Dermoscopy Observation of Bee Sting in a 3-Year-Old Girl

Nan Wang Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Lin Ma Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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Ya Bin Zhou Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China

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A 3-year-old girl presented to our outpatient clinic with a bee sting on her neck. One hour earlier, a honeybee had landed on her neck, and she had swatted it, resulting in a painful sting. The patient did not exhibit any symptoms of fever, cough, cold, nausea, vomiting, breathlessness, chest pain, palpitations, blackouts, or loss of consciousness, but she did report pain in the area where she was stung. On examination, we observed a foreign body on the right side of the patient’s neck (Figure 1A). Dermoscopy revealed that the foreign body was the residue of the honeybee’s body (Figure 1B). We removed the stinger by scraping it with a credit card (Figure 1C), and no residual stinger was observed on dermoscopy (Figure 1D). After treatment with 0.1% mometasone furoate cream, the lesion completely resolved within 1 day.

Figure 1.
Figure 1.

(A) A foreign body with surrounding edematous erythema was observed on the right side of the neck. (B) Honeybee body residue was observed by dermoscopy. (C) A stinger was removed. (D) An edematous erythema without residual stinger was observed by dermoscopy.

Citation: The American Journal of Tropical Medicine and Hygiene 109, 3; 10.4269/ajtmh.23-0188

Hymenoptera stings are common and painful envenomations that lead to an annual average of 62 deaths in the United States.1 The stinging insects of the Hymenoptera order are divided into three groups: Apidae (honeybees, bumblebees), Vespidae (wasps, yellow jackets, hornets), and Formicidae (ants).2 Honeybees leave their stingers in the victim’s skin and die shortly after they sting.3 Bumblebees have a stinger with fewer barbs and a stronger attachment, enabling them to sting multiple times without dying.4 Wasps, yellow jackets, and hornets are also capable of multiple stings, like bumblebees.4 Most fire ants sting the lower extremities in clusters.2 Unlike bees, wasps, yellow jackets, and hornets, fire ants inject venom slowly, which results in a delayed onset of pain.3

Although honeybees are notorious for leaving their stingers in the victim’s skin, other members of the Hymenoptera order may also leave a stinger behind.4 Therefore, it is crucial to remove any stinger promptly. The stinger should be extracted by sweeping the dull blade of a butter knife or the edge of a credit card across the skin at an almost parallel angle to the surface.2 Using tweezers for removal should be avoided, as it can result in the injection of additional venom into the sting site.4 Although dermoscopy is a useful tool to detect stingers left by Hymenoptera stings, only a wasp stinger has been reported in the literature.5 To the best of our knowledge, this is the first report of a bee sting observed with dermoscopy. Dermoscopy can be useful for detecting stingers, but its utility in detecting bee stings has not been widely reported.

REFERENCES

  • 1.

    2019. QuickStats: number of deaths from hornet, wasp, and bee stings,* among males and females – National Vital Statistics System, United States,† 2000–2017. MMWR Morb Mortal Wkly Rep 68: 649.

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  • 2.

    Herness J, Snyder MJ, Newman RS, 2022. Arthropod bites and stings. Am Fam Physician 106: 137147.

  • 3.

    Fitzgerald KT, Flood AA, 2006. Hymenoptera stings. Clin Tech Small Anim Pract 21: 194204.

  • 4.

    Steen CJ, Janniger CK, Schutzer SE, Schwartz RA, 2005. Insect sting reactions to bees, wasps, and ants. Int J Dermatol 44: 9194.

  • 5.

    Chauhan P, Jindal R, Errichetti E, 2022. Dermoscopy of skin parasitoses, bites and stings: a systematic review of the literature. J Eur Acad Dermatol Venereol 36: 17221734.

    • PubMed
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    • Export Citation

Author Notes

Address correspondence to Ya Bin Zhou, Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No. 56 Nan Lishi Rd., Xicheng District, Beijing 100045, China. E-mail: chouyabin@163.com

Disclosure: Informed consent was obtained from the patient’s mother for publication of case details.

Authors’ addresses: Nan Wang, Lin Ma, and Ya Bin Zhou, Department of Dermatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China, E-mails: yaodeyumao1986@sohu.com, bch_maleen@aliyun.com, and chouyabin@163.com.

  • Figure 1.

    (A) A foreign body with surrounding edematous erythema was observed on the right side of the neck. (B) Honeybee body residue was observed by dermoscopy. (C) A stinger was removed. (D) An edematous erythema without residual stinger was observed by dermoscopy.

  • 1.

    2019. QuickStats: number of deaths from hornet, wasp, and bee stings,* among males and females – National Vital Statistics System, United States,† 2000–2017. MMWR Morb Mortal Wkly Rep 68: 649.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Herness J, Snyder MJ, Newman RS, 2022. Arthropod bites and stings. Am Fam Physician 106: 137147.

  • 3.

    Fitzgerald KT, Flood AA, 2006. Hymenoptera stings. Clin Tech Small Anim Pract 21: 194204.

  • 4.

    Steen CJ, Janniger CK, Schutzer SE, Schwartz RA, 2005. Insect sting reactions to bees, wasps, and ants. Int J Dermatol 44: 9194.

  • 5.

    Chauhan P, Jindal R, Errichetti E, 2022. Dermoscopy of skin parasitoses, bites and stings: a systematic review of the literature. J Eur Acad Dermatol Venereol 36: 17221734.

    • PubMed
    • Search Google Scholar
    • Export Citation
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