Treatment for Chigger Bites
For chigger bites, treatment should focus on symptomatic relief with topical antipruritics, oral antihistamines, and topical corticosteroids, as these bites are typically self-healing within two weeks. 1
First-Line Treatment Options
Topical Treatments
- Topical corticosteroids: Apply a mild topical corticosteroid (e.g., clobetasone butyrate) to reduce inflammation and itching 2
- Emollients with high lipid content: Use as a base treatment, especially beneficial for elderly patients 2
- Calamine lotion: Helps reduce itching and inflammation 2
Oral Medications
- Non-sedating antihistamines: Consider fexofenadine, loratadine, or cetirizine to control itching 2
- Avoid sedating antihistamines, especially in elderly patients, due to increased risk of falls, confusion, and anticholinergic effects
Management of Severe Cases
- For severe itching that doesn't respond to first-line treatments:
Prevention of Secondary Infection
- Keep nails short to minimize trauma from scratching 2
- Clean the bite area thoroughly with soap and water 2
- Monitor for signs of secondary infection:
- Increasing redness, warmth, pain
- Purulent drainage
- Systemic symptoms like fever or chills
If secondary 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 2
Prevention Strategies
- Apply DEET-containing repellents (10-30%) to skin and clothing 2, 3
- Wear protective clothing (long sleeves and pants) when in potentially infested areas 2
- Avoid areas with tall grass and brush where chiggers commonly reside
- Shower and wash clothing promptly after potential exposure 2
When to Seek Further Medical Care
Refer to secondary care if:
- Symptoms don't improve after 2 weeks of treatment
- Signs of systemic infection develop
- Unusual or severe reactions occur 2
Special Considerations
- Chiggers are the larval stage of Trombiculidae mites that feed on the host's epidermal cells 4
- Unlike ticks, chiggers do not burrow into the skin but attach to the skin surface
- In the United States, chigger bites typically cause only localized reactions and are not known to transmit diseases like scrub typhus, which is seen in other parts of the world 5
- The combination of digestive enzymes secreted by the mite and the host's immune response produces the characteristic pruritic erythematous papules 4
Proper identification and prompt symptomatic treatment are key to managing chigger bites effectively, with most cases resolving without complications within two weeks.