From the Guidelines
To effectively treat bed bug skin infestation, permethrin 1% cream rinse or pyrethrins with piperonyl butoxide should be applied to the affected areas and washed off after 10 minutes, as recommended by the 2015 guidelines 1. When dealing with bed bug infestations, it's crucial to address both the skin infestation and the environmental aspect.
- For the skin infestation, the treatment options include:
- Permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes
- Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes, as outlined in the guidelines 1
- In addition to treating the skin, a comprehensive approach to eliminate the bed bugs from the environment is necessary, including washing and drying bedding, clothing, and fabrics on high heat, thorough vacuuming, and the use of EPA-registered insecticides.
- It's also important to consider non-chemical methods such as steam cleaning and the use of bed bug-proof encasements for mattresses and box springs.
- Persistence and follow-up are key, as bed bugs can be resilient and may require repeated treatments over a period of time, ideally continuing for at least two weeks after the last sighting to ensure all eggs have hatched and been eliminated.
From the Research
Bed Bug Skin Infestation Treatment
- Bed bug bites are often painless, but can cause pruritic, erythematous maculopapules, and lesions that appear in clusters or in a linear or curvilinear distribution in exposed areas of the body 2
- Reactions to bed bug bites are self-limited, and treatment is mainly symptomatic, with topical pramoxine and oral antihistamines used to alleviate pruritus 2
- Topical corticosteroids can be used for significant eruptions to control inflammation and pruritus, and to hasten resolution of the lesions 2
- A variety of clinical reactions to bed bugs have been reported, including cutaneous and rarely systemic reactions, with empirical treatments such as antibiotics, antihistamines, topical and oral corticosteroids, and epinephrine used for bite reactions with varying results 3
- Common dermatological responses to bed bug bites include the early development of small macular spots that may later progress into prominent wheals accompanied by intense itching, with patients exposed to numerous bed bugs presenting with a widespread erythematous rash or urticaria 4
- Symptomatic control of bed bug bites involves treatment of the patient with antihistamines and corticosteroids, and ensuring that the infestation responsible for the problem is effectively eliminated 4
- Cutaneous reactions to bed bug bites can start out as small macular lesions that can develop into distinctive wheals, which are accompanied by intense itching, with bullous eruptions occasionally resulting 5
Control Options
- The control of bed bugs is challenging and should encompass a multidisciplinary approach utilizing nonchemical means of control and the judicious use of insecticides 5
- Integrated pest management, an approach for the eradication of bed bugs, includes monitoring devices, and judicious use of nonchemical and chemical treatments known to be effective 2
- Nonchemical interventions include keeping affected areas clean and free of clutter, vacuuming, washing linens with hot water, caulking wall holes and cracks where bugs can hide, proper disposal of highly infested items, and placement of bed bug traps/interceptors at the base of beds and furniture 2
- Chemical interventions involve the use of insecticides such as synthetic pyrethroids, silicates, insect growth disruptors, carbamates, organophosphates, neonicotinoids, diethyl-meta-toluamide, chlorfenapyr, fipronil and plant essential oils, but should be used with caution to prevent over-exposure and toxicity 2