Caterpillar dermatitis revisited: lepidopterism after contact with oak processionary caterpillar

Caterpillar dermatitis (lepidopterism) is a disease that is caused by butterflies, moths and their caterpillars. Clinical signs and symptoms vary from itchy skin lesions to conjunctivitis, pharyngitis, malaise and anaphylactic reactions. We present the case of two brothers with typical skin lesions of leptidopterism. The older boy showed skin lesions after playing with caterpillars in the garden, whereas his younger brother was affected without direct contact to the caterpillars but only by playing with his brother. As the mother could show two caterpillars, lepidopterism could easily be diagnosed. Under a local therapy with a medium potent corticosteroid cream and a non-sedating orally administered antihistamine, all skin lesions as well as itching disappeared within 1 week.