Insect Bites and Stings - DERMBOARD

What is the difference between bug bites and bug stings?

Bites are simply insertion of a part of the insect into your skin to feed on your blood, while stings are injection of the insect venom (poison) into your skin. Bites may become apparent within few minutes to hours in the form of an itchy bump with central small red dot, while stings are immediately noticeable in the form of stinging pain and red bump, usually with a central red dot and skin swelling.

Should I see my health care provider for insect bites and stings?

In the vast majority of cases reactions are mild in the form of one or several itchy bumps. However, if you develop any of the following: overall feeling of being sick, lightheadedness, feeling of passing out, difficulty breathing, weakness, dizziness, nausea, vomiting, lip or tongue swelling, swelling in areas away from the bite (hands, feet, face), hoarseness, sudden itching or rash everywhere you should immediately call emergency services (911 in the US), and/or seek help from people around you. Under no circumstance you should drive yourself to the emergency room, because you are risking a car accident, plus it will likely take longer to get the needed help. If the sting or bite has occurred in your mouth, you should also immediately seek help from anyone around you, without waiting for any of the above-mentioned signs and symptoms. This happened to my relative at the community swimming pool, when a bee quietly entered her can of soda. The bee stung her in her mouth. She immediately informed people around her, who called 911, which had saved her life.

There are many long-term issues with insect bites and stings such as Lyme disease and Lyme disease-like illnesses (ticks), West Nile encephalitis (mosquitoes), leishmaniasis (sandflies) etc. Therefore you should always report any recent bites or stings, if you happened to see your health care provider for some seemingly unrelated illness.

In addition, a very brisk and out of proportion local skin reaction including blisters and ulcers to common insect bites such as mosquitoes may be a sign of some underlying disorder of your immune system. Those disorders include leukemia (cancer of the blood), and AIDS (acquired immunodeficiency syndrome) among others, and therefore such severe and localized skin reactions should also be reported to your health care provider.

How can I treat bug bites and stings?

For life-threatening reactions, or bites and stings in the mouth, you should call emergency services immediately and seek help from anyone around you as described above. For reactions limited to the skin only follow the advice below. For most bites and stings no treatment is needed, except for washing the bite site with soap and water, as well as prompt removal of any possible insect part from the skin. But if the bite or sting is really bothersome, you can first try an ice pack, over-the-counter lotions such as Sarna Sensitive that contains numbing medicine pramoxine and /or hydrocortisone 1% ointment or cream (brand name Cortizone-10). If creams and lotions do not help, then try diphenhydramine pill (brand name Benadryl), cetirizine pill (brand name Zyrtec) or loratadine pill (brand name Claritin). For all over-the-counter medicines please follow manufacturers instructions and warnings on the package. I need to mention that some pills (e.g. Benadryl) may make you sleepy and drowsy, which may impair your judgment and capabilities to drive or operate machinery.

How can I prevent bug bites and stings?

It is important to mention that the best treatment is the prevention, so use bug sprays or lotions (insect repellents), wear long white socks (so that crawling bugs are easier to spot), white loose shirts with long sleeves etc. Light colored clothing may reduce chance of being stung. Also, if eating and drinking outside, cover all food and drink containers (see the story of my relative above), and clean all the spills immediately. Do not try to remove or poison any stinging insect nests yourself, leave that to the professionals.

How can my health care provider help me?

For life-threatening reactions, or bites and stings in the mouth, you should immediately call emergency services and seek help from anyone around you as described above. For reactions limited to the skin only, if none of the over-the-counter medicines are helping, then we prescribe triamcinolone acetonide 0.1% ointment, or for more severe skin reactions clobetasol 0.05% ointment for a week or two.

Life-threatening reactions should be treated as soon as possible with injection of epinephrine (medication that immediately increases blood pressure and heartbeat and therefore fights shock). If you have survived such severe reaction, you should be seen by an allergist as soon as possible, and you should be provided with an epinephrine autoinjector for self-treatment to carry it at all times with you. After you had to use epinephrine autoinjector you should still immediately call emergency services (911 in the US), and/or seek help from people around you. This is necessary because after the short initial improvement, the allergic reaction may come back. In addition you may be a candidate for “allergy shots†also known as immunotherapy. The goal of “allergy shots†is to make you less sensitive to insect venom. The “allergy shots†given at an allergist office may be continued for several years or in some cases the entire life.

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