Clinical features

• flea bites on humans most commonly identified in children - generally on the lower leg just above sock level (which acts as a barrier). Bites may occur at other sites if a child plays on the floor or an adult (or child) sit with a pet on his/her knee
• flea bites are inflammatory blisters or papules (papular urticaria) - there may be a central haemorrhagic spot at the site of a flea bite which reflects that the saliva deposited into the skin by the flea contains anticoagulant chemicals
• there is often grouping of flea bites reflecting that fleas often take several meals - sometimes known as the ‘breakfast, lunch and dinner sign’. This shows 3 or more bites with pruritic, erythematous-oedematous papules in a linear array or triangular, a few centimetres apart. (1)

Reference

1. Peres G, Yugar LBT, Haddad Junior V. Breakfast, lunch, and dinner sign: a hallmark of flea and bedbug bites. An Bras Dermatol. 2018 Sep-Oct;93(5):759-760.