Treatment of Chigger Bites
Chigger bites are self-limited and require only symptomatic treatment with topical corticosteroids, oral antihistamines, and supportive care—no antibiotics or aggressive interventions are needed. 1, 2
Immediate Management
Symptomatic Relief (First-Line)
- Apply topical hydrocortisone 0.5-1% to affected areas 3-4 times daily to reduce inflammation and pruritus 3
- Administer oral antihistamines to control itching systemically 1, 4, 5
- Use topical antipruritics containing polidocanol or cooling agents for additional relief 1, 5
- Apply cold compresses or alcohol compresses to reduce local inflammation 5
When to Escalate Treatment
- For severe pruritus unresponsive to standard therapy, consider intralesional triamcinolone acetonide injection 2
- Systemic antihistamines are indicated when topical measures fail to control itching 5
- Zinc lotions may provide additional symptomatic relief 5
What NOT to Do (Critical Pitfalls)
- Do not prescribe antibiotics—chigger bites cause allergic inflammation from mite digestive enzymes and host immune response, not bacterial infection 1, 4
- Do not perform aggressive debridement or wound manipulation—these are superficial dermatologic reactions that heal spontaneously within 1-2 weeks 2
- Avoid iodine or antibiotic-containing topical solutions, which offer no benefit 6
Natural Course and Expectations
- Chigger bites manifest as intensely pruritic erythematous papules, papulovesicles, or urticarial plaques, often with vesicular transformation 1, 5
- Lesions typically appear along sock lines, belt lines, and areas where clothing fits tightly 4
- Complete resolution occurs within 1-2 weeks without intervention 2
- The intense pruritus results from digestive enzymes secreted by mite larvae feeding on epidermal cells combined with the host immune response 1
Prevention (Most Important Strategy)
- Apply DEET 10-35% or picaridin 20% to exposed skin before entering infested areas 4, 2
- Treat clothing with permethrin spray 7, 4
- Wear protective clothing that completely covers the skin, with long sleeves tucked into pants and pants tucked into socks 7, 2
- Shower immediately after potential exposure and launder clothing 2
Disease Transmission Considerations
While chiggers in Asia (genus Leptotrombidium) transmit scrub typhus (Orientia species), North American chiggers (Eutrombicula species) do not transmit significant human pathogens in routine clinical practice 8. The primary concern remains symptomatic dermatitis, not infectious disease transmission in the United States 1, 4.