How should I manage bedbug bites and eradicate a bedbug infestation?

Bedbug Treatment

For bedbug bites, use topical corticosteroids and oral antihistamines for symptomatic relief, while simultaneously implementing integrated pest management with professional extermination to eradicate the infestation.

Management of Bedbug Bites

Symptomatic Treatment

• Topical corticosteroids control inflammation and pruritus while hastening resolution of lesions in patients with significant eruptions 1.
• Topical pramoxine alleviates pruritus associated with bedbug bites 1.
• Oral antihistamines reduce itching and improve patient comfort 1.
• Hydrocortisone cream is FDA-approved for temporary relief of itching associated with insect bites 2.
• Most bedbug bite reactions are self-limited and resolve within 1-2 weeks without treatment 3.

Clinical Presentation to Recognize

• Pruritic, erythematous maculopapules occurring in clusters or linear/curvilinear distribution on exposed body areas are typical 1.
• Three bites in a row ("breakfast, lunch, dinner" pattern) and papules on the upper eyelid with erythema and edema are highly suggestive of bedbug bites 1.
• A small red punctum may be visible at the center of bite marks 1.
• Exaggerated reactions including vesicles, urticarial wheals, bullae, and nodules can occur in previously sensitized individuals 1.

Systemic Complications (Rare)

• Monitor for asthma, angioedema, generalized urticaria, iron deficiency anemia, and rarely anaphylaxis in patients with systemic reactions 3.
• Secondary bacterial infections can develop from scratching 4.

Eradication of Bedbug Infestation

Integrated Pest Management Approach

Integrated pest management combining nonchemical and chemical interventions is the most effective eradication strategy 1.

Nonchemical Interventions (First-Line)

• Keep affected areas clean and free of clutter 1.
• Vacuum thoroughly and frequently, focusing on mattress seams, bed frames, and furniture crevices 1, 3.
• Wash all linens, bedding, and clothing in hot water (>130°F) followed by high-heat drying 1.
• Encase mattresses, box springs, and pillows in zippered, allergen-proof covers to trap bedbugs and prevent access 5.
• Caulk wall holes and cracks where bugs can hide 1.
• Place bedbug traps/interceptors at the base of beds and furniture 1.
• Properly dispose of highly infested items that cannot be salvaged 1.
• Heat treatment (exposing items to temperatures >120°F) or cold treatment (freezing at 0°F for several days) kills bedbugs 3.

Chemical Interventions (Professional Application Required)

• Chemical treatments should only be undertaken by trained pest control professionals due to insecticide resistance patterns and toxicity risks 5.
• Available insecticide classes include neonicotinoids, insect growth regulators, and chlorfenapyr 5.
• Other options include synthetic pyrethroids, silicates, carbamates, organophosphates, fipronil, and plant essential oils 1.
• Insecticides should be used with extreme caution to prevent cardiovascular and neurologic toxicity, especially in homes with young children 1.
• Multiple mechanisms of insecticide resistance exist, making professional expertise essential 1, 6.

Monitoring and Follow-Up

• Use monitoring devices including active monitors (heat or carbon dioxide attractants) and passive monitors (sticky pads) to detect ongoing infestation 1.
• Continue monitoring after treatment to ensure complete eradication 3.

Critical Pitfalls to Avoid

• Do not rely on a single eradication strategy—bedbugs continue to bite until the infestation is completely eliminated 4.
• Do not attempt chemical treatment without professional help—improper pesticide use creates health hazards and worsens resistance 1, 6.
• Do not overlook psychological distress—bedbug infestations cause significant anxiety, insomnia, poor self-esteem, and adverse effects on quality of life 1, 3, 4.
• Report infestations to the state public health department to support tracking and management efforts 4.

When to Consult a Professional Exterminator

Consultation with a professional exterminator is recommended to fully eradicate an infestation 1. Professional pest control is essential because:

• Bedbugs are hardy insects that withstand a large temperature range 3.
• Insecticide resistance is widespread 6.
• Improper treatment leads to incomplete eradication and reinfestation 1.
• Health concerns exist about spraying mattresses with pesticides 6.