Management of Hickory Tussock Caterpillar Exposure with Rash and Blister
For Hickory Tussock Caterpillar exposure causing rash and blisters, the hairs should be carefully removed using adhesive tape, and the affected area should be washed with soap and water to prevent further irritation and promote healing.
Initial Management
Hair Removal and Wound Care
- Remove caterpillar hairs immediately using adhesive tape (tape-stripping method) to lift the tiny barbed hairs from the skin surface 1
- Wash the affected area thoroughly with soap and water to remove any remaining irritants
- Drain intact blisters when they are painful by:
- Piercing the blister at its lowest point using a sterile needle
- Allowing fluid to drain by gravity
- Keeping the blister roof intact as a natural protective covering 1
- Apply a bland emollient such as 50% white soft paraffin/50% liquid paraffin to support barrier function and encourage re-epithelialization 1
Symptomatic Treatment
- Apply cool compresses to reduce inflammation and provide relief
- Consider topical corticosteroids for inflammation:
- Apply a potent topical corticosteroid such as clobetasol propionate 0.05% cream once daily to affected areas 2
- Continue application until inflammation subsides
- For pruritus, consider oral antihistamines 2
Special Considerations
Ocular Involvement
Caterpillar hairs can cause serious ocular problems that may result in:
- Keratoconjunctivitis
- Granulomatous reactions (keratitis nodosum) 3
If eyes are affected:
- Urgent ophthalmology consultation is required 2
- Do not rub the eyes as this may embed the hairs deeper
- Irrigate the eyes gently with saline solution 2
- Daily ophthalmology review during the acute phase may be necessary 2
Oral/Mucosal Involvement
If ingestion or oral exposure has occurred:
- Assess for drooling, refusal to drink, or other signs of oral irritation 4
- Apply white soft paraffin ointment to affected lips every 2 hours 2
- Clean the mouth with warm saline mouthwashes 2
- Consider an anti-inflammatory oral rinse containing benzydamine hydrochloride every 2-4 hours 2
Monitoring and Follow-up
Signs of Secondary Infection
Monitor for signs of infection including:
- Increasing redness, warmth, pain
- Purulent discharge
- Red streaks extending from the affected area
- Fever
If infection develops, consider oral antibiotics such as:
- Dicloxacillin 250 mg four times daily
- Cephalexin 250 mg four times daily
- Clindamycin 300-400 mg three times daily 1
Prognosis
- Most cases of Hickory Tussock Caterpillar dermatitis are self-limiting and resolve within 1-2 weeks with appropriate treatment 5
- Recurrent inflammatory reactions can last for months in some cases, especially with ocular involvement 3
- Complete recovery is expected in the majority of cases with proper management 4
- Severe systemic reactions are rare but can occur in sensitive individuals 6
Prevention
- Wear protective clothing when in wooded areas, especially during caterpillar season
- Avoid touching caterpillars, especially those with visible hairs or spines
- Educate children about not handling unfamiliar caterpillars
- Promptly wash any area of skin that comes into contact with caterpillars
The key to successful management is prompt removal of the caterpillar hairs, appropriate wound care, and symptomatic treatment of inflammation and pruritus.