Bed bugs: Diagnosis and treatment

How do you know if you have bed bugs?

To find out if you have bed bugs, you need to look for two things:

1. Bites on your body

2. Signs of bed bugs

Bites on your body: If you have bed bugs, you’re likely to have bites. Bed bug bites usually cause itchy welts. These welts usually appear in a zigzag pattern as show in the photo below.

Bed bug bites

When bedbugs bite, you often see clusters of bites. Each cluster usually contains 3 to 5 bites that appear in a zigzag pattern.

You’ll seldom see bed bugs, so many people mistakenly believe that mosquitoes, fleas, or spiders bit them. Sometimes people mistake bed bug bites for a common skin condition such as an itchy rash, hives, or chickenpox.

To make sure you have bed bugs, you’ll need to look for signs of bed bugs.

How to check for bed bugs

Although bed bugs don’t usually require serious medical attention, they can cause a great deal of anxiety and restless nights. To help find bed bugs before they find you (and your belongings), dermatologists recommend looking for the following signs near places where you sleep.

Signs of bed bugs: This step is important. If you have a bed bug infestation, you need to find out so that you can get rid of the bed bugs. Getting rid of the bed bugs is the only way to stop the bites.

If you have a large number of bed bugs, you may see the bugs. Most people, however, only see signs of bed bugs. To look for signs of bed bugs, check the places that people sleep for the following:

• A sweet, musty odor. Take a deep breath. If you notice a sweet, musty in your hotel room, cruise-ship cabin, or other sleeping area, there may be a heavy bed bug infestation in the room. Bed bugs produce chemicals to help them communicate, although not everyone will notice the smell.

• Specks of blood on bedding, mattresses, or upholstered furniture such as couches and headboards. Look carefully at your blankets, sheets, and mattress pads and then check the mattress and box spring. Are there specks of blood anywhere, especially near the seams? If so, there could be a bed bug infestation. You should also check for specks of blood on all upholstered furniture, including couches and headboards.

• Exoskeletons. Bed bugs have an outer shell that they shed and leave behind. Do you see shell-like remains on the mattress, mattress pad, or beneath couch cushions?

• Tiny, blackish specks. If you see blackish specks on the bedding, mattress, headboard, or beneath couch cushions, it could be bed bug excrement.

• Eggs. After mating, female bed bugs lay white, oval eggs in cracks and crevices. Keep in mind that these will be small, as a bed bug is only about the size of an apple seed. The photo below shows a bed bug near eggs. The photo was magnified so that you can see the bed bug and eggs.

If you do get bed bugs and have many bites or a bite that looks infected, see a board-certified dermatologist. A dermatologist can treat an infection and help relieve the itch.

Bed bug with eggs

A bed bug is a tiny insect with a broad, oval body. If it has recently eaten, it has a reddish-brown color.

If you see bed bugs, they will likely scurry toward the closest hiding place. Any dark place such as inside a mattress or even a picture frame makes a good hiding place.

As you watch bed bugs move, it can look like they are flying or jumping because they can crawl quickly. Bed bugs cannot fly or jump; they can only crawl.

If you find signs of bed bugs, call a pest-control company or your property manager. You should not use bug spray or a fogger. These products have little effect on bed bugs.

Treating bed bug bites

You should see a dermatologist for treatment if you have:

• Many bites

• Blisters

• Skin infection (bites feel tender or ooze discharge, such as pus)

• An allergic skin reaction (skin red and swollen or hives)

Your dermatologist may prescribe the following to treat bed bug bites:

• Allergic reaction. Some people may require an injection of an antihistamine, corticosteroid, or epinephrine (adrenaline) for a severe allergic reaction.

• Infection. An infection may require an antibiotic. If the infection is mild, your dermatologist may recommend an antiseptic medication that you can buy without a prescription. Your dermatologist will tell you which one to use. Your dermatologist also may recommend an antiseptic to prevent a skin infection.

• Itch. A prescription antihistamine pill or liquid can help. You also can apply a corticosteroid to the bites. Your dermatologist will tell you which is best for you.

At-home treatment

If you do not have any signs of an infection or a serious reaction, you can often treat the bites at home.

To treat bed bug bites:

• Wash the bites with soap and water. This will help prevent a skin infection and help reduce itchiness.

• If the bites itch, apply a corticosteroid cream to the bites. You can get a weak form of this medicine without a prescription at your local drugstore. Stronger corticosteroids require a prescription.

Bed bug bites usually heal and go away within a week or two.

Image
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References
Leverkus M et al. “Bullous Allergic Hypersensitivity to Bed bug Bites Mediated by IgE against Salivary Nitrophorin." J of Invest Dermatol. 2006;126:2364-2366.

Liebold K et al. “Disseminated bullous eruption with systemic reaction caused by Cimex lectularius.” J Euro Acad of Dermat and Vener. 2003;17:461-463.

Steen CJ, Carbonaro PA, Schwartz RA. “Arthropods in dermatology.” J Am Acad Dermatol 2004; 50:819-42.