Treatment for Chigger Bites
Chigger bites should be treated symptomatically with topical antipruritics (calamine lotion, polidocanol, or topical corticosteroids), oral antihistamines for itch control, and cold compresses, as these bites are self-limited and do not require antibiotics. 1, 2, 3
Immediate Management
- Cleanse the affected skin with soap and water and allow to dry before applying any topical treatments 4
- Apply cold compresses or alcohol compresses to reduce inflammation and provide symptomatic relief 3, 5
- The intense pruritus typically lasts 3-4 days, with swelling resolving within 4-5 days on average 5
Topical Therapy
- Calamine lotion is the primary topical treatment: shake well, apply to affected areas using cotton or soft cloth as often as needed for comfort 4
- Zinc lotions can be used as an alternative topical agent 3
- Topical agents containing polidocanol or glucocorticosteroids are effective for controlling local reactions 3
- For children under 2 years: consult a physician before using calamine 4
Systemic Therapy
- Oral antihistamines are indicated to control itching and represent the mainstay of systemic treatment 1, 2, 3, 5
- Systemic corticosteroids may be considered for more severe reactions, though most cases resolve with antihistamines alone 1
Important Clinical Considerations
- Chigger bites do NOT require antibiotic therapy - they are caused by mite larvae feeding on epidermal cells and represent a hypersensitivity reaction, not a bacterial infection 1, 2
- The typical presentation includes erythematous papules, urticarial plaques, and sometimes vesicular transformation with intense pruritus 3
- Bites commonly occur along sock lines, belt lines, and other areas where clothing fits tightly 2
- Look for a characteristic papule or bite puncture mark (present in 50% of cases) and check for bites on other body areas (present in 56% of cases) 5
Prevention
- Apply insect repellent containing DEET 10-35% or picaridin 20% to exposed skin when visiting areas known to harbor chiggers 2, 3
- Wear protective clothing including long pants, long-sleeved shirts, and closed shoes when in wooded areas, parks, or tall grass 2
- Treatment of clothing with permethrin provides additional protection 2
Common Pitfall
Do not confuse chigger bites with bacterial infections requiring antibiotics - the evidence clearly shows these are hypersensitivity reactions to mite digestive enzymes that resolve with symptomatic treatment only 1, 2. While chiggers in some parts of the world (particularly Asia) can transmit scrub typhus, this is not a concern in routine North American practice 6.