Have a patient who states that they have bed bugs or scabies? Do they have small erythematous lesions that are consistent with a small insect bite, but you are still not sure? Simply ask them “Does anyone else in your household have these lesions?”

If it is scabies or bed bugs, then chances are very high that their significant other who shares the bed with them or other household members would be getting bitten as well. Its almost a certainty that they would have lesions. This typically spreads like wildfire in a home.

Sometimes, the spouse or other household members will not have the lesions though. If this is the case, then chances are very low that it is scabies or bed bugs, and further workup should commence from there. Often times, it is some form of atopic dermatitis vs. “bed bugs.”

So, remember to ask the patient if anyone else in the home has the lesions. If so, then it is likely scabies or bed bugs, if not, then continue searching for the appropriate diagnosis!