Pulsating skin lesions on a child's leg, a rare manifestation of Quincke's sign.

Blinking Skin? Unmasking the Mystery of Pulsating Papules

Elliot Brynn in Health & Wellness December 2025 • 4 min read.

"Discover the rare phenomenon of pulsating skin lesions linked to insect bites, and what it means for your health."

Have you ever heard of skin that blinks? It sounds like something out of a science fiction movie, but it's a real, albeit rare, phenomenon. Known as Quincke's sign when observed at the nailbed, this pulsating blanching and flushing can be an indicator of underlying health issues.

Typically, Quincke’s sign is associated with cardiovascular conditions like aortic regurgitation or conditions causing a wide pulse pressure, such as fever or anemia. However, a recent case has shed light on a less common trigger: insect bites.

In this article, we'll delve into a peculiar case of a young boy whose insect bites led to pulsating skin lesions. We'll explore the science behind this 'blinking skin,' its potential causes, and what you should do if you ever encounter it.

What Causes Skin to Blink? The Curious Case of Pulsating Papules

Pulsating skin lesions on a child's leg, a rare manifestation of Quincke's sign.

Recently, a team of dermatologists reported the case of a 5-year-old boy who developed pruritic papules and plaques after sustaining insect bites at an outdoor music festival. Initially, the lesions appeared on his right leg and gradually spread to his limbs, buttocks, and wrists. What made this case particularly intriguing was that several of these lesions started to 'pulsate' a couple of days later.

Physical examinations revealed scattered erythematous, urticated papules and plaques concentrated on the legs, buttocks, and wrists. What was remarkable was the pulsatility—a striking alternating erythema and blanching synchronized with the boy's pulse. This phenomenon diminished when the boy stood up. A biopsy of a lesion on his left knee revealed spongiotic dermatitis with pustules and inflammation featuring eosinophils, which aligned with an insect bite reaction. Further tests ruled out other potential causes, leading to a diagnosis of Quincke sign arising from the insect bites.

Here's a breakdown of the key observations:

Initial Symptoms: Pruritic papules and plaques developed after insect bites.
Pulsating Lesions: Several lesions began to 'pulsate' in sync with the patient's pulse.
Location: Predominantly on legs, buttocks, and wrists.
Histopathology: Spongiotic dermatitis with eosinophils, consistent with insect bites.

The patient was treated with clobetasone butyrate ointment and emollient cream. Over several days, the pulsatility gradually decreased, and the lesions resolved entirely within four weeks, leaving no scars.

When to Worry About 'Blinking Skin'

While the case described is unusual, it underscores that Quincke's sign can manifest in healthy individuals as a response to insect bites. However, it’s crucial to remember that this sign is more commonly associated with cardiovascular issues. If you notice pulsating skin lesions, especially if they're not linked to obvious insect bites, consult a healthcare professional for thorough evaluation and peace of mind.

About this Article -

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Everything You Need To Know

What is 'blinking skin' and what causes it?

'Blinking skin,' or Quincke's sign, refers to the pulsating blanching and flushing of the skin, often observed at the nailbed. In the context, it's caused by insect bites that triggered pulsating papules and plaques. The pulsatility, a striking alternating erythema and blanching, synchronized with the boy's pulse was observed in the case of a 5-year-old boy. This is a rare manifestation, and the underlying mechanism involves the body's inflammatory response to the insect bites. The lesions, initially pruritic papules and plaques, started pulsating a couple of days later. This differs from the more common causes, like cardiovascular conditions. The boy's condition resolved within four weeks with treatment.

How are insect bites connected to Quincke's sign in the specific case presented?

In the case described, insect bites acted as the trigger for Quincke's sign. The 5-year-old boy developed pruritic papules and plaques after being bitten at an outdoor music festival. These lesions, particularly on his legs, buttocks, and wrists, began to pulsate, exhibiting alternating erythema and blanching synchronized with his pulse. A biopsy of a lesion confirmed spongiotic dermatitis with eosinophils, consistent with an insect bite reaction. This diagnosis was made after ruling out other potential causes, establishing a direct link between the insect bites and the manifestation of Quincke's sign.

What are the typical symptoms and observations associated with pulsating skin lesions from insect bites?

The typical symptoms include the appearance of pruritic papules and plaques following insect bites. These lesions are often found on the legs, buttocks, and wrists. A key observation is the pulsatility of the lesions, where there is an alternating erythema (redness) and blanching (paleness) synchronized with the patient's pulse. In the case of the young boy, the pulsatility decreased when he stood up. Histopathology revealed spongiotic dermatitis with pustules and inflammation featuring eosinophils, consistent with an insect bite reaction.

Besides insect bites, what other health conditions are typically associated with Quincke's sign?

Quincke's sign is more commonly associated with cardiovascular conditions. Aortic regurgitation is a well-known cause, as are conditions causing a wide pulse pressure, such as fever or anemia. These conditions affect blood flow and pressure, leading to the pulsating blanching and flushing that characterizes Quincke's sign. While the case described highlights an unusual trigger, it's important to understand that Quincke's sign is a more common indicator of underlying cardiovascular issues.

When should someone be concerned about 'blinking skin' and seek medical advice?

While 'blinking skin' can be caused by insect bites, as demonstrated in the specific case, it's crucial to seek medical advice, especially if the lesions are not linked to obvious insect bites. Since Quincke's sign is often associated with cardiovascular problems, pulsating skin lesions should prompt a thorough evaluation by a healthcare professional to rule out any underlying health issues. This is particularly important if the symptoms persist or worsen.