Insect Bites

Mosquitos

found in humid or warm climates

• can transmit malaria or West nile virus

Fleas

bites are usually multiple and grouped, occurs on the legs or ankles with intense itching

Bedbugs

usually hide and deposit eggs into crevices of walls, floors, beddings, and furniture

• become active at night

• irritation at site of bite

• dermal hemorrhage

• multiple bites in a line

Ticks

feed on the blood of humans and animals, holds on firmly to the host and can be removed by fine tweezers

• can transmit diseases (Rocky mountain fever and Lyme disease)

• Bullseye rash

Chiggers

Lives in shrubbery, trees, grass

• multiple bites that cause intense itching

Spiders

single bite with two fang marks

(refer if black widow or brown recluse spider bites)

Scabies

“the itch”, contagious parasitic skin infection that causes inflammation and intense itching

• refer these paitents

Non-pharm treatment

Repellents: (prevention of bites, not stings)

• Contains DEET

• apply no more than every 4 to 8 hours

• Can be used by 2 months or older with below 10% DEET

• High the concentration the longer they protect not the better they work

Works: doesn’t kill insects, but the repellent releases vapors that discourage the approach of insects

Adverse effects: skin irritation, toxic if digested

Examples: Cutter Backwoods, Off insect repellent, repel ultra roll on

Exclusions to OTC for insect bites

• scabies

• confined site

• patients younger than 2

• signs of infections (fever, yellow/green pus, worsening of bite area)

Bee sting

Fire ants

intense itching and burning

Non-Pharm for stinging insects

• avoid perfumes, scented lotions, bright colors

• control odors in picnic or garbage areas

• destroy nests near home

• remove stinger and apply ice pack

OTC devices:

• Bug bite thing insect bite + sting suction tool

• tick remover tweezers

Allergic reaction to stings symptoms/treatment

seek medical care of use Epipen

• hives, excessive swelling, dizziness, N/V, difficulty treating

Pharm treatments to bites and stings

• local anesthetics

• topical antihistamines

• counterirritants

• hydrocortisone

Local anesthetics for bites and stings

relieves itching and irritation of area

• approved for burns, sunburns, minor cuts, insect bites, and minor skin irritation

• Apply 3-4 times daily for no longer than 7 days

Works: reversible blockade of conduction of nerve impulses at the site of application, loss of sensation

Adverse effects: Contact dermatitis

Ex) benzocaine, pramoxine, benzyl alcohol, lidocaine, dibucaine, and phenol

Topical antihistamines for insect bites or stings

Diphenhydramine hydrochloride 0.5% to 2%

• apply 3 to 4 times daily no longer than 7 days

• approved for: minor burns, sunburns, insect bites, poison oak, ivy and sumac

• causes no systematic side effects (unless used over large areas in children)

• Have to be 2 years or older

• oral diphenhydramine can also be used to treat itching of bites even though not labeled indication

Works: exerts an anesthetic effect by depressing cutaneous receptors thereby relieving pain and itching

Counterirritants for bug bites and stings

camphor 0.1% to 3%, menthol 0.1% to 1%

• apply 3-4 times daily for no more than 7 days

• do not ingest

Works: depresses cutaneous receptors and exerts an analgesic effect

Hydrocortisone

reduces inflammation and relieves pain and itching

• Apply 3-4 times daily, no more than 7 days

• approved for minor skin irritations, itching, rashes from dermatitis, insect bites, poison ivy/oak/sumac, and cosmetics

Refer: if patient has fungal or bacterial infections

Pediculosis

lice

Head lice

• lice require frequent blood feedings

• grip hair shafts

• do not jump or fly

• nits= lice eggs

Pubic lice

transmitted through sexual contact, toilet seats, shared undergarments, or bedding

body lice

• hygiene related

• live, hide, lay their eggs in clothes, attack body areas for blood feedings

Non-pharm treatment for lice

• inspect hair, after proof use lice comb

• wash hair bushes, clothes, bedding, towels in hot water

• Objects that cant be washed place in a garbage bag for 2-4 weeks

• don’t share combs, brushes, towels or hats

Nic and Rid - home lice control spray

Synergized pyrethrins (RID)

comes from chrysanthemum flowers

• treats head and pubic lice

• Available in shapoos, foams, solutions, and gels

• Repeat treatment in 7 to 10 days

• 2 years or older

Works: blocks nerve impulse transmission, causing paralysis and death of lice

Adverse effects: irritation, itching, and swelling

Avoid if allergic to ragweed or chrysanthemums

Permethrin (Nix)

• use for head lice only

• retreatment in 7 to 10 days is not recommended

• 2 months or older

• High resistance to RID or Nix due to overuse, improper use, or insufficient contact time

Works: disrupts the sodium channel, delaying repolarization and causing paralysis of the parasite

Adverse effects: itching, burning, and irritation

Elimite (permethrin) - prescription can treat scabies

Ivermectin lotion 0.5% (sklice)

• treats head lice

• ages 6 months or older

Prevention of lice

lice shield

• repels lice, doesn’t kill lice or eggs

• decreases chances of lice by 80%

• contains (citronella, lemongrass, eucalyptus)

• use during the duration of ice bath