patient presented to pharmacy with bug bites on the back of | Figure 1

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Patient presented to pharmacy with bug bites on the back of the thigh that have been getting worse over the last 3 weeks. Patient states that the itching is worse at night and it is "impossible" not to scratch; but that the scratching then produces the hives seen in the photos. Has been treating with 1% hydrocortisone cream with little relief.... the bites look like mosquito bites (just a bump with no other defining features) but the patient doesn't have any of the bites anywhere else on the body. I'm wondering if it could be a more nuisance pest like fleas or scabies due to the intensity and duration of the itching? ... Thoughts or follow up recommendations? Thanks!

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