The eyelid sign: A clue to bed bug bites

In pediatric patients, determining the culprit insect in arthropod assaults can be challenging. The patient's history may be vague, the causative insect may not be readily associated with the bites, and the clinical appearance of bites can be variable. Six pediatric patients from the Penn State Milton S. Hershey Medical Center dermatology offices with bed bug bites were identified. All had bites involving the face, trunk, and extremities. Five patients demonstrated papules on one upper eyelid associated with erythema and edema. One patient had papules on both upper eyelids. When an arthropod assault is suspected, the "eyelid sign," i.e., bites involving the upper eyelid associated with erythema and edema, may point to bed bugs.