Fleas are not a great problem in Scandinavia today, with one important exception of diagnostic importance: every spring (April-May) several patients seek medical advice because of intensely pruritic papules on their skin, almost always on their legs (Figure 24.9). The history is often the same: handling of a bird's nesting-house, especially if taking it into the warmth in-door for cleaning, and a few days later intensely itching big papules appear.

Figure 24.9 Flea bites: various species of fleas, each species specific for a special kind of animal, or human, are rare nowadays. Fleas live in the moist areas of floors, but they search for 'blood meals' from animals or humans. Flea bites are most common on the lower legs. (See Colour Plate XII.)
Figure 24.10 Nodulus cutaneous after a mosquito bite: a small (approximately 5mm), very hard papule, with a characteristic ring of pigmentation (see text). (See Colour Plate XIII.)
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