plague).


Clinical features. History of exposure and look for fleas in the affected individual’s' immediate environment; to confirm diagnosis and allow for treatment of primary host.

Differential diagnosis

Urticaria, other arthropod bites such as bed bugs.

Prevention & Therapy

Keep the affected area dry and use topical antipruritic measures (zinc oxide lotion, corticosteroid lotion). Systemic antihistamines. Insecticides and repellents. Treat potential primary hosts in the immediate environment such as pets and pigeons. Prophylactic measures include flea bands for dogs and cats.

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