What is the treatment for chigger bites?

Treatment of Chigger Bites

Topical corticosteroids such as hydrocortisone 1% are the first-line treatment for chigger bites, applied up to 3-4 times daily to reduce inflammation and itching. 1, 2

Primary Treatment Options

1. Topical treatments:

   • Hydrocortisone 1% cream: Apply to affected areas up to 3-4 times daily 1, 2
   • Calamine lotion: Can provide soothing relief for itching 1

2. Oral medications:

   • Antihistamines (cetirizine, loratadine, fexofenadine): Effective for relieving itching and discomfort 1
   • Acetaminophen or NSAIDs: For pain relief if needed 1

3. Additional measures:

   • Clean the affected area with mild soap and water 1
   • Avoid scratching to prevent secondary infection
   • Concentrated heat application can rapidly reduce inflammation, pain, and itching within 2-5 minutes 1

Special Considerations

Severe Reactions

• For severe local reactions with intense pruritus, a brief course of oral corticosteroids may be considered 1, 3
• In rare cases of severe reactions, intralesional triamcinolone acetonide injection may be used 4

Secondary Infections

• Monitor for signs of secondary infection (increasing redness, warmth, pain, purulent drainage) 1
• If infection develops, consider antibiotics such as:
  • Amoxicillin-clavulanate (875/125 mg twice daily)
  • Cephalexin (250-500 mg four times daily)
  • Clindamycin (300-400 mg three times daily) for penicillin-allergic patients 1

Prevention of Future Bites

• Use DEET-containing repellents (10-30% concentration) on exposed skin 1, 5
• Wear long sleeves and pants, especially during outdoor activities 1
• Avoid areas with high grass and weeds where chiggers commonly reside 1, 6
• Consider treating clothing with permethrin for additional protection 5

Clinical Course and Prognosis

Most chigger bites are self-limiting and resolve within 1-2 weeks with symptomatic treatment 4. The typical duration of swelling ranges from 1-18 days (mean 4.1 days), and pruritus typically lasts 0-14 days (mean 3.0 days) 7.

Common Pitfalls to Avoid

• Misdiagnosis: Chigger bites can be confused with other insect bites but tend to appear along sock and belt lines 5
• Overtreatment: Avoid unnecessary antibiotics unless secondary infection is present
• Inadequate prevention: Failing to use proper repellents and protective clothing when returning to infested areas
• Scratching: Advise patients to avoid scratching, which can lead to secondary infection and prolonged symptoms

Remember that chigger bites in the United States typically cause only localized reactions and do not transmit diseases like scrub typhus (which is associated with chiggers in other parts of the world) 6.