From the Guidelines
For a persistent itchy insect bite that's still bothering you after two weeks, try applying an over-the-counter hydrocortisone cream (1%) 2-3 times daily for up to 7 days to reduce inflammation and itching, as recommended by recent guidelines 1. You can also take an oral antihistamine like cetirizine (Zyrtec) 10mg or diphenhydramine (Benadryl) 25-50mg to help control the itching. Cold compresses for 10-15 minutes several times a day can provide additional relief. Some key points to consider when treating an insect bite include:
- Keeping the area clean and avoiding scratching to prevent infection
- Watching for signs of infection, such as increasing redness, warmth, swelling, pus, or red streaks
- Monitoring for fever or severe pain, which could indicate a more serious reaction
- Considering a brief course of oral corticosteroids for severe cases, although antibiotics are usually not necessary unless there is evidence of secondary infection 2. If symptoms worsen or don't improve within another week with these treatments, consult a healthcare provider as you may need stronger prescription medications. It's also important to note that some insect bites can cause prolonged reactions due to your body's immune response to proteins in the insect's saliva, which is why symptoms can persist for weeks 3.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... insect bites Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily Purpose Anti-itch
Treatment for possible insect bite 2 weeks ago that is still itchy may include applying hydrocortisone (TOP) to the affected area, as it is used to temporarily relieve itching associated with minor skin irritations and insect bites.
- Apply to the affected area not more than 3 to 4 times daily for adults and children 2 years of age and older 4, 5.
- For children under 2 years of age, ask a doctor before applying 5.
- The primary purpose of this product is Anti-itch 6.
From the Research
Treatment Options for Insect Bites
- Antihistamines and topical corticosteroids are available over the counter (OTC) in the UK for the treatment of insect bites, although there is a lack of evidence for their efficacy 7
- Cimetidine, an H-2-receptor-blocking antihistamine, has been used to treat recalcitrant acute allergic urticaria in response to insect stings, with dramatic responses within 15 minutes 8
- Levocetirizine has been shown to be effective in reducing the size of wheals and accompanying pruritus caused by mosquito bites, with a decrease of 60% and 62% respectively compared to placebo 9
Considerations for Treatment
- The treatment of simple insect bites is often based on expert opinion and clinical experience, rather than evidence-based recommendations 7
- The use of antihistamines such as levocetirizine may be effective in reducing symptoms of insect bites, particularly in subjects with large wheals 9
- Cimetidine may be considered for patients with recalcitrant acute allergic urticaria who are already being treated with H-1-receptor-blocking antihistamines 8