What is the recommended treatment for bed bug bites?

Treatment for Bed Bug Bites

The recommended treatment for bed bug bites is primarily symptomatic and includes topical pramoxine, oral antihistamines, and topical corticosteroids for significant eruptions to control inflammation and pruritus. 1

Clinical Presentation

• Bed bug bites typically appear as pruritic, erythematous maculopapules occurring in clusters or in a linear/curvilinear distribution on exposed areas of the body 1
• A small red punctum may be visible at the center of the bite mark 1
• Three bites in a row ("breakfast, lunch, and dinner" pattern) and papules on the upper eyelid with erythema and edema are highly suggestive of bed bug bites 1
• Exaggerated local reactions including vesicles, urticarial wheals, bullae, and nodules may occur in previously sensitized individuals 1, 2
• Widespread erythematous rash or urticaria can develop in patients exposed to numerous bed bugs 2

First-Line Treatment

• Reactions to bed bug bites are self-limited, so treatment is mainly symptomatic 1
• For pruritus management:
  • Topical pramoxine to affected areas 1
  • Oral antihistamines (such as diphenhydramine or cetirizine) 1, 2
• For significant eruptions:
  • Topical corticosteroids to control inflammation, reduce pruritus, and hasten lesion resolution 1, 2
• Cold compresses may help reduce local pain and swelling 3

Special Considerations

• Anaphylaxis has been reported, albeit rarely, and may require emergency treatment with epinephrine 2
• Bed bug bites can trigger asthmatic reactions in susceptible individuals 2
• Secondary bacterial infection may occur due to scratching and require antibiotic treatment 4
• Systemic reactions are uncommon but may require oral corticosteroids in severe cases 4

Management of Infestation

While treating the bites is important, addressing the infestation is crucial:

• Consult with a professional exterminator for complete eradication 1
• Non-chemical interventions include:
  • Keeping affected areas clean and free of clutter 1
  • Washing linens with hot water 1
  • Vacuuming thoroughly 1
  • Decontaminating bedding and clothing by machine-washing and drying using hot cycles 3
  • Placing bed bug traps/interceptors at the base of beds and furniture 1

Psychological Impact

• Bed bug infestations may cause significant psychological distress, anxiety, poor self-esteem, and substantial adverse effects on quality of life 1
• Addressing patient concerns and providing reassurance is an important part of management 5
• There is no evidence that bed bugs transmit human pathogens or communicable diseases 4

Common Pitfalls to Avoid

• Misdiagnosing bed bug bites as other skin conditions (scabies, allergic reactions, etc.) 5
• Treating with antibiotics when there is no evidence of secondary infection 4
• Failing to address the underlying infestation, which will result in continued bites 1
• Using insecticides without professional guidance, which can lead to overexposure and toxicity, particularly in households with young children 1

Remember that while treating the symptoms is important for patient comfort, identifying and eliminating the infestation is essential for long-term resolution of the problem 1, 2.