Treatment of Bed Bug Bites
For symptomatic relief of bed bug bites, use topical corticosteroids (such as hydrocortisone cream) to control inflammation and pruritus, combined with oral antihistamines and topical pramoxine to alleviate itching. 1, 2
Primary Treatment Approach
Topical Corticosteroids
- Hydrocortisone cream is FDA-approved for temporary relief of itching associated with insect bites and can be applied directly to affected areas. 1
- For significant eruptions, topical corticosteroids help control inflammation, reduce pruritus, and hasten resolution of lesions. 2
- Low to medium potency topical steroids are appropriate for bed bug bite reactions, as these are typically self-limited conditions. 2
Antipruritic Agents
- Topical pramoxine provides direct relief of itching at the bite sites. 2
- Oral antihistamines (such as cetirizine, loratadine, or fexofenadine) help manage systemic pruritus and allergic responses. 2
Clinical Presentation to Recognize
Bed bug bites present with characteristic features that guide treatment decisions:
- Pruritic, erythematous maculopapules occurring in clusters or linear/curvilinear distribution on exposed body areas. 2
- The "breakfast, lunch, and dinner" pattern (three lesions in a row) is highly suggestive of bed bug bites. 3
- A small red punctum may be visible at the center of bite marks. 2
- Exaggerated reactions in sensitized individuals can include vesicles, urticarial wheals, bullae, or nodules. 2
Important Clinical Considerations
Self-Limited Nature
- Reactions to bed bug bites are self-limited, making treatment primarily symptomatic rather than curative. 2, 4
- No evidence-based interventions have been identified that significantly alter outcomes compared to no treatment. 4
Disease Transmission Risk
- Despite historical attribution of over 40 human diseases to bed bugs, there is little evidence that they serve as vectors of communicable disease. 4
- Treatment focuses on symptomatic relief rather than infection prevention. 4
Systemic Reactions
- Rarely, bed bug bites can cause systemic reactions including asthma exacerbations or anaphylaxis in highly allergic individuals. 5
- Epinephrine should be available for patients with known severe hypersensitivity reactions. 4
Common Pitfalls to Avoid
- Do not prescribe antibiotics routinely - bed bug bites are not infectious unless secondary bacterial infection develops from scratching. 4
- Avoid over-treatment with high-potency corticosteroids for what is typically a self-resolving condition. 2
- Address patient anxiety and psychological distress, as bed bug infestations cause significant emotional stress and poor quality of life beyond the physical symptoms. 2
Environmental Control is Essential
While creams treat symptoms, eradication of the infestation is paramount:
- Advise patients that symptomatic treatment alone is insufficient without addressing the source of infestation. 2
- Recommend consultation with professional exterminators for integrated pest management. 2
- Nonchemical interventions include hot water washing of linens, vacuuming, and decluttering affected areas. 2