Approach

Bed bug bites are usually self-limiting and resolve within 1-2 weeks without treatment, so long as the household infestation is eradicated.[2][3][12]​​​​ Symptomatic relief is the main goal of treatment. Eradication and preventative measures, including environmental cleaning (e.g., laundering clothing and bedding, vacuuming furniture, examination of mattresses), should be instituted once a diagnosis of bed bug infestation has been made.[3][7]​​[12][30]​ Several bed bug monitors have been developed, which can aid in detecting light bed bug infestations.[2][31] However, professional extermination is usually necessary in infestations.​[2][3][7]​​​​[16][32]​​

Symptomatic treatment

Initial therapy consists of oral antihistamines and antipruritic agents for mild cases. Oral antihistamines (e.g., hydroxyzine) minimise pruritus, but do not change the duration or appearance of rash.[6][12][33] The antipruritic effect is primarily mediated through their sedative effect. Topical antipruritics (e.g., pramocaine/camphor/calamine ointment or doxepin cream) provide symptomatic relief.

In patients with more significant discomfort, the use of low- to mid-potency topical corticosteroids may hasten rash resolution and decrease pruritus.[6][12] Agents include triamcinolone or hydrocortisone. Topical corticosteroids should generally be used for no longer than 2 weeks. In patients with more severe/widespread reactions (e.g., diffuse cutaneous eruption with disabling pruritus), a short course of oral corticosteroids should be considered. Adrenaline is used only in patients with anaphylaxis.

Secondary infection

Due to disruption of the skin barrier from inflammation and scratching, skin may be secondarily infected with staphylococci (usually Staphylococcus aureus) or streptococci (usually Streptococcus pyogenes).[5]​ Treatment with oral antibiotics or topical antimicrobials is effective.

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