Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Lepidopterism: Skin disorders secondary to caterpillars and moths

Eric W Hossler, MD
Section Editor
Ted Rosen, MD
Deputy Editor
Abena O Ofori, MD


"Lepidopterism" is the term for a variety of cutaneous and systemic reactions that result from contact with larvae (ie, caterpillars) or adult forms of moths and butterflies (order, Lepidoptera) (table 1). "Erucism" (from Latin "eruca," caterpillar) is another term used to refer to reactions from contact with caterpillars.

The primary clinical manifestations of lepidopterism include sting reactions, hypersensitivity reactions, and lonomism, a potentially life-threatening hemorrhagic diathesis. The diagnosis is straightforward in many patients due to a history of contact with caterpillars or moths followed closely by the onset of symptoms.

Most sting and hypersensitivity reactions are mild and self-limited and can be managed with measures for symptomatic relief. In contrast, patients with lonomism often require inpatient supportive care and prompt medical intervention.

The clinical features, diagnosis, and management of lepidopterism will be reviewed here. Bites and stings from other insects are reviewed separately. (See "Insect bites" and "Bee, yellow jacket, wasp, and other Hymenoptera stings: Reaction types and acute management" and "Bedbugs".)


There are few epidemiologic studies of lepidopterism. Because many reactions are self-limited and mild, and because many human-insect encounters occur in tropical areas with poor health care access, lepidopterism is probably underreported. 

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: May 05, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Centers for Disease Control (CDC). Rash illness associated with gypsy moth caterpillars--Pennsylvania. MMWR Morb Mortal Wkly Rep 1982; 31:169.
  2. Press E, Googins JA, Poareo H, Jones K. Health hazards to timber and forestry workers from the Douglas fir tussock moth. Arch Environ Health 1977; 32:206.
  3. Benaim-Pinto C, Pernia-Rosales B, Rojas-Peralta R. Dermatitis caused by moths of Hylesia genus (Lepidoptera, Saturniidae) in northeastern states of Venezuela: I. Bioecology of Hylesia metabus (Cramer). Clinical features of lepidopterism determined by this species. Am J Contact Derm 1991; 2:213.
  4. Centers for Disease Control (CDC). Moth-associated dermatitis--Cozumel, Mexico. MMWR Morb Mortal Wkly Rep 1990; 39:219.
  5. Ooi PL, Goh KT, Lee HS, Goh CL. Tussockosis: an outbreak of dermatitis caused by tussock moths in Singapore. Contact Dermatitis 1991; 24:197.
  6. Dinehart SM, Archer ME, Wolf JE Jr, et al. Caripito itch: dermatitis from contact with Hylesia moths. J Am Acad Dermatol 1985; 13:743.
  7. Hoover AH, Nelson E. Skin symptoms attributed to tussock moth infestation. Cutis 1974; 13:597.
  8. Vega J, Vega JM, Moneo I, et al. Occupational immunologic contact urticaria from pine processionary caterpillar (Thaumetopoea pityocampa): experience in 30 cases. Contact Dermatitis 2004; 50:60.
  9. Werno J, Lamy M, Vincendeau P. Caterpillar hairs as allergens. Lancet 1993; 342:936.
  10. Maier H, Spiegel W, Kinaciyan T, et al. The oak processionary caterpillar as the cause of an epidemic airborne disease: survey and analysis. Br J Dermatol 2003; 149:990.
  11. Gottschling S, Meyer S. An epidemic airborne disease caused by the oak processionary caterpillar. Pediatr Dermatol 2006; 23:64.
  12. Gottschling S, Meyer S, Dill-Mueller D, et al. Outbreak report of airborne caterpillar dermatitis in a kindergarten. Dermatology 2007; 215:5.
  13. Mindlin MJ, le Polain de Waroux O, Case S, Walsh B. The arrival of oak processionary moth, a novel cause of itchy dermatitis, in the UK: experience, lessons and recommendations. Public Health 2012; 126:778.
  14. Vega JM, Moneo I, Ortiz JC, et al. Prevalence of cutaneous reactions to the pine processionary moth (Thaumetopoea pityocampa) in an adult population. Contact Dermatitis 2011; 64:220.
  15. Pinto AF, Berger M, Reck J Jr, et al. Lonomia obliqua venom: In vivo effects and molecular aspects associated with the hemorrhagic syndrome. Toxicon 2010; 56:1103.
  16. Lemaire C. The Saturniidae of America: Hemileucinae, Antiquariat Geock & Evers, Germany 2002.
  17. van Nieukerken EJ, Kaila L, Kitching IJ, et al. Order Lepidoptera Linnaeus, 1758. In: Animal Biodiversity: An Outline of Higher-Level Classification and Survey of Taxonomic Richness, Zhang ZQ (Ed), Magnolia Press, Auckland 2011. Vol 3148, p.212.
  18. Walker RB, Thomas T, Cupit D, Giaquinto-Shreves J. An epidemic of caterpillar sting dermatitis in a rural West Virginia community. W V Med J 1993; 89:58.
  19. Balit CR, Geary MJ, Russell RC, Isbister GK. Clinical effects of exposure to the White-stemmed gum moth (Chelepteryx collesi). Emerg Med Australas 2004; 16:74.
  20. Everson GW, Chapin JB, Normann SA. Caterpillar envenomations: a prospective study of 112 cases. Vet Hum Toxicol 1990; 32:114.
  21. Balit CR, Geary MJ, Russell RC, Isbister GK. Prospective study of definite caterpillar exposures. Toxicon 2003; 42:657.
  22. McGovern JP, Barkin GD, McElhenney TR. Megalopyge opercularis: Observations of its life history, natural history of its sting in man, and report of an epidemic. JAMA 1961; 175:1155.
  23. Eagleman DM. Envenomation by the asp caterpillar (Megalopyge opercularis). Clin Toxicol (Phila) 2008; 46:201.
  24. Stipetic ME, Rosen PB, Borys DJ. A retrospective analysis of 96 "asp" (Megalopyge opercularis) envenomations in Central Texas during 1996. J Toxicol Clin Toxicol 1999; 37:457.
  25. Rodriguez-Mahillo AI, Gonzalez-Muñoz M, Vega JM, et al. Setae from the pine processionary moth (Thaumetopoea pityocampa) contain several relevant allergens. Contact Dermatitis 2012; 67:367.
  26. Santos-Magadán S, González de Olano D, Bartolomé-Zavala B, et al. Adverse reactions to the processionary caterpillar: irritant or allergic mechanism? Contact Dermatitis 2009; 60:109.
  27. Fuentes Aparicio V, Zapatero Remón L, Martínez Molero MI, et al. Allergy to pine processionary caterpillar (Thaumetopoea pityocampa) in children. Allergol Immunopathol (Madr) 2006; 34:59.
  28. Holm G, Andersson M, Ekberg M, et al. Setae from larvae of the northern processionary moth (Thaumetopoea pinivora, TP) stimulate proliferation of human blood lymphocytes in vitro. PLoS One 2014; 9:e113977.
  29. Kuspis DA, Rawlins JE, Krenzelok EP. Human exposures to stinging caterpillar: Lophocampa caryae exposures. Am J Emerg Med 2001; 19:396.
  30. Bonamonte D, Foti C, Vestita M, Angelini G. Skin Reactions to pine processionary caterpillar Thaumetopoea pityocampa Schiff. ScientificWorldJournal 2013; 2013:867431.
  31. Paniz-Mondolfi AE, Pérez-Alvarez AM, Lundberg U, et al. Cutaneous lepidopterism: dermatitis from contact with moths of Hylesia metabus (Cramer 1775) (Lepidoptera: Saturniidae), the causative agent of caripito itch. Int J Dermatol 2011; 50:535.
  32. Gamborgi GP, Metcalf EB, Barros EJ. Acute renal failure provoked by toxin from caterpillars of the species Lonomia obliqua. Toxicon 2006; 47:68.
  33. Pinto AF, Dobrovolski R, Veiga AB, Guimarães JA. Lonofibrase, a novel alpha-fibrinogenase from Lonomia obliqua caterpillars. Thromb Res 2004; 113:147.
  34. Reis CV, Farsky SH, Fernandes BL, et al. In vivo characterization of Lopap, a prothrombin activator serine protease from the Lonomia obliqua caterpillar venom. Thromb Res 2001; 102:437.
  35. Guerrero Guerrero BA, Arocha-Piñango CL, Gil San Juan A. Lonomia achelous caterpillar venom (LACV) selectively inactivates blood clotting factor XIII. Thromb Res 1997; 87:83.
  36. Guerrero B, Perales J, Gil A, Arocha-Piñango CL. Effect on platelet FXIII and partial characterization of Lonomin V, a proteolytic enzyme from Lonomia achelous caterpillars. Thromb Res 1999; 93:243.
  37. Zannin M, Lourenço DM, Motta G, et al. Blood coagulation and fibrinolytic factors in 105 patients with hemorrhagic syndrome caused by accidental contact with Lonomia obliqua caterpillar in Santa Catarina, southern Brazil. Thromb Haemost 2003; 89:355.
  38. Caovilla JJ, Barros EJ. Efficacy of two different doses of antilonomic serum in the resolution of hemorrhagic syndrome resulting from envenoming by Lonomia obliqua caterpillars: a randomized controlled trial. Toxicon 2004; 43:811.
  39. Arocha-Piñango CL, de Bosch NB, Torres A, et al. Six new cases of a caterpillar-induced bleeding syndrome. Thromb Haemost 1992; 67:402.
  40. Brito R, Specht A, Filho WS, et al. Abdominal macrochaetae of female Hylesia oratex Dyar, 1913 (Insecta: Lepidoptera: Saturniidae): external morphology and medical significance. An Acad Bras Cienc 2015; 87:1763.