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Summer Series: How to Treat Common Insect Bites

by Sue Hubbard, M.D.

As we continue our summer series, it’s time to talk about pesky insect bites.  From May/June until Fall, I consistently see children who are brought to my office for me to look at their insect bites.  Just last week a mother brought in a 7 year old that she thought had chickenpox, but in reality it was numerous bug bites, which were located on the child’s arms and legs (exposed skin) rather than on the trunk which is seen with early chickenpox.  In many cases, the offending biting insect is not accurately identified, as it could be the ubiquitous mosquito, or biting flies, gnats or fleas. Systemic reactions from insect bites are much less common that systemic reactions to insect stings.

The immediate reaction to the insect bite usually occurs in 10–15 minutes with local swelling and itching, and may disappear in an hour or less.  The delayed reaction may appear in 12–24 hours with the development of an itchy red papule (bump) which may persist for days to even weeks. This is the reason that some people do not remember being bitten while they were outside, but the following day may present with the bites all over their arms and legs or chest, depending on what part of the body was exposed.

Large local reactions to mosquito bites are common in children. For some reason it seems to me that “baby fat”  reacts more to the bite of the mosquito. (No science here).  The toddler set will often have itchy, red, are warm swellings appearing within minutes of the bites and they may even go on to develop bruising, and spontaneous blistering in 2–6 hours after being bitten.

These bites then may persist for days or weeks, so in theory their little legs will be affected for most of the summer.  Severe local reactions are called “sweeter syndrome” and occur within hours of being bitten and may involve swelling of an entire body part such as the hand, face or extremity.  These are often misdiagnosed as cellulitis, but with a good history, the rapidity with which the area developed redness, swelling, warmth to touch and tenderness,  would be uncommon for a bacterial infection.

Systemic reactions to mosquito bites including generalized hives, swelling of the lips and mouth, nausea, vomiting and wheezing have been reported due to a true allergy to the mosquito salivary proteins but are extremely rare.

The treatment of local reactions to bites involves the use of topical anti-itching preparations like Calamine lotion,  Sarna lotion, Dommeboro soaks etc.  This may be supplemented by topical steroid creams (either over the counter or prescription) which may be used several times a day for a week or so to minimize scarring.

An oral antihistamine (Benadryl)  may also reduce some of the swelling and itching.  Do not use topical antihistamines.  It is also important to try and prevent secondary infection (by scratching and picking) by using antibacterial soaps, trimming fingernails and applying an antibiotic cream like Polysporin to open bites.

The best treatment is actually prevention. Using a DEET preparation before going outside (lowest concentration that is effective) may be used in children over the age of 6 months.  Mosquito netting may be used for infants. Try to avoid going outside at dawn and dusk and make sure that you check pots etc for standing water that may be breeding areas for mosquitoes. Wearing long sleeves and long pants will also help (can’t imagine when it is 105 degrees !)

That’s your daily dose for today.  We’ll chat again tomorrow!

Send your question to Dr. Sue right now!

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