Bed bugs, leeches and hookworm larvae in the skin

Bed bugs, leeches, and hookworm-related cutaneous larva migrans are skin infestations that are usually considered of minor importance because they produce discomfort rather than cause or transmit disease. Bed bugs have been increasing tremendously in high-income countries in recent years, causing distress to affected individuals and economic loss. Infestation by land leeches causes mainly unpleasant skin reactions, whereas infestation by aquatic leeches may be more dangerous, leading to anemia and in severe cases, to death. Cutaneous larva migrans produces an intense pruritus that can be exasperating for the patient and cause sleep disturbance. An overview is given of these three infestations with a discussion of the causative agents, transmission, clinical manifestations, diagnosis, and treatment.