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It used to be not unusual at all to see people who had obvious signs of parasitic infections, at least in parts of the world that have warmer climates. One of the most common of these was dracunculiasis is an infection caused by the nematode Dracunculus medinensis,also known as the guinea worm. This wasn't an exotic infection that one could only encounter in places like Africa. It was even well known in parts of the Mediterranean and in the southern United States. It has been seen as recently as the 1970's and 1980's in Texas.

You catch the guinea "worm" by drinking water contaminated by water fleas that have eggs of the nematode in their feces. The digestive acids in your stomach break down the water flea and its feces, but don't dissolve the eggs of the guinea worm. The female worm hatches in your small intestine and slowly and painfully burrows through your body until it can emerge through your skin, most commonly through your feet, but sometimes through your arm. As they emerge, they cause a small, round ulcer, but your body's immune reaction to the worm triggers nausea, vomiting, and fever. The female release its eggs, and if they find their way into drinking water, the cycle can start all over again.

Pain from the exit site can incapacitate people for weeks. In parts of Nigeria, school children used to miss, on average, 25 percent of each school year because they couldn't stand the pain of the exiting guinea worms. When the worm exited through the eye, blindness resulted. The only way to get rid of the infection was to pull the worm out very carefully, winding it around a stick. If a piece of the worm broke off, you would be infected all over again.

You may say to yourself, "Nothing like this ever happened to me," but in Europe, parts of South America, and parts of the United States, there is another pattern. The male guinea worm calcifies inside the host's body. While the dead parasite can't burrow to the skin, its corpse may break out now and again, only for more and more of the long, dead thread slowly to rise to the surface. Here's what you can do:

  • Warm, moist heat from a compress or a water bottle can relieve pain when these kinds of bumps come to the surface.
  • If you dig around and try to extract the dead worm, which isn't recommended, be very sure to keep the wound site clean. The parasite can't harm you any more, but bacteria that get into the wound can.
  • Apply bacitracin or mupirocin (Bactroban) ointments to prevent a second, bacterial infection.

Not all white bumps that come and go are due to parasites. Sometimes bumps break out in response to the skin's production of histamine, the same chemical that initiates allergic reactions. This is most common when the skin is exposed to heat: intense sunlight, an electric blanket, or getting to close to a fire. Avoid the heat, and you avoid the bumps.

Sometimes small white bumps, even just one small white bump, is a manifestation of urticaria, also known as hives. Urticaria don't just result from allergies. They can also result from pressure. The bump or bumps may not be obvious for four to six hours after pressure has been applied to the skin. In this case, it really, really doesn't help to try to cut off the bump. You'll just make it worse. This kind of bumps is treated by avoiding pressure and by taking antihistamines. In the most severe cases, there drugs like colchicine and dapsone, but these are for multiple bumps.

When your "bump" starts out as a "line" that fills in, the problem may be something called dermographism. Also a form of urticaria, it starts out as a reaction to stroking the skin (using a towel to dry off, scratching an itch). It's made worse by heat and emotional stress. Dermographism is also treated with antihistamines. About 5 percent of the population has this skin problem.


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