What is the recommended treatment for bed bug bites?

Treatment for Bed Bug Bites

For bed bug bites, prescribe topical corticosteroids (such as hydrocortisone cream) for inflammation and pruritus, combined with oral antihistamines for symptomatic relief of itching. 1, 2

Symptomatic Management Algorithm

First-Line Topical Treatment

• Apply topical corticosteroids (hydrocortisone cream) to affected areas 3-4 times daily to control inflammation and pruritus, and to hasten resolution of lesions 1, 2
• Hydrocortisone is FDA-approved for temporary relief of itching associated with insect bites 1
• Clean the affected area before application and apply no more than 3-4 times daily 1

Oral Antihistamines for Pruritus

• Prescribe oral antihistamines to alleviate itching, which is often the most bothersome symptom 2, 3, 4
• Antihistamines provide symptomatic control while reactions self-resolve 4

Additional Symptomatic Measures

• Topical pramoxine can be used as an alternative or adjunct for pruritus relief 2
• For significant eruptions with widespread inflammation, consider a short course of oral corticosteroids 2, 3

Clinical Presentation to Recognize

Bed bug bites typically present as:

• Pruritic, erythematous maculopapules in clusters or linear/curvilinear distribution on exposed body areas 2
• Small red punctum may be visible at the center of bite marks 2
• Three bites in a row ("breakfast, lunch, dinner" pattern) is highly suggestive of bed bugs 2
• Papules on upper eyelid with erythema and edema are characteristic 2

Exaggerated Reactions in Sensitized Individuals

• Vesicles, urticarial wheals, bullae, nodules, or diffuse urticaria may occur 2, 5, 4
• Rarely, anaphylaxis has been reported 5, 4
• Asthma exacerbations can be triggered by bed bug bites 4, 6

Critical Management Principles

Self-Limited Nature

• Reactions to bed bug bites are self-limited, so treatment is primarily symptomatic 2
• No evidence exists that outcomes differ significantly between treated and untreated patients 3

What NOT to Prescribe

• Do not prescribe antibiotics routinely—bed bug bites are not infected unless secondary bacterial infection develops from scratching 2
• Antibiotics have been used empirically but without evidence of benefit 3

Disease Transmission Concerns

• There is no evidence that bed bugs transmit communicable diseases to humans, despite testing for over 40 pathogens 3
• Reassure patients about this lack of disease transmission 3

Beyond Pharmacotherapy: Addressing the Infestation

The most important intervention is eradication of the infestation itself, as ongoing exposure will perpetuate symptoms 2, 3, 4

Recommend Professional Extermination

• Consultation with a professional exterminator is essential for complete eradication 2
• Integrated pest management combining nonchemical and chemical methods is most effective 2

Patient Education on Nonchemical Measures

• Keep affected areas clean and clutter-free 2
• Vacuum regularly and wash linens in hot water 2
• Use mattress encasements and bed bug interceptors at furniture bases 2
• Properly dispose of heavily infested items 2

Psychological Impact Considerations

Address the significant psychological burden that bed bug infestations cause:

• Patients experience stigmatization, poor self-esteem, emotional stress, and anxiety 2
• Quality of life is substantially affected 2
• Provide reassurance and support while coordinating eradication efforts 4