Bedbug Bites Treatment & Management

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD   more...
 
Updated: May 19, 2011
 

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.

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

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Prevention of Bedbug Bites

To reduce bedbug infestations, use insecticides and eliminate bedbug hiding sites.[17] 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.[18]

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. 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.[19]

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 supportiveTreatment 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.

A heat treatment method to eliminate bedbug infestations in room contents has been evaluated.[20] 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.[21]

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Special Concerns

Theoretically, failure to diagnose bedbug bites puts a patient at increased risk of hepatitis B or some other infection. Because bedbugs may 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.[12]

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig A Elmets, MD  Professor and Chair, Department of Dermatology, Director, 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, and Society for Investigative Dermatology

Disclosure: Palomar Medical Technologies Stock None; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor; UpToDate Salary Employment; Biogen Grant/research funds Independent contractor; Clinuvel Independent contractor; Covan Basilea Pharmaceutical Grant/research funds Independent contractor; ISDIN None Consulting; TenX BIopharma Grant/research funds Independent contractor

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, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD  Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System

William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology

Disclosure: Elsevier Royalty Other

References

  1. Romero A, Potter MF, Potter DA, Haynes KF. Insecticide resistance in the bed bug: a factor in the pest's sudden resurgence?. J Med Entomol. Mar 2007;44(2):175-8. [Medline].

  2. Pfiester M, Koehler PG, Pereira RM. Effect of population structure and size on aggregation behavior of Cimex lectularius (Hemiptera: Cimicidae). J Med Entomol. Sep 2009;46(5):1015-20. [Medline].

  3. Abdel-Naser MB, Lotfy RA, Al-Sherbiny MM, Sayed Ali NM. Patients with papular urticaria have IgG antibodies to bedbug (Cimex lectularius) antigens. Parasitol Res. May 2006;98(6):550-6. [Medline].

  4. Mouchtouri VA, Anagnostopoulou R, Samanidou-Voyadjoglou A, Theodoridou K, Hatzoglou C, Kremastinou J, et al. Surveillance study of vector species on board passenger ships, risk factors related to infestations. BMC Public Health. Mar 27 2008;8:100. [Medline].

  5. Gbakima AA, Terry BC, Kanja F, Kortequee S, Dukuley I, Sahr F. High prevalence of bedbugs Cimex hemipterus and Cimex lectularis in camps for internally displaced persons in Freetown, Sierra Leone: a pilot humanitarian investigation. West Afr J Med. Oct-Dec 2002;21(4):268-71. [Medline].

  6. Lee IY, Ree HI, An SJ, Linton JA, Yong TS. Reemergence of the bedbug Cimex lectularius in Seoul, Korea. Korean J Parasitol. Dec 2008;46(4):269-71. [Medline].

  7. Ogston CW, Wittenstein FS, London WT, Millman I. Persistence of hepatitis B surface antigen in the bedbug Cimex hemipterus (Fabr.). J Infect Dis. Sep 1979;140(3):411-4. [Medline].

  8. Pipkin AC Sr. Transmission of Trypanosoma cruzi by arthropod vectors: anterior versus posterior route infection. Int Rev Trop Med. 1969;3:1-47. [Medline].

  9. Iqbal MM. Can we get AIDS from mosquito bites?. J La State Med Soc. Aug 1999;151(8):429-33. [Medline].

  10. Webb PA, Happ CM, Maupin GO, Johnson BJ, Ou CY, Monath TP. Potential for insect transmission of HIV: experimental exposure of Cimex hemipterus and Toxorhynchites amboinensis to human immunodeficiency virus. J Infect Dis. Dec 1989;160(6):970-7. [Medline].

  11. KINNEAR J. Epidemic of bullous erythema on legs due to bed-bugs. Lancet. Jul 10 1948;2(6515):55. [Medline].

  12. Reinhardt K, Kempke D, Naylor RA, Siva-Jothy MT. Sensitivity to bites by the bedbug, Cimex lectularius. Med Vet Entomol. Mar 9 2009;[Medline].

  13. Crissey JT. Bedbugs: An old problem with a new dimension. Int J Dermatol. Jul-Aug 1981;20(6):411-4. [Medline].

  14. Liebold K, Schliemann-Willers S, Wollina U. Disseminated bullous eruption with systemic reaction caused by Cimex lectularius. J Eur Acad Dermatol Venereol. Jul 2003;17(4):461-3. [Medline].

  15. Masetti M, Bruschi F. Bedbug infestations recorded in Central Italy. Parasitol Int. Mar 2007;56(1):81-3. [Medline].

  16. Scarupa MD, Economides A. Bedbug bites masquerading as urticaria. J Allergy Clin Immunol. Jun 2006;117(6):1508-9. [Medline].

  17. Fletcher MG, Axtell RC. Susceptibility of the bedbug, Cimex lectularius, to selected insecticides and various treated surfaces. Med Vet Entomol. Jan 1993;7(1):69-72. [Medline].

  18. Weeks EN, Logan JG, Gezan SA, et al. A bioassay for studying behavioural responses of the common bed bug, Cimex lectularius (Hemiptera: Cimicidae) to bed bug-derived volatiles. Bull Entomol Res. Jan 27 2010;1-8. [Medline].

  19. Lindsay SW, Snow RW, Armstrong JR, Greenwood BM. Permethrin-impregnated bednets reduce nuisance arthropods in Gambian houses. Med Vet Entomol. Oct 1989;3(4):377-83. [Medline].

  20. Pereira RM, Koehler PG, Pfiester M, Walker W. Lethal effects of heat and use of localized heat treatment for control of bed bug infestations. J Econ Entomol. Jun 2009;102(3):1182-8. [Medline].

  21. Wang C, Gibb T, Bennett GW, McKnight S. Bed bug (Heteroptera: Cimicidae) attraction to pitfall traps baited with carbon dioxide, heat, and chemical lure. J Econ Entomol. Aug 2009;102(4):1580-5. [Medline].

 
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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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