6.9 & 6.11 Head Lice, Scabies, and Insect Bites & Stings
Head Lice and Scabies
Head Lice
Common in schools and daycare centers, peaking in the fall.
Spread through direct head-to-head contact.
Lice bite causes an itchy wheel or papule.
Eggs (nits) are laid in the hair, cemented to the hair shaft.
Empty eggshells remain in the hair, not always viable; schools' no-nit policies may not be therapeutically sound.
Live lice are identified by physically seeing bugs crawling around.
Nits are cemented to the hair shaft and hard to remove.
Black powdery specks on pillowcases or collars indicate lice feces.
Lice Life Cycle:
Eggs hatch in 7-10 days (average 8-9 days).
Hatchlings need to feed within 24 hours to survive.
Exclusions to Self-Care for Head Lice
Infestation in eyelashes or eyebrows (refer for petrolatum treatment).
Secondary infection (pus, purulent discharge, malodorous smell, fever – all require referral).
Pregnancy or breastfeeding (refer to a doctor).
Patients aged 2 to 24 months (recommend consulting a doctor).
Agents for Head Lice
Over-the-Counter (OTC) Agents
RID (pyrethrins): Kills live lice.
Apply to dry hair, leave on for 10 minutes, add water, lather, and rinse.
Comb through with a lice comb to remove nits.
Repeat treatment in 7-10 days (ideally day 9).
Contraindicated in patients with ragweed or chrysanthemum allergies (derived from chrysanthemums).
NYX (permethrin): Kills live lice and may have a residual effect.
Shampoo and towel dry hair before application, leaving hair damp.
Apply to hair, leave on for 10 minutes, and comb with a lice comb.
May need reapplication in 7-10 days if live lice are observed.
Avoid using conditioner because it rinses off the residue.
Labeled to avoid with ragweed allergy but has a lower risk.
SCLICE (ivermectin): Topical lotion.
Apply to dry hair, leave on for 10 minutes, and rinse with warm or tepid water.
Wait 24 hours before shampooing.
Reapplication is often unnecessary but combing is still recommended to see if there are dead bugs.
Prescription Agents
Spinisad (Natroba):
Apply to dry hair, leave on for 10 minutes, and rinse with warm water.
Has high ovicidal activity.
Shake well before use.
Malathion (Ovide):
Apply to dry hair, allow to air dry and cover; wash off after 8-10 hours.
Has high ovicidal activity, rarely needing retreatment.
Highly flammable due to alcohol content; avoid hair dryers, hair irons, smoking, and open flames.
Lindane:
Available in some states, use only when other agents have failed due to potential for seizures.
Not for patients under 110 pounds or infants.
Leave on for no more than 4 minutes.
Reapply only if live lice are seen.
Usage Considerations for all Agents
Only treat infested family members to avoid overuse and resistance.
Ensure the product remains on the hair for the full 10 minutes (or as directed).
If a mistake occurs, reapply the same day for the full duration.
Rinse hair over a sink with cool or tepid water to minimize contact with other body parts and reduce absorption.
Avoid contact with eyes and mucous membranes.
Treatment Failures
Resistance: If no dead lice are seen after use.
Improper Application: Not leaving the product on for the full 10 minutes.
If resistance is suspected, switch to a different product.
If there's resistance to RID, NYX will likely be ineffective due to chemical similarity.
Additional Options
Knit Combing: Regular combing every day for 2-3 days over several weeks can kill off lice.
Cetaphil: Suffocates lice by applying to hair, drying, and reapplying in 7-10 days.
Dimethicone (Nix Ultra): A silicone-based product that suffocates lice but is not an approved OTC treatment.
LouseBuster: A special device that is like a hairdryer for lice that requires a trainer.
Electric Zappers: No evidence they work.
Homeopathic products (e.g., Vamoose): Not recommended.
Non-Pharmacological Measures
Wash hair accessories in hot water for 10 minutes.
Wash clothing in hot water and a hot dryer.
Inspect all family members regularly.
Avoid close contact with affected individuals.
Use permethrin sprays on objects (not as room sprays).
Vacuum items that can't be washed.
Seal non-washable items in plastic bags for two weeks.
Scabies
Caused by mites that burrow under the skin.
Symptoms include intense itching (especially at night), papular rash with excoriation, and burrows.
Commonly affects interdigital web spaces, wrists, elbows, groin, and buttocks.
Face and neck are usually unaffected in adults.
Secondary infections may present as pustules or nodules.
Increased risk in overcrowded conditions (e.g., group homes, prisons).
Transmitted through body contact and fomites.
Female mites burrow, lay eggs, and cause allergic reactions to feces.
Mites can't live without a host for more than three days.
Agents for Scabies
Permethrin 5% Cream (Elimite): Main drug for treatment.
Apply from the neck to the toes to all visible skin at bedtime and wash off after 8-14 hours.
Repeat a second dose in one to two weeks automatically.
Dispense 30 grams per person (60-gram tube). 1 tube should be enough for one person unless they are excessively large.
Safe for infants greater than two months old; apply to head and neck in children under five.
Oral Ivermectin (Stromectol): Weight-based dosing.
Other Agents
Compounded Sulfur and Petrolatum: For newborns, pregnant, or lactating patients.
Crotamiton (Eurax): Alternative, but not first-line.
Lindane Lotion: No longer available.
Counseling for Scabies
Itching may persist for some time after treatment.
Use cool compresses, oatmeal baths, or oral antihistamines (hydroxyzine, diphenhydramine, doxylamine) for itch relief.
Avoid topical steroids.
Treat all household members and those with prolonged skin-to-skin contact within one month of
diagnosis, regardless of symptoms.Wash anything that has contacted the patient's body in hot water and a hot dryer or store them in a plastic bag for seven days.
Insect Bites and Stings
Insect Bites
The clinical presentation of a bug bite is a distinctive hive, also known as a wheel.
Fleas usually bite on the legs or ankles, resulting in small, several different bites in the same area, but still a hive.
Bed bug bites can look different for different people, but there might be like almost a slight dermal hemorrhage, like you might see like a blood spot on there, and they appear in clusters and areas towards your feet because that's where they congregate in the bed.
Usually with ticks, you actually see the tick embedded in your skin.
Chiggers usually form clusters of red papules and spider bites can be variable
When to Refer
Severe pain associated with spider bites.
Tissue damage from spider bites.
Systemic symptoms such as fever or dizziness.
Symptoms away from the bite area.
Bull's eye rash.
Tick embedded for more than 36-48 hours.
Systemic reactions such as fatigue, fever, or headache.
Secondary infection.
Infants.
Pharmacological Treatment
Local Anesthetics (benzocaine, lidocaine, dibucaine, benzyl alcohol): Numb the area.
Patients with allergies to benzocaine or lidocaine may be able to use promoxine or benzyl alcohol.
Topical Diphenhydramine: Effective for localized reactions, but not for atopic dermatitis or psoriasis.
Apply three to four times a day for no more than seven days.
Oral Antihistamines (diphenhydramine, hydroxyzine, cetirizine): Help with nighttime pruritus.
Camphor and Menthol: Counterirritants that bring focus to a cooling sensation to help forget about the itchiness.
Hydrocortisone: Helps with itch.
Protectants (Calamine): Protect the area from further irritation.
Non-Pharmacological Treatment
Wash the area after getting bit.
Use cool compresses or ice packs.
Avoiding scratching.
Avoiding Irritating clothing.
Insect Repellents
DEET: Releases vapors that discourage insects from approaching. Use more than 20%.
Reapply every 4-8 hours.
Apply sunscreen first, then insect repellent.
Apply only enough to cover exposed skin.
Do not use on broken skin
Apply the sunscreen first underneath the insect repellent
Insect stings
When to Refer
Hives with any of the followings excessive swelling, dizziness weakness, nausea, vomiting, difficulty breathing.
A severe reaction in the past from a bit or a sting.
Insects younger than two
A family history of a significant allergic reactions
Pharmacological Treatment
Oral analgesics
Non-Pharmacological Treatment
Remove the stinger with credit card and then apply ice.
Okay, I can create patient treatment plans based on the information in the note for managing head lice (pediculosis), scabies, and insect bites and stings.
Head Lice (Pediculosis) Treatment Plan
Confirm Diagnosis: Visually inspect the hair for live lice, not just nits.
Choose Appropriate Agent:
OTC Options:
RID (pyrethrins): For patients without chrysanthemum or ragweed allergies. Apply to dry hair, leave for 10 minutes, rinse, and comb out nits. Repeat in 7-10 days.
NYX (permethrin): Shampoo and towel dry hair, apply, leave for 10 minutes, rinse, and comb. Reapply in 7-10 days if needed. Avoid conditioner.
SCLICE (ivermectin): Apply to dry hair, leave for 10 minutes, rinse. Comb to check for dead lice. Reapplication may not be needed.
Prescription Options (if OTC fails or as directed by a healthcare provider):
Spinisad (Natroba): Apply to dry hair, leave for 10 minutes, rinse.
Malathion (Ovide): Apply to dry hair, air dry, wash off after 8-10 hours. (Flammable - caution advised!).
Lindane: Use only if other agents have failed and with caution due to seizure risk. Not for patients under 110 lbs or infants.
Application Instructions:
Ensure product covers all hair and scalp.
Leave product on for the full recommended time.
Rinse over a sink with cool or tepid water.
Avoid contact with eyes and mucous membranes.
Nit Removal:
Use a fine-toothed comb to remove nits.
Regular combing every 2-3 days for several weeks can help.
Environmental Control:
Wash hair accessories in hot water for 10 minutes.
Wash clothing and bedding in hot water and dry in a hot dryer.
Seal non-washable items in plastic bags for two weeks.
Follow-Up:
Inspect hair regularly.
Re-treat with the same or different agent in 7-10 days if live lice are seen.
Counseling:
Treat only infested family members.
Inform school or daycare.
Scabies Treatment Plan
Confirm Diagnosis: Identify burrows, papular rash, and intense itching (especially at night).
Choose Appropriate Agent:
First-Line: Permethrin 5% Cream (Elimite): Apply from the neck to the toes to all visible skin at bedtime and wash off after 8-14 hours. Repeat in 1-2 weeks.
Alternative: Oral Ivermectin (Stromectol): Weight-based dosing.
Special Populations: Compounded Sulfur and Petrolatum: For newborns, pregnant, or lactating patients.
Application Instructions:
Apply cream to all skin from neck to toes.
For infants under five, also apply to the head and neck.
Leave on for 8-14 hours.
Repeat treatment in one to two weeks.
Symptom Management:
Cool compresses or oatmeal baths for itch relief.
Oral antihistamines (hydroxyzine, diphenhydramine, doxylamine) for nighttime pruritus.
Avoid topical steroids.
Environmental Control:
Wash clothing, bedding, and towels in hot water and dry in a hot dryer, or store in a plastic bag for seven days.
Counseling:
Treat all household members and close contacts, regardless of symptoms.
Inform patients that itching may persist for some time after treatment.
Stress the importance of hygiene.
Insect Bites and Stings Treatment Plan
Assess Symptoms: Determine the type and severity of the reaction.
When to Refer:
Severe pain or tissue damage from spider bites.
Systemic symptoms (fever, dizziness).
Symptoms away from the bite area.
Bull's eye rash (Lyme disease).
Tick embedded for more than 36-48 hours.
Secondary infection.
Infants.
History of severe allergic reactions.
Pharmacological Treatment:
Local Anesthetics: benzocaine, lidocaine, dibucaine, benzyl alcohol to numb the area. Use promoxine or benzyl alcohol if allergic to benzocaine/lidocaine.
Topical Diphenhydramine: For localized reactions (not for atopic dermatitis or psoriasis). Apply three to four times a day for no more than seven days.
Oral Antihistamines: diphenhydramine, hydroxyzine, cetirizine for nighttime pruritus.
Camphor and Menthol: Counterirritants to relieve itching.
Hydrocortisone: For itch relief.
Protectants: Calamine to protect the area from further irritation.
Non-Pharmacological Treatment:
Wash the area after getting bit or stung.
Apply cool compresses or ice
Here are the typical presentations of head lice, scabies, insect bites, and stings:
Head Lice:
Itchy scalp is the most common symptom.
Presence of nits (eggs) attached to the hair shafts, close to the scalp.
Live lice are small, brownish insects that move quickly; difficult to spot.
Black powdery specks (lice feces) on pillowcases or collars may be present.
Scabies:
Intense itching, especially at night.
Papular rash with excoriations (scratch marks).
Presence of burrows (tiny, raised, grayish-white lines) in the skin.
Commonly affects interdigital web spaces, wrists, elbows, groin, and buttocks.
Insect Bites:
Distinctive hive (wheal) at the site of the bite.
Flea bites often appear as small, multiple bites in the same area, typically on legs or ankles.
Bed bug bites can vary in appearance, often with slight dermal hemorrhage (blood spots). They appear in clusters, usually near the feet.
Tick bites may show the tick embedded in the skin, or later a bull’s-eye rash (in the case of Lyme disease).
Chigger bites usually appear as clusters of red papules.
Insect Stings:
Immediate pain, redness, and swelling at the sting site.
A wheal (raised, itchy area) may form around the sting.
In some cases, hives, excessive swelling, dizziness, weakness, nausea, vomiting, or difficulty breathing may occur, indicating a severe allergic reaction.
Head Lice
OTC Agents
RID (pyrethrins): Apply and repeat in 7-10 days
NYX (permethrin): Apply and maybe reapply in 7-10 days if needed
SCLICE (ivermectin): Apply and combing is recommended
Prescription Agents
Spinisad (Natroba): Apply
Malathion (Ovide): Apply, wash off after 8-10 hours
Lindane: Reapply only if live lice are seen
Scabies
Permethrin 5% Cream (Elimite): Apply and Repeat a second dose in one to two weeks automatically
Oral Ivermectin (Stromectol): Weight-based dosing.
Compounded Sulfur and Petrolatum: Apply (For newborns, pregnant, or lactating patients)
Crotamiton (Eurax): Alternative, but not first-line.
Insect Bites and Stings
Local Anesthetics (benzocaine, lidocaine
Local Anesthetics (benzocaine, lidocaine, dibucaine, benzyl alcohol): Numb the area.
Patients with allergies to benzocaine or lidocaine may be able to use promoxine or benzyl alcohol.
Topical Diphenhydramine: Effective for localized reactions, but not for atopic dermatitis or psoriasis.
Apply three to four times a day for no more than seven days.
Oral Antihistamines (diphenhydramine, hydroxyzine, cetirizine): Help with nighttime pruritus.
Camphor and Menthol: Counterirritants that bring focus to a cooling sensation to help forget about the itchiness.
Hydrocortisone: Helps with itch.
Protectants (Calamine): Protect the area from further irritation.
Exclusions to Self-Care for Head Lice:
Infestation in eyelashes or eyebrows (refer for petrolatum treatment).
Secondary infection (pus, purulent discharge, malodorous smell, fever – all require referral).
Pregnancy or breastfeeding (refer to a doctor).
Patients aged 2 to 24 months (recommend consulting a doctor).
When to Refer for Insect Stings:
Hives with any of the followings excessive swelling, dizziness weakness, nausea, vomiting, difficulty breathing.
A severe reaction in the past from a bit or a sting.
Insects younger than two
A family history of a significant allergic reactions
When to Refer For Insect Bites
Severe pain associated with spider bites.
Tissue damage from spider bites.
Systemic symptoms such as fever or dizziness.
Symptoms away from the bite area.
Bull's eye rash.
Tick embedded for more than 36-48 hours.
Systemic reactions such as fatigue, fever, or headache.
Secondary infection.
Infants.
For head lice, OTC options that can be considered first-line are pyrethrins (RID) for patients without chrysanthemum or ragweed allergies, permethrin (NYX), or ivermectin (SCLICE). If OTC treatments fail, prescription options like spinosad (Natroba), malathion (Ovide), or lindane can be considered, though lindane should be reserved for cases where other agents have failed due to potential risks.
The first-line treatment for scabies is Permethrin 5% Cream (Elimite). Oral Ivermectin (Stromectol) may be considered as an alternative option. If other populations are present (ex. newborns, pregnant, or lactating patients), compounded sulfur and petrolatum can be considered and Crotamiton (Eur
For head lice, OTC options that can be considered first-line are pyrethrins (RID) for patients without chrysanthemum or ragweed allergies, permethrin (NYX), or ivermectin (SCLICE). If OTC treatments fail, prescription options like spinosad (Natroba), malathion (Ovide), or lindane can be considered, though lindane should be reserved for cases where other agents have failed due to potential risks.
The first-line treatment for scabies is Permethrin 5% Cream (Elimite). Oral Ivermectin (Stromectol) may be considered as an alternative option. If other populations are present (ex. newborns, pregnant, or lactating patients), compounded sulfur and petrolatum can be considered and Crotamiton (Eurax) can be considered as alternative options.
Several patient-specific parameters can impact the treatment plan for conditions like head lice, scabies, and insect bites/stings:
1. Location of the Condition:
Head Lice: If the infestation involves eyelashes or eyebrows, OTC treatments are contraindicated, and referral for petrolatum treatment is necessary.
Scabies: The location can guide application. For infants under five, permethrin should be applied to the head and neck as well.
2. Patient-Specific Requests/Preferences:
- Some patients may prefer OTC options due to ease of access, while others may seek prescription treatments for quicker results or due to previous treatment failures.
3. Age:
- Head Lice: Patients aged 2 to 24 months should be referred to a doctor.
- Scabies: Permethrin 5% cream is safe for infants older than two months. For newborns, compounded sulfur and petrolatum are preferred.
- Insect Stings: Infants should be referred to a doctor.
4. Pregnancy/Breastfeeding:
- Pregnant or breastfeeding women with head lice or scabies should be referred to a doctor for appropriate treatment options (e.g., compounded sulfur and petrolatum for scabies).
5. Allergies/Sensitivities:
- Head Lice: Patients with allergies to ragweed or chrysanthemum should avoid pyrethrins (RID). Though labeled to avoid with ragweed allergy, permethrin (NYX) is a lower risk.
- Patients with allergies to benzocaine or lidocaine may be able to use pramoxine or benzyl alcohol for insect bites.
6. Coexisting Conditions:
- For insect bites, topical diphenhydramine should be avoided in patients with atopic dermatitis or psoriasis.
7. Secondary Infections:
- The presence of secondary infections (pus, purulent discharge, malodorous smell, fever) requires referral for all three conditions.
8. Treatment Failures/Resistance:
- If resistance to initial treatments occurs, alternative medications should be considered. For example, if there's resistance to RID for head lice, NYX will likely be ineffective.
9. Cost of Medication:
- The cost of prescription versus OTC medications can significantly influence a patient's choice. Some patients may opt for more affordable OTC options initially, even if prescription treatments might be more effective.
10. Provider Preferences:
- Healthcare providers may have their preferred treatment approaches based on their clinical experience and familiarity with certain medications.
11. Systemic Symptoms or Severe Reactions:
- Such as systemic reactions (e.g., fatigue, fever, headache) from insect bites, or severe allergic reactions to insect stings, necessitate referral and possibly more aggressive treatment.
12. Tick Bites and Lyme Disease Risk:
- The risk of Lyme disease following a tick bite might influence the treatment approach, including possible prophylactic antibiotics.
Considering these parameters ensures a tailored, effective, and safe treatment plan that addresses the specific needs and circumstances of each patient.
Here are details on the appropriate use of pediculicides and scabicides, including application instructions, duration, and when repeat treatment is recommended:
Head Lice
OTC Agents
RID (pyrethrins): Apply to dry hair, leave on for 10 minutes, add water, lather, and rinse. Comb through with a lice comb to remove nits. Repeat treatment in 7-10 days (ideally day 9).
NYX (permethrin): Shampoo and towel dry hair before application, leaving hair damp. Apply to hair, leave on for 10 minutes, and comb with a lice comb. May need reapplication in 7-10 days if live lice are observed. Avoid using conditioner because it rinses off the residue.
SCLICE (ivermectin): Apply to dry hair, leave on for 10 minutes, and rinse with warm or tepid water. Wait 24 hours before shampooing. Reapplication is often unnecessary but combing is still recommended to see if there are dead bugs.
Prescription Agents
Spinisad (Natroba): Apply to dry hair, leave on for 10 minutes, and rinse with warm water. Shake well before use.
Malathion (Ovide): Apply to dry hair, allow to air dry and cover; wash off after 8-10 hours. Highly flammable due to alcohol content; avoid hair dryers, hair irons, smoking, and open flames.
Lindane: Leave on for no more than 4 minutes. Reapply only if live lice are seen. Use only when other agents have failed due to potential for seizures. Not for patients under 110 pounds or infants.
Usage Considerations for all Agents
Ensure the product remains on the hair for the full 10 minutes (or as directed). If a mistake occurs, reapply the same day for the full duration. Rinse hair over a sink with cool or tepid water to minimize contact with other body parts and reduce absorption. Avoid contact with eyes and mucous membranes.
Treatment Failures: Resistance is suspected if no dead lice are seen after use or improper application (not leaving the product on for the full 10 minutes). If resistance is suspected, switch to a different product. If there's resistance to RID, NYX will likely be ineffective due to chemical similarity.
Scabies
Permethrin 5% Cream (Elimite): Apply from the neck to the toes to all visible skin at bedtime and wash off after 8-14 hours. Repeat a second dose in one to two weeks automatically.
Oral Ivermectin (Stromectol): Weight-based dosing.
Compounded Sulfur and Petrolatum: For newborns, pregnant, or lactating patients.
Crotamiton (Eurax): Alternative, but not first-line.
Counseling for Scabies
Itching may persist for some time after treatment. Treat all household members and those with prolonged skin-to-skin contact within one month of diagnosis, regardless of symptoms. Wash anything that has contacted the patient's body in hot water and a hot dryer or store them in a plastic bag for seven days.
Here are some counseling points for medications used to treat head lice, scabies, and insect bites/stings:
Head Lice
Treat only infested family members to avoid overuse and resistance.
Ensure the product remains on the hair for the full 10 minutes (or as directed).
If a mistake occurs, reapply the same day for the full duration.
Rinse hair over a sink with cool or tepid water to minimize contact with other body parts and reduce absorption.
Avoid contact with eyes and mucous membranes.
If resistance is suspected (no dead lice are seen after use), switch to a different product. Note that if there's resistance to RID, NYX will likely be ineffective due to chemical similarity.
Wash hair accessories in hot water for 10 minutes and clothing in hot water and a hot dryer.
Inspect all family members regularly and avoid close contact with affected individuals.
Scabies
Itching may persist for some time after treatment.
Use cool compresses, oatmeal baths, or oral antihistamines (hydroxyzine, diphenhydramine, doxylamine) for itch relief; avoid topical steroids.
Treat all household members and those with prolonged skin-to-skin contact within one month of diagnosis, regardless of symptoms.
Wash anything that has contacted the patient's body in hot water and a hot dryer or store them in a plastic bag for seven days.
Insect Bites
Local Anesthetics (benzocaine, lidocaine, dibucaine, benzyl alcohol): Numb the area. Patients with allergies to benzocaine or lidocaine may use promoxine or benzyl alcohol.
Topical Diphenhydramine: Effective for localized reactions, but not for atopic dermatitis or psoriasis; apply three to four times a day for no more than seven days.
Oral Antihistamines (diphenhydramine, hydroxyzine, cetirizine): Help with nighttime pruritus.
Camphor and Menthol: Counterirritants that bring focus to a cooling sensation to help forget about the itchiness.
Hydrocortisone: Helps with itch.
Protectants (Calamine): Protect the area from further irritation.
Non-Pharmacological Treatment: Wash the area after getting bit, use cool compresses or ice packs, avoid scratching, and avoid irritating clothing.
Insect Stings
Remove the stinger with a credit card and then apply ice.
Seek immediate medical attention if there are signs of a severe allergic reaction, such as hives with excessive swelling, dizziness, weakness, nausea, vomiting, or difficulty breathing.
Treatment Failures:
Resistance is suspected if no dead lice are seen after use or improper application (not leaving the product on for the full 10 minutes).
If resistance is suspected, switch to a different product.
If there's resistance to RID, NYX will likely be ineffective due to chemical similarity.
Additional Options:
Knit Combing: Regular combing every day for 2-3 days over several weeks can kill off lice.
Cetaphil: Suffocates lice by applying to hair, drying, and reapplying in 7-10 days.
Dimethicone (Nix Ultra): A silicone-based product that suffocates lice but is not an approved OTC treatment.
LouseBuster: A
LouseBuster: A special device that is like a hairdryer for lice that requires a trainer.
Non-Pharmacological Measures for Head Lice
Wash hair accessories in hot water for 10 minutes.
Wash clothing in hot water and a hot dryer.
Inspect all family members regularly.
Avoid close contact with affected individuals.
Use permethrin sprays on objects (not as room sprays).
Vacuum items that can't be washed.
Seal non-washable items in plastic bags for two weeks.
Non-Pharmacological Measures for Scabies
Wash anything that has contacted the patient's body in hot water and a hot dryer or store them in a plastic bag for seven days.
Non-Pharmacological Measures for Insect Bites
Wash the area after getting bit.
Use cool compresses or ice packs.
Avoid scratching.
Avoid Irritating clothing.
Non-Pharmacological Measures for Insect Stings
Remove the stinger with credit card and then apply ice.
Pharmacological Treatment:
Local Anesthetics (benzocaine, lidocaine, dibucaine, benzyl alcohol): Numb the area.
Patients with allergies to benzocaine or lidocaine may be able to use promoxine or benzyl alcohol.
Topical Diphenhydramine: Effective for localized reactions, but not for atopic dermatitis or psoriasis.
Apply three to four times a day for no more than seven days.
Oral Antihistamines (diphenhydramine, hydroxyzine,
Oral Antihistamines (diphenhydramine, hydroxyzine, cetirizine): Help with nighttime pruritus.
DEET: Releases vapors that discourage insects from approaching. Use more than 20%.
Reapply every 4-8 hours.
Apply sunscreen first, then insect repellent.
Apply only enough to cover exposed skin.
Do not use on broken skin
Apply the sunscreen first underneath the insect repellent