What is the recommended treatment for mosquito bites?

Treatment for Mosquito Bites

For typical mosquito bites, the recommended first-line treatment includes topical hydrocortisone cream and oral antihistamines to reduce itching, inflammation, and discomfort. 1

Immediate Treatment for Standard Mosquito Bites

• Apply topical hydrocortisone cream (0.5-1%) to the affected area up to 3-4 times daily to reduce itching and inflammation 1
• Take oral antihistamines to minimize cutaneous reactions and reduce itching 2, 3
• Apply cold compresses to reduce local pain and swelling 4
• For children under 2 years of age, consult a doctor before applying hydrocortisone 1

Prevention Strategies

• Use insect repellents containing DEET (N,N diethylmetatoluamide) on exposed skin, which is the most effective mosquito repellent available 4, 2
• Apply DEET-containing repellents sparingly to exposed skin or clothing 4
• Avoid applying high-concentration DEET products to skin, particularly on children 4
• Wear long-sleeved clothing and long pants when outdoors, especially during evening hours 4
• Use permethrin (Permanone) on clothing for additional protection 4
• Stay in well-screened areas and use mosquito nets when sleeping in endemic areas 4
• Use pyrethrum-containing flying-insect spray in living and sleeping areas during evening hours 4

Special Considerations

• For large local reactions, a short course of oral corticosteroids may be considered in severe cases 4
• Antibiotics are usually not necessary for mosquito bites unless secondary infection develops 4
• For patients with history of severe allergic reactions to mosquito bites, referral to an allergist-immunologist is recommended 4
• Patients with systemic reactions should carry emergency epinephrine and be familiar with proper use 4

Severe Reactions

• Systemic allergic reactions to mosquito bites are rare but can occur 5, 6
• Acute systemic reactions should be treated like any anaphylactic reaction, with injectable epinephrine, supportive therapy, and transport to an emergency department 4
• The recommended dose of epinephrine for anaphylaxis is 0.01 mg/kg (up to 0.3 mg in children and 0.3-0.5 mg in adults) 4
• Fatal reactions have been associated with delay in administration of epinephrine 4

Long-term Management

• For patients with recurrent severe reactions to mosquito bites, specific immunotherapy with mosquito extracts may be considered, though this is not widely available 5, 7
• Tolerance to mosquito bites can develop naturally in people living in heavily infested areas 6
• Prophylactic antihistamines (such as cetirizine or ebastine) taken before expected exposure can reduce reaction severity 3, 6

Common Pitfalls

• Misdiagnosing mosquito bite reactions as other conditions (e.g., cellulitis)
• Overuse of topical corticosteroids, which should not be applied more than 3-4 times daily 1
• Failure to recognize systemic reactions that require immediate medical attention
• Relying on ineffective prevention methods such as electronic buzzers, which do not effectively repel mosquitoes 4