Treatment of Bedbug Bites
For bedbug bites in a patient with no prior medical history, treatment is symptomatic and focuses on controlling pruritus and inflammation with topical corticosteroids and oral antihistamines, as the reactions are self-limited. 1
Immediate Symptomatic Management
First-Line Topical Treatment
- Apply topical corticosteroids to control inflammation and pruritus and hasten resolution of lesions. 1 Hydrocortisone cream can be applied to affected areas 3-4 times daily for adults and children over 2 years of age. 2
- For significant or bullous eruptions, high-potency topical corticosteroids may be warranted, as bedbug bite reactions can reflect cutaneous vasculitis in severe cases. 3
Oral Antihistamines
- Administer oral antihistamines such as cetirizine to alleviate pruritus and reduce itching associated with the skin reactions. 1
- Antihistamines address the allergic component of the bite reaction, which is IgE-mediated in nature. 4
Additional Symptomatic Measures
- Topical pramoxine can be used as an alternative or adjunct to reduce pruritus. 1
- Cold compresses may provide additional relief from local pain and swelling. 5
Clinical Recognition and Diagnosis
Characteristic Presentation
- Bedbug bites typically present as pruritic, erythematous maculopapules in clusters or linear/curvilinear distribution on exposed body areas (face, distal extremities). 1, 6
- A small red punctum may be visible at the center of bite marks. 1
- Lesions appearing "three in a row" are highly suggestive of bedbug bites. 1
- Papules on the upper eyelid with erythema and edema are also characteristic. 1
Exaggerated Reactions
- Previously sensitized individuals may develop vesicles, urticarial wheals, bullae, or nodules. 1
- Bullous reactions reflect cutaneous vasculitis and are not rare (occurring in approximately 6% of cases), requiring more aggressive topical corticosteroid treatment. 3
Critical Pitfall to Avoid
Do not confuse the erythema and swelling from bedbug bites with bacterial cellulitis. 7 The inflammatory response is allergic in nature, not infectious, and antibiotics are not indicated unless there is clear evidence of secondary bacterial infection such as purulent drainage, fever, or progressive worsening beyond 48-72 hours. 7
Addressing the Infestation
While symptomatic treatment addresses the immediate medical concern, identification and elimination of the bedbug infestation is paramount to prevent ongoing bites and psychological distress. 1, 4
Nonchemical Interventions
- Keep affected areas clean and clutter-free. 1
- Vacuum thoroughly and wash all linens in hot water. 1
- Caulk wall holes and cracks where bedbugs hide. 1
- Place bedbug interceptors at the base of beds and furniture. 1
Professional Extermination
- Consultation with a professional exterminator is recommended for complete eradication, as bedbugs are difficult to eliminate and multiple mechanisms of insecticide resistance exist. 1
- Chemical treatments should only be undertaken by trained professionals to prevent toxicity, especially with children present. 1
Monitoring and Follow-Up
- Bedbug bite reactions are self-limited but may take weeks to fully heal, particularly bullous lesions. 3
- In patients with bullous reactions, monitor for evidence of systemic vasculitis, as the histologic picture resembles Churg-Strauss vasculitis. 3
- Address psychological distress, anxiety, and stigmatization, which can significantly affect quality of life. 1, 8