Bug Bites

Bug bites

May 14, 2022

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What is a bug bite?


The term “bug bite” references a hypersensitivity reaction in the skin induced by an insect vector.  To break this down further, there is a wide range of potential insects that can potentially cause a reaction in the skin. Furthermore, the range of reactions, how each person reacts, and who is at risk also varies.  The term “bug bite" does not reference a particular disease transmitted by the insect, it only references the immune reaction our skin has to its interaction with the bug directly or some component of the bug.

 




 

 

How do people get bug bites? 


Generally speaking, people get bug bites by coming into contact with an insect in some capacity.  There are factors related to the person individually or the environment they are in.  These factors place them at risk of coming into contact with different critters that can trigger bites.


Bug Bites



Individual factors related to the person that can attract bugs include:


  • Body heat
  • Carbon dioxide in the air we exhale
  • Movement
  • Sweat
  • Skin’s bio flora
  • Body odor
  • Hormones, including those related to pregnancy
  • Possibly alcohol intake
  • Factors related to certain medications some people may be on

Environmental factors that can place us at risk for exposure to insects include:

  • Tropical areas
  • Summer months or warmer temperatures
  • Outdoor activities that involve gardening or other exposure to landscaping and florals
  • Pet or animal exposure
  • Close contact from close living quarters such as hospitals and dormitories
  • Poor living conditions
  • Public spaces that are used by a high volume of people such as trains, buses, and hotels. 





The types of environments listed above place an individual in a situation where exposure to an insect is more likely to occur followed by personal factors that make the individual a more likely target for the insect to bite.  Once contact with the bug is made, a bite can occur.



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What are the most common types of insects that you see that cause bug bites? 



The most common types of bites I see in practice tend to be mosquitoes, fleas, and bed bugs.  However, bear in mind, that the most common cause of bug bites will vary based on circumstance and location.  Biting flies, midges, and mites can affect people based on geographic location and situations, and ticks up here in the Northeast are also common. 


For example, if bites are noted on ankles and calves in the summer times, mosquitoes or fleas may be a likely source.  If bites are noted in the winter with no known exposure to pets or travel, bed bugs may be a more likely cause.






How do bug bites most commonly appear on the skin? 


Most commonly, patients present with pink swollen papules or bumps with a central punctum or crust.  These can appear hive-like and very itchy.  Depending on the intensity of the itch reaction, bruising or expanding edema, as well as swelling, can be noted in the area.  There can even be the potential for bullous or blister-like reactions to bug bites, especially when on the legs.


bug bites





How can you tell if you have a bug bite? 


Interestingly, you may not always know that you have been bitten by a bug.  Remember that the bite from a bug is not in and of itself the cause of the itchy bump you may see.  


When a bug bite occurs, if you are sensitive to the bite from the saliva of the insect or trauma to the skin, an immune reaction will follow that leads to swelling and the release of mediators in the skin that heighten the sensation of itching.  

 

Related: Lice | When to see a doctor

However, if you are not sensitive to the bite, you may have little to no evidence of the bite taking place.  This can make certain infestation type bites challenging to diagnose.  I have had a number of cases where a couple shares a bed with bed bugs – one person has intense itching with repeated reactions while the other demonstrates no evidence of bites.   






What should you do if you have a bug bite? 


The instinct most people have is to scratch.  The challenge here is that the tendency to scratch a bite only intensifies the reaction to the bite. Large wheals and papular urticaria or hive-like reactions can occur.  Instead of just scratching, consider taking the following steps:


  • Reduce the intensity of the immune response by cooling the skin with ice packs or placing a moisturizer in the fridge to cool the skin on contact when applied to help.  
  • The use of topical steroids or antihistamines may help with significant reactions depending on the cause of the bite.  
  • If the bite is the result of an infestation with mites or lice as the culprit, the use of an anti-mite agent may be warranted.

When should medical attention be sought for bug bites?


For bites that appear as transient hive-like wheals or welts that present with itching but no other symptoms and last less than a week with no other systemic symptoms developing, it is not unreasonable to seek medical help if systemic symptoms develop. For presentations that last longer, other family members are also affected, and/or other unexplained symptoms occur, seek medical attention.

If the development of new bites is short-lived, just a few days, and does not surpass a week, there is a good chance that a situational exposure led to the bites.  This would not likely result in new bites developing beyond a week. It is important to note, however, that even a situational exposure can result in the development of new areas of papular urticaria that can be delayed for a few days after the initial “bite” occurs simply because it can take some time for the immune reaction to develop or occur after the initial exposure.


If someone has an exaggerated reaction or potentially anaphylaxis may warrant systemic steroids. 


For bites with a target-like appearance, skin breakdown, and/or the presence of systemic symptoms such as fever, chills, joint pains, muscle pains, headaches, blurry vision, photophobia, jaundice, etc, it is essential to be evaluated by your doctor.



 

How dangerous are bug bites?


The bug bite itself may not necessarily be dangerous if excess itching is reduced to avoid the risk of a secondary bacterial infection at the site of the bite.  However, some bugs can be responsible for transmitting disease.  


A bug bite can be dangerous if the bug serves as a vector for transmission of disease. Depending on where you live, here is the list of potential diseases that certain insects can serve as a vector for disease transmission.


Mosquito-Borne Diseases include: Zika Virus, Malaria, Dengue virus, West Nile virus, yellow fever, eastern equine and Japanese encephalitis virus, chikungunya virus


Flea Borne Diseases: Murine Typhus, tularemia, tungiasis, and, perhaps the most famous: the bubonic plaque


Bed bugs do not spread disease.


Biting Flies can transmit bartonellosis, leishmaniasis, and sandfly fever.


Midges can transmit diseases such as bluetongue virus to livestock.


Ticks transmit Lyme disease, babesiosis, Rocky Mountain spotted fever, ehrlichiosis, tularemia, and tick-borne relapsing fever.

 





What are the safest bug repellant options for kids?

To avoid most types of bug bites, it does help to use insect repellents when outdoors.  There are a variety of options ranging from chemical to more natural options.  


DEET is found in many commercial insect repellents and is overall considered safe.  


Many parents tell me they would still prefer a more natural option.  These include sprays that contain:

  • Citronella
  • Peppermint
  • Sandalwood 
  • Cedarwood 

For ticks and lice, it is worth considering routine checks when possible exposure may have occurred. Also, try to avoid wearing perfumes and colognes to avoid attracting bees.


I also find that parents can benefit from treating their outdoor spaces where kids frequent to minimize the volume of bugs when needed.  If you are planning an outdoor event it helps to get citronella candles, torches, or sprays that can be used.



 
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