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Last updated: September 26, 2025View editorial policy

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Differential Diagnosis for Hickory Tussock Caterpillar Exposure with Rash and Blister

Single Most Likely Diagnosis

  • Contact Dermatitis: This is the most likely diagnosis due to the direct exposure to the hickory tussock caterpillar, which is known to cause skin irritation and allergic reactions. The rash and blister are consistent with a contact dermatitis reaction.

Other Likely Diagnoses

  • Urticaria: An allergic reaction to the caterpillar's venom or hairs could lead to urticaria, characterized by itchy hives and possibly blisters.
  • Erythema Multiforme: A skin condition that could be triggered by an allergic reaction to the caterpillar exposure, presenting with target-like lesions and blisters.
  • Insect Bite Reaction: While not as specific, a reaction to the caterpillar's bite could mimic other insect bites, leading to a similar presentation of rash and blister.

Do Not Miss Diagnoses

  • Anaphylaxis: Although rare, anaphylaxis is a life-threatening condition that could occur if the individual has a severe allergic reaction to the caterpillar's venom. Early recognition and treatment are crucial.
  • Cellulitis: If the blister becomes infected, cellulitis could develop, requiring prompt antibiotic treatment to prevent serious complications.

Rare Diagnoses

  • Toxic Epidermal Necrolysis (TEN): A severe skin condition usually triggered by medications but could potentially be caused by an extreme allergic reaction to the caterpillar's venom, leading to widespread skin necrosis and detachment.
  • Stevens-Johnson Syndrome: Another severe skin and mucous membrane disorder that could be triggered by an allergic reaction, although it is more commonly associated with medication use or infections.

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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