What are the causes of small, raised, itchy papules that are not erythematous (red)?

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Differential Diagnosis for Small Raised Bites that are Itchy and Not Red

  • Single most likely diagnosis
    • Insect bites (e.g., mosquito, flea, or bed bug bites): These are common causes of small, raised, itchy bites that may not be red, especially if the person is not highly sensitive to the bite.
  • Other Likely diagnoses
    • Allergic contact dermatitis: This condition can cause small, raised, itchy lesions due to an allergic reaction to substances like nickel, latex, or certain plants.
    • Irritant contact dermatitis: Similar to allergic contact dermatitis but caused by irritation rather than an allergic reaction, leading to itchy, possibly raised lesions.
    • Scabies: Although scabies typically causes intense itching and redness, in some cases, especially in the early stages or in individuals with darker skin tones, the lesions might appear as small, raised, itchy bumps without significant redness.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Tick bites with potential for Lyme disease or other tick-borne illnesses: While tick bites can appear as small, raised lesions, they are critical to identify due to the potential for transmitting serious diseases.
    • Leishmaniasis: Transmitted by the bite of an infected sand fly, it can cause skin lesions that are initially small and raised, potentially itchy, and may not be red.
  • Rare diagnoses
    • Cutaneous larva migrans: Caused by the larvae of certain nematodes (roundworms), this condition leads to creeping eruptions on the skin, which can start as small, raised, itchy lesions.
    • Myiasis: Infestation of the skin by fly larvae, which can cause lesions that might initially appear as small, raised, and itchy, though this is less common and typically associated with travel to endemic areas or specific occupational exposures.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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