From the Guidelines
Bed bug lesions typically appear as small, red, itchy welts on exposed skin areas, often arranged in a line or cluster. These bites may develop into painful swellings with a clear center in some individuals, while others might not react at all. Treatment focuses primarily on symptom management, starting with thorough cleaning of the affected area using soap and water. For itching relief, apply over-the-counter corticosteroid creams like 1% hydrocortisone two to three times daily for up to a week, or take oral antihistamines such as diphenhydramine (Benadryl) 25-50mg every 4-6 hours as needed 1. For more severe reactions, prescription-strength steroids may be necessary. Apply cold compresses to reduce swelling and avoid scratching to prevent secondary infections. If signs of infection develop (increased pain, warmth, swelling, or pus), seek medical attention as antibiotics may be required. Most importantly, eliminate the bed bug infestation through professional pest control services to prevent recurring bites. Bed bug reactions occur because their saliva contains proteins that trigger immune responses in humans, with symptoms typically appearing within hours to days after being bitten.
Some key points to consider in managing bed bug lesions include:
- Cleaning the affected area with soap and water
- Using over-the-counter corticosteroid creams or oral antihistamines for itching relief
- Applying cold compresses to reduce swelling
- Avoiding scratching to prevent secondary infections
- Seeking medical attention if signs of infection develop
- Eliminating the bed bug infestation through professional pest control services
It's also important to note that while the provided evidence primarily discusses insect stings and other skin reactions, the principles of symptom management and prevention of secondary infections can be applied to bed bug lesions as well 1. However, the most recent and relevant guideline for first aid, including management of insect bites, is from 2024 1, which supports the use of over-the-counter treatments and emphasizes the importance of preventing secondary infections.
From the Research
Symptoms of Bed Bug Lesions
- Bed bug bites are often painless, but typical reactions include pruritic, erythematous maculopapules occurring in clusters or in a linear or curvilinear distribution in exposed areas of the body 2
- A small red punctum may be visualized at the center of the bite mark 2
- Lesions that appear three in a row and papules on the upper eyelid associated with erythema and edema are highly suggestive of bites from bed bugs 2
- Exaggerated local reactions such as vesicles, urticarial wheals, urticarial perilesional plaques, diffuse urticaria, bullae, and nodules may occur in previously sensitized individuals 2
- Bedbug bites typically cause pruritic wheals with central punctum on exposed skin, which are noted upon awakening 3
Treatment Options for Bed Bug Lesions
- Reactions to bed bug bites are self-limited, and treatment is mainly symptomatic 2
- Topical pramoxine and oral antihistamines can be used to alleviate pruritus 2
- Topical corticosteroids can be used for significant eruptions to control inflammation and pruritus, and to hasten resolution of the lesions 2
- A wide range of empirical treatments, including antibiotics, antihistamines, topical and oral corticosteroids, and epinephrine, have been used for bite reactions with varying results 4
Eradication of Bed Bugs
- Integrated pest management, an approach for the eradication of bed bugs, includes monitoring devices, and judicious use of nonchemical and chemical treatments known to be effective 2
- Nonchemical interventions include keeping affected areas clean and free of clutter, vacuuming, washing linens with hot water, caulking wall holes and cracks where bugs can hide, proper disposal of highly infested items, and placement of bed bug traps/interceptors at the base of beds and furniture 2
- Chemical interventions involve the use of insecticides such as synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil and plant essential oils 2
- A threshold-based management approach (non-chemical only or non-chemical and chemical) can eliminate bed bugs in a similar amount of time, using little to no pesticide compared to a chemical only approach 5