Creepy Crawlers!


Summer is here and with warmer weather comes creepy crawlers! Protect yourself and your family by knowing what to look for to prevent bug bites and how to treat it if you do get a bite.

Common Summer Bugs

Bed Bugs:

  • Blood-sucking human parasite found worldwide
  • Oval shaped, flat, reddish brown, and up to 5 mm long
  • Bed bugs are attracted by warmth and generally feed at night. They can survive for long periods (e.g. up to one year) without feeding
  • Often hide in the cracks and crevices of mattresses, bed frames, and other nearby structures
  • Can travel in furniture, luggage, and clothing, or can migrate through holes in walls, water pipes, or gutters
  • Bite in a linear pattern (a line) on exposed areas of skin such as the face, neck, hand, and arms
  • Most patients do not experience a reaction to a bed bug bite, and the only evidence is a tiny punctum (hole) at the site of the bite. When a reaction occurs, the lesions are most commonly 2 to 5 mm red, itchy bumps. If they are not scratched they usually resolve in a week or so
  • Hire a licensed professional pesticide applicator with experience in treating bed bugs

Venomous Insects (Stingers):

  • A sting is usually an attack by a venomous insect that injects toxic and painful venom through its stinger as a defense mechanism
  • Bees, wasps, hornets, yellow jackets, and fire ants
  • Hypersensitivity reactions to bee and wasp stings may result in localized swelling or anaphylaxis and precipitate discoid eczema or vasculitis
  • Secondary infection may result in impetigo or cellulitis

Venomous Spider Bites:

  • Black widow (North America), Red-back (Australia), Shoe-button (South Africa), Violin spiders, Recluse spiders, Brown recluse spiders, Fiddleback spiders
  • The venom produced by spider bites is generally either neurotoxic or cytotoxic
  • Features of neurotoxic venom bites: severe pain in the chest and abdomen (cramp-like pains), breathing difficulties, heart palpitations, nausea and vomiting, Sweating, fever, excessive salivation, increased blood pressure, rash may develop
  • Symptoms usually start about 1-3 hours after being bitten
  • Features of cytotoxic venom bites: Affects cellular tissue and is usually restricted to the area of the bite, initial bite is painless but symptoms develop about 2–8 hours later, the area becomes painful and swollen, blister may form over a necrotic lesion which then sloughs to create an ulcerated wound (up to 10cm), the ulcer will heal over months and leave behind a scar. In extreme cases, skin grafts may be necessary

Non-Venomous Insect Bites:

  • Non-venomous insects pierce the skin to feed on blood
  • Results in intense itching
  • Mosquitos, fleas, ticks, bed bugs, louse, and scabies
  • Local reaction is the most common presentation following an ant bite/sting. It consists of localized pain, itch, redness, swelling, and induration
  • Swelling is usually less than 5 cm in diameter and is sometimes urticarial
    (wealing/hives). A local reaction lasts for less than 24 hours


  • Insect bite reactions are a response to irritating salivary secretions injected by the female
    mosquito to anticoagulate the blood
  • Males mosquitoes are harmless as they do not have piercing mouthparts
  • Bites may appear urticarial (hive-like), bumpy or eczematous
  • Malaria is caused by Anopheles mosquitoes
  • West Nile fever and Dengue fever are caused by Aedes mosquito


  • Blood-sucking parasites
  • Tick-borne diseases include: Lyme disease, relapsing fever, tularemia, and babesiosis, Rocky Mountain spotted fever, ehrlichiosis and anaplasmosis, and Q fever 
  • 0.5–2 cm red areas, papules (small bumps), or thin plaques may form at the site of attachment within 1 to 3 days. The lesion may feel hard and may be surrounded by redness. Mild swelling or blister formation can occur. The bite can be mild to severely itchy
  • Ticks still attached to the skin should be physically removed. Equipment necessary for tick removal includes gloves, isopropyl alcohol or other skin disinfectant, and fine-toothed forceps

Management for Bug Bites May Include

  • Oral antihistamines for itch and hives (Zyrtec or Claritin)
  • NSAIDS if painful
  • Topical steroids for itchiness and quicker resolution
  • Education for insect avoidance: remove visible ant nests, avoid walking barefoot
  • Wear work gloves when gardening
  • Avoid areas such as forests or fields where ticks are found
  • Use insect repellent containing DEET on the skin, and permethrin on the clothes
  • Wear long-sleeved clothing that fits tightly around the wrists, waist, and ankles
  • Check twice daily for attached ticks and remove them immediately
  • Dry clothing at high heat in a tumble dryer

- Carly Chandler, PA-C