Treatment for No-See-Um Bites
For no-see-um (biting midge) bites, apply topical hydrocortisone cream or ointment (up to 2.5%) to the affected area 3-4 times daily for symptomatic relief of itching and inflammation. 1
First-Line Topical Treatment
- Topical corticosteroids are the primary treatment for insect bite reactions, with hydrocortisone being FDA-approved specifically for itching associated with insect bites 1
- Apply hydrocortisone (0.5-2.5%) to affected areas not more than 3-4 times daily 1
- For children under 2 years of age, consult a physician before use 1
- Medium- to high-potency topical corticosteroids can be used for more severe reactions, though low-potency formulations like hydrocortisone are typically sufficient for simple insect bites 2
Adjunctive Symptomatic Measures
- Cool compresses applied to the bite area can provide symptomatic relief by substituting cooling sensation for itch 2, 3
- Emollients should be used regularly to prevent skin dryness, which can worsen itching 3, 4
- Ice application immediately after the bite can help limit initial swelling and discomfort 5
Role of Antihistamines
- Oral antihistamines have limited evidence for efficacy in treating localized insect bite itching 2, 6
- Non-sedating antihistamines like cetirizine may provide some benefit for immediate wealing reactions 7
- Sedating antihistamines at bedtime can be helpful if itching disrupts sleep, though their direct anti-itch effect is questionable 2, 4
What NOT to Do
- Avoid low-potency corticosteroid ointments (below 0.5%), as studies show 2.5% hydrocortisone ointment was not effective for improving symptoms in contact dermatitis, suggesting concentration matters 2
- Do not use topical antibiotics like bacitracin unless there are signs of secondary bacterial infection (increasing redness, warmth, purulent discharge) 8
- Avoid scratching, which can lead to secondary bacterial infections such as impetigo or cellulitis 6
When to Seek Medical Attention
- If signs of secondary bacterial infection develop (spreading redness, warmth, pus, fever) 6
- If severe allergic reactions occur (extensive swelling, difficulty breathing, systemic symptoms) 5
- If symptoms persist beyond 1-2 weeks despite appropriate topical treatment 4
Common Pitfalls
- Using antihistamines as monotherapy without topical corticosteroids—the evidence supports topical steroids as first-line, not oral antihistamines 2, 6
- Applying topical treatments less frequently than recommended—the FDA label specifies 3-4 times daily application for optimal effect 1
- Failing to maintain skin hydration with emollients, which is essential for breaking the itch-scratch cycle 3, 4