Bug Bites: What Matters and What Doesn’t

I just got off the phone with one of my absolute favorite gal pals and she described what sounded like a possible new world record set for bug bites this season: both in number and size. Giant, red, itchy blotches covering skin on exposed extremities as well as along the waistline and back, too.

This echoes exactly what I’ve been seeing in my clinical practice this summer: people bringing their children in not only for concern about ticks and Lyme disease but also for dramatic skin reactions to insect bites and fears about allergies, poisonous spiders, and even insect repellents. And I’m not even talking about the bites that got infected. Have you noticed a lot of bug bites on your kids as well?

It seems that some mythbusting is in order.

Myth: An inflamed bug bite is an allergic reaction

Let me start by saying that while some people seem to react more strongly to bug bites than others, this does NOT always mean that they are “allergic” to mosquitoes or other insects.  A very common misperception is that if you get a big red reaction around the bite then you must have an allergy, and this just isn’t the case. You may get an impressive inflammatory response to the bite, but unless you break out in hives and get eye and/or lip swelling and wheezing or symptoms which are typical of allergic reaction, it’s probably not an allergy.

There’s some voodoo that exists around the look of the bite as well, and the reality is that many insect bites look awfully similar. Pink or red bumps. So how do you tell them apart? It can be hard to distinguish a mosquito bite from an ant bite sometimes. One thing I find useful is considering whether or not there are single bites (can be several in various places) or whether there are crops of bites all clustered together. Single bites are more typical of mosquitos or bee stings where as crops of bites are more typical of fleas or ants.

Ok so now we have 2 categories: single bites and clusters of bites. Let’s further distinguish these.

Single bites- bee stings are typically associated with more localized swelling in a large area of the soft tissue around the bite than mosquitos, which tend to be only swollen around the red bite itself (although some are larger than others).

Crops of bites- flea bites are tiny and very itchy; ant bites are larger and are often only mildly itchy.

At the end of the day though, does it matter? Unless there’s an allergic reaction going on (see above), it probably doesn’t. The treatment is simply supportive care and symptom management. Keeping the area clean, maybe some anti-itch cream, and leaving it alone. That’s it.

Myth: All spider bites are life-threatening

Most people assume that all spider bites (I know- spiders are arachnids, not insects) are from a very dangerous spider such as the brown recluse or black widow, but in fact those spiders are, in general, localized to very specific places in the United States. Brown recluse spiders are found in nature in the southern midwest and black widows are found throughout the US. When they are located elsewhere, it’s usually because they are stowaways: in wood pallets and other construction materials most commonly. That being said, other spiders do bite, and the bites tend to be red and angry, often rapidly turning into a single ulcer on the skin. No magic treatment for this either, but in many cases these bites need to be treated like real wounds with dressing changes and very close observation for signs of infection.

Myth: A red tick bite means it’s Lyme disease

I’ve written about ticks elsewhere so I’ll just refer you to that blog for more information, but the hallmark look of that bite is of course the target or bull’s eye lesion of Lyme Disease. It’s important to note, however, that tick bites can just look like red bumps, similar to mosquito bites. Annoying at best. Be vigilant about nightly tick checks.

Any of these bites can get infected. And when that happens, the redness and discomfort increase, and frequently there are red streaks tracking up the skin away from the bite. Sometimes there’s some cloudy drainage, and if left alone, fever and systemic illness can result. This needs to an urgent medical evaluation. But it’s a myth that ALL red bites are infected somehow. As was the case with the allergic reaction paragraph above, sometimes the bites are simply inflamed.

Myth: DEET is toxic and dangerous

A lot of people think that insect repellent that contains DEET is toxic and dangerous, too. Another myth. Repellents that contain up to 30% DEET are safe and effective, down to the age of 2 months. Picaridin is another ingredient that has been shown to be effective in preventing some bites. An important message here is making sure that you don’t combine sunscreen and insect repellent because combination formulations are made, but because sunscreen must be reapplied every 2 hours and insect repellent less frequently, it’s better to use single agents rather than the combined products. Some people like products with citronella and lemon-eucalyptus, and while those are safe for kids they haven’t been proven to work like DEET and picaridin.

If I could send you away with any take-home points from this bug-busting, myth-busting blog entry it would be these:

1. In most cases and in the absence of a specific allergy, identification of the bug that generates the bug bite is less important than the body’s response to the bite and whether or not it gets infected.
2. Even an impressively large red bump around a single bite (or several) is usually NOT indicative of an allergic reaction.
3. Prevention is really the best proactive measure. If you know you and your kids will be outside and near wooded areas, wear long sleeved shirts and long pants and use insect repellent. Then when everyone comes inside, do a thorough skin check to make sure there are no ticks embedded and any visible bites can be washed with soap and water to keep them clean.

I’ll close by saying that I’m not trying to minimize the annoyance and discomfort of bug bites of any type, and that true allergy to stings is serious business as are skin infections. As a physician I’m always happy to take a look and rule in or out any disease process that might require an intervention- it’s what doctors are here for, so don’t hesitate to look us up! 😉