What is the treatment for dermatitis due to a bee sting?

Treatment for Dermatitis Due to Bee Sting

For dermatitis due to bee sting, remove the stinger as quickly as possible (by scraping or plucking), wash the area with soap and water, and treat symptoms with oral antihistamines, topical corticosteroids, and cold compresses. 1

Initial Management

1. Remove the stinger immediately

   • Remove any stinger remaining in the skin as soon as possible 1
   • Method of removal (scraping vs. plucking) is less important than speed of removal 2
   • Honeybee stingers can continue to deliver venom for up to 60 seconds if left in place 1

2. Clean the area

   • Wash the sting site with soap and water 1
   • This helps reduce risk of secondary infection

Treatment of Local Reactions

For Pain Relief:

• Apply ice or cold compresses to the affected area 1
• Use over-the-counter acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) 1

For Itching:

• Use over-the-counter oral antihistamines 1
• Apply topical corticosteroids to the affected area 1, 3
  • Hydrocortisone cream can be applied to affected area up to 3-4 times daily 3

Special Considerations

Large Local Reactions:

• Characterized by extensive swelling >10 cm in diameter around the sting site 1
• May persist for 5-10 days 1
• Treatment includes:
  • Oral antihistamines
  • Cold compresses
  • Short course of oral corticosteroids in severe cases 1
• Antibiotics are usually NOT necessary unless there is evidence of secondary infection 1

When to Seek Medical Attention:

1. For stings to the eye - These should be evaluated by a trained medical professional immediately 1
2. Signs of anaphylaxis - Difficulty breathing, tongue/throat swelling, lightheadedness, vomiting, or disseminated hives require immediate emergency response 1
3. Unusual tissue reactions - Rarely, untreated bee stings can lead to skin and soft tissue necrosis requiring surgical intervention 4

Monitoring and Follow-up

• Most local reactions to bee stings are self-limiting and resolve within hours to days without treatment 5
• Monitor for signs of secondary infection (increasing redness, warmth, purulence)
• If swelling continues to worsen beyond 48 hours or if symptoms don't improve with home treatment, medical evaluation may be needed

Common Pitfalls to Avoid

1. Delayed stinger removal - Don't waste time deciding how to remove the stinger; quick removal by any method is most important 2
2. Misdiagnosing large local reactions as infection - The swelling from bee stings is caused by allergic inflammation, not infection, and doesn't require antibiotics 1
3. Missing signs of anaphylaxis - Always monitor for systemic symptoms that may indicate a severe allergic reaction requiring emergency treatment 1, 6
4. Squeezing the stinger during removal - This may inject more venom; scraping or flicking is preferred 1

Remember that while most bee sting reactions are mild and self-limiting, patients with a history of large local reactions have up to a 10% risk of developing systemic reactions to future stings 1.