Buzz off: Managing arthropod complications in everyday dermatology | AAD 2026

This evening’s session at the 2026 American Academy of Dermatology Annual Meeting focused on an often-overlooked culprit in dermatology: arthropods. Titled “What’s Bugging You? Arthropods of Dermatologic Importance and Their Management: An Up-to-Date Review,” the session was led by Eric Winfield Hossler, M.D., a dermatologist at Geisinger Medical Center in Pennsylvania. It explored how insect and arachnid bites can both cause and mimic various skin conditions.

Hossler structured the presentation as a fictional “day in the life” of a dermatologist, guiding attendees through a series of patient cases that illustrated the diagnostic challenges of arthropod-related conditions. He began with a brief overview of insect classification, noting that insects have six legs, three body segments, and often one or two pairs of wings.

One case involved an elderly man presenting with a persistent rash he had experienced for months. Initially suggestive of contact dermatitis, the diagnosis quickly changed when a bed bug fell from the patient’s clothing during the examination. Hossler stressed the need to identify bed bugs at every stage of their life cycle, since patients might bring in adult bugs or nymphs. He also noted that bedbug bites typically occur on exposed skin but can be difficult to distinguish from other conditions. Complicating matters further, up to one-third of patients may show no visible skin symptoms, despite active infestation.

The session also highlighted the importance of obtaining a thorough travel history. In another case, a patient developed a lesion on his arm shortly after returning from Brazil. The lesion worsened over time and was accompanied by a sensation of movement beneath the skin. The diagnosis was furuncular human myiasis, a parasitic infection caused by fly larvae. Hossler explained that this condition can arise when flies deposit eggs on biting insects such as mosquitoes or ticks, which then transfer the larvae to human skin. Alternatively, flies may lay eggs directly into open wounds, called wound myiasis.

Turning to arachnids, Hossler outlined their distinguishing features: eight legs, two body segments and the absence of wings and antennae.

“Thank goodness,” Hossler joked. “I have a little bit of arachnophobia, so the situation would be very scary if spiders could fly.”

A key takeaway from the session was the frequent misdiagnosis of “spider bites.” Hossler stressed that most suspected spider bites are caused by something other than spiders. He cited research showing that approximately 85% of patient-reported spider bites treated in emergency departments are actually soft tissue infections. Misattribution can delay appropriate care and obscure more serious diagnoses.

He presented several examples to underscore this point. In one case, a lesion believed to be a spider bite was ultimately diagnosed as squamous cell carcinoma. In another, the correct diagnosis was cutaneous mucormycosis, a rare but potentially life-threatening fungal infection. These cases highlighted the risks of relying on assumptions rather than clinical evidence.

“The term ‘spider bite’ is often a misnomer,” Hossler said, describing it as a “deceit-ism” used to explain severe lesions without confirmed exposure.

Overall, the session emphasized the importance of careful clinical evaluation, detailed patient history and maintaining a broad differential diagnosis. As arthropod-related conditions continue to present in diverse and sometimes misleading ways, dermatologists must remain vigilant in distinguishing true bites from conditions that merely mimic them.