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Bedbug Bites Treatment & Management

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
Updated: Jun 02, 2016

Approach Considerations

Medical care of bedbug bites depends on the patient's clinical picture. Treatment of these bites is not usually required. However, if secondary infection occurs, apply local antiseptic lotion or antibiotic cream or ointment. Creams with corticosteroids and oral antihistamines may be advised in the presence of an allergic reaction. Infestation often leads to nervousness, anxiety, and insomnia.[3]

Papular Urticaria and Acute Urticaria for complete information on these topics.


Prevention of Bedbug Bites

To reduce bedbug infestations, use insecticides and eliminate bedbug hiding sites.[23] However, due to the development of insecticide resistance, new tools and techniques are needed for bed bug control. Behavior and physiology modifying chemicals may be exploitable for this purpose.[24]

Because bites occur on exposed skin surfaces, advise affected individuals to wear nightclothes that cover as much skin as possible.

Permethrin, diethyltoluamide, and pyrethrums

A number of insecticides are effective, including permethrin, and diethyltoluamide is an excellent insect repellent. Bedbugs feeding after insecticide exposure may alter the effects of the pesticide on bedbug mortality.[25] Permethrin spray can be applied to clothing. Combined use of permethrin-treated clothing and cutaneous diethyltoluamide may be considered. In an African survey of rural homes, bed nets impregnated with permethrin were responsible for the disappearance of bedbugs.[26]

Note that encephalopathy may occur in children exposed to high concentrations of diethyltoluamide. Infant bedding can be treated separately with pyrethrums.

To prevent bedbugs from gaining access to the bed, try inserting bedposts of bedbug-free beds into containers of paraffin oil. However, bedbugs can be resourceful; they have been known to climb walls and across ceilings to drop onto their victims during the night. See the image below.

Treatment for bedbug bites is typically supportive Treatment for bedbug bites is typically supportive. Local antiseptic lotions or antibiotic creams can be applied for secondary infections, whereas corticosteroid creams and oral antihistamines can be used for allergic reactions. Bedbugs can be eliminated through the use of permethrin insecticides, baited traps, special bedbug-free beds, and bed nets. Homemade methods, such as wrapping duct tape around bed legs as shown, may be effective, but bedbugs have been known to climb other objects and then fall down onto a bed. Image courtesy of Wikimedia Commons.

Control and elimination measures

Structural insect proofing can be performed to prevent the bugs from entering homes and beds, in addition to using control measures such as spraying infested buildings with insecticides such as malathion. Eradication of a bedbug infestation may require a professional exterminator.

Bedbug control can be challenging. One approach is room heat treatment, vacuuming, and nonchemical pesticides, and possibly chemical ones.

A heat treatment method to eliminate bedbug infestations in room contents has been evaluated.[27] High temperatures caused temporary immobilization even with exposures that did not have lethal effects. One method for limited heat treatment of furniture and other room contents required equipment costing less than US$400 and provided an opportunity for residual pesticide application with minimal disruption in use of the treated room.

Baited traps may be effective tools for evaluating bedbug control programs and detecting early bedbug infestations. Carbon dioxide was significantly more attractive to bed bugs than heat.[28]


Special Concerns

At this time, no evidence suggests bedbugs actually transmit pathogens to humans.[29] Theoretically, failure to diagnose bedbug bites puts a patient at increased risk of hepatitis B or some other infection. Because bedbugs may at least theoretically transmit disease, the physician may be at medicolegal risk if the patient develops any such infection. Reinhardt et al suggest the delayed reaction time of skin to bites has implications in litigation, such as when people seek compensation from hotels.[17]

DEET is a highly effective bedbug repellent, but it has a substantial order and can dissolve certain plastics.[30]

Bedbugs can spread through ventilation ducts, water pipes, and gutters and can travel in clothing and luggage.[4] Travelers should examine hotel rooms, looking behind the headboard and in mattress seams, for evidence of bedbugs.

Contributor Information and Disclosures

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Craig A Elmets, MD Professor and Chair, Department of Dermatology, Director, Chemoprevention Program Director, Comprehensive Cancer Center, UAB Skin Diseases Research Center, University of Alabama at Birmingham School of Medicine

Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: University of Alabama at Birmingham; University of Alabama Health Services Foundation<br/>Serve(d) as a speaker or a member of a speakers bureau for: Ferndale Laboratories<br/>Received research grant from: NIH, Veterans Administration, California Grape Assn<br/>Received consulting fee from Astellas for review panel membership; Received salary from Massachusetts Medical Society for employment; Received salary from UpToDate for employment. for: Astellas.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author, Anna Gorkiewicz-Petkow, MD, PhD, to the development and writing of this article.

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The bedbug is a flat, oval, reddish brown insect that turns violaceous after feeding. Courtesy of Colonel Dirk M. Elston, MD (from Elston, 2000).
Bedbugs feeding on a human host. Courtesy of Colonel Dirk M. Elston, MD (from Elston, 2000).
Human infestation with bedbugs, lice, and mites are common causes of dermatologic symptoms. Although these organisms thrive in conditions of overcrowding and decreased sanitation, Americans of all socioeconomic backgrounds may be at risk for infestation. Clinicians must maintain high suspicion in the appropriate set of clinical circumstances to identify and treat infestations, as they can cause substantial dermatologic and psychological discomfort for patients. Images courtesy of the US Centers for Disease Control and Prevention.
Bedbugs are parasitic arthropods from the family Cimicidae. They are typically less than 1 cm in length and reddish brown in color. Bedbugs can be found in furniture, floorboards, peeling paint, or other small spaces, most commonly in areas of clutter. These insects come out at night in search of prey upon which to feed, with peak feeding times just before dawn. Bedbugs are typically attracted to body heat, carbon dioxide, vibration, sweat, and odor. The image of a Cimex lectularius is shown courtesy of the US Centers for Disease Control and Prevention (CDC).
After bedbugs find a food source, they bite down with their mouths and inject anticoagulant and anesthetic compounds into the skin. Depending on the species, these parasites feed on the host blood via 1 of 2 mechanisms. Vessel feeders directly insert their mouthparts into superficial capillaries, whereas pool feeders damage the superficial tissue and feed on the accumulated blood. As bedbugs feed, their color may change as they swell with the host blood, as shown in this picture of a larval bedbug feeding on a volunteer host. Image courtesy of the US Centers for Disease Control and Prevention (CDC).
Bedbug bites themselves are typically painless. However, the subsequent allergic reaction that may develop can cause intense pruritus. While feeding, bedbugs may inject one of several pharmacologically active substances, including hyaluronidase, proteases, and kinins. These compounds may induce different skin reactions, such as erythema, wheals, vesicles, or hemorrhagic nodules. Repeated bites may sensitize individuals, leading to more pronounced cutaneous manifestations or systemic hypersensitivity reactions. The local trauma from bedbug bites can lead to secondary bacterial infection, causing ecthyma, cellulitis, or lymphangitis. There is some evidence that bedbugs may also be a vector for hepatitis B and Chagas disease. Histologic findings from bite-site biopsy specimens typically show eosinophilic infiltrates, which are indicative of the allergic nature of the reaction. The image shown is papular urticaria, which may develop from bedbug bites.
Treatment for bedbug bites is typically supportive. Local antiseptic lotions or antibiotic creams can be applied for secondary infections, whereas corticosteroid creams and oral antihistamines can be used for allergic reactions. Bedbugs can be eliminated through the use of permethrin insecticides, baited traps, special bedbug-free beds, and bed nets. Homemade methods, such as wrapping duct tape around bed legs as shown, may be effective, but bedbugs have been known to climb other objects and then fall down onto a bed. Image courtesy of Wikimedia Commons.
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