There is very little evidence-based information about the treatment of bed bug bites. Therefore, bed bug bites are generally treated symptomatically (Table 1). Pruritic lesions can be treated with topical nonprescription and prescription antipruritic agents. Topical antipruritic agents that may provide relief include emollients, cooling agents (e.g., camphor, menthol), anesthetics (e.g., pramoxine), corticosteroids (e.g., triamcinolone), and antihistamines (e.g., diphenhydramine). The use of topical antihistamines is generally limited due to the potential for allergic contact dermatitis. Oral antihistamines such as diphenhydramine and oral corticosteroids have also been used to treat the bites.
A case series of 17 patients determined that topical corticosteroids reduced the duration of lesions and provided itch relief. The case series also determined that oral antihistamines helped relieve itch but did not reduce the duration of the lesions. More severe reactions have been treated using high-dose oral corticosteroids (prednisone 40–60 mg). However, the case series reported poor response to prednisone 40 to 60 mg daily.
Patients should be advised not to scratch the bites. Scratching the bites will lead to inflammation and excitation of C-nerve fibers, which will result in more itching and scratching and potentially a secondary skin infection. If a secondary skin infection does occur, it can be treated with topical antibiotics such as mupirocin. Systemic antibiotics may be necessary in more severe cases. In the rare instance of an anaphylactic reaction, treatment is similar to other types of insect-induced anaphylaxis using agents such as intramuscular epinephrine, antihistamines, and corticosteroids. Patients who experience severe reactions to the bites should consider keeping an epinephrine pen on hand.
US Pharmacist. 2012;37(8):47-50. © 2012 Jobson Publishing