Summer is here and one of the ways that I know this is when I start seeing patients coming in with discrete red bumps in various areas but mostly the legs and arms consistent with bug bites. The funny thing is that while most people are aware that the bumps they have are bug bites, about 10% of patients swear to me that this is not possible. When I ask them why they say that, they say, “Well, that’s because I have never seen a bug inside my house and that’s when I notice the bumps!”
While that may be true, I then explain that the bites are probably not happening when you notice them; rather, it takes a few hours to a day to develop the bump that you are now noticing from getting bitten.
It always helps to reassure patients about bug bites since most cases will self-resolve and don’t need any treatment except topical steroids, ice and perhaps some over the counter Benadryl. Some cases can present with secondary infection because of scratching, however, which is one of the reasons that we recommend not to scratch at bug bites, despite how itchy they are. In rare cases, though, there may be a patient who is allergic enough to the bites themselves to need treatment with stronger medicines.
So, what can we do to prevent bug bites?
Of course, there are many types of bugs that like to bite humans. I will focus on mosquito bites since that is the most common type of insect bite seen in the summer.
If you want to avoid getting bitten, it is important to wear long sleeves and long pants when you are most likely to get bitten (e.g. during dusk, or when hiking or camping). Clothing, although not guaranteed to work, is a deterrent and can help prevent bites. Also, it is imperative to avoid being out around dusk, when mosquitoes are most active. If you cannot avoid this, you may consider using an over the counter insect repellent, natural or DEET based. I have heard various other ideas such as taking niacin, eating garlic, or avoiding sugar, but none of this has any scientific basis. The last simple recommendation in terms of preventing mosquito bites is to always make sure that you do not leave doors and/or windows open without a functioning screen. Make sure that you don’t let mosquitoes into your home!
If you have been bitten by a mosquito, do not scratch it! Scratching will only inflame the lesion and lead to more swelling, pain, potential scarring and infection. Instead, clean the area, use a piece of ice to numb the spot, then massage in some hydrocortisone cream and cover with a Band-Aid. Lastly, please make an appointment to see your dermatologist so that you can get a prescription for a stronger steroid cream which should help resolve your symptoms faster as well as preventing unsightly scars from the bites.
Of course, there are many types of bug bites, including spider bites, tick bites and flea bites to name a few. For each particular kind of bug, there are recommendations for how to avoid bites. I will not be going into detail on any other bites. However, I would like to touch on another common and potentially more serious ailment we see this time of year…
Although serious anaphylactic reactions to bee stings are thankfully rare, local pain, swelling and itching can be debilitating and require treatment, albeit less emergently. Bee stings, like bug bites, can also become secondarily infected so be careful to clean the site of a bee sting right away with either rubbing alcohol or another antiseptic and avoid scratching the wound. If you have been stung by a bee, first, inspect the wound for the stinger. If the stinger is still in place, it is important to remove it by first cleaning the wound and then using a pair of tweezers to gently dislodge the stinger from the wound. After that, use first aid ointment (if you are not allergic to it) and cover the wound with a Band-Aid. You can also use some over the counter hydrocortisone cream and Benadryl 25-50mg every 6-12 hours to help calm the reaction. (For children, please consult with your pediatrician on dosing of Benadryl.)
Since you can never know for sure how you are going to react to a bee sting, it is important to closely monitor the situation and head to the nearest emergency room if you are developing any swelling around the head or neck, or having trouble breathing. I also advise patients to make an appointment to see their dermatologist to get a prescription strength topical steroid or perhaps even a cortisone shot to help manage the symptoms.
The last topic I will discuss is how to avoid sunburns. I am passionate about this topic, because I am passionate about melanoma prevention. Although we do not know the exact cause or causes of melanoma, we do know that there are multiple factors involved. However most of them, such as family history, are beyond our control. The one main preventable risk factor in melanoma prevention is UV radiation. Since UV radiation builds up over time, it is crucial to take as many steps as possible to limit unnecessary or unwanted UV exposure. Numerous studies have shown that sunscreen is a proven and effective way of preventing UV damage so of course, I cannot emphasize enough the importance of using sunscreen, especially on those areas such as the face, neck and back of the hands that are always exposed daily.
However, I always advise my patients that sunscreen is the last line of defense against the sun. What does this mean? Instead of relying on sunscreen, consider the other ways in which UV exposure can be limited that can have huge impact which involve avoidance and covering up, rather than reliance on sunscreen. I counsel my patients that these measures are safe and effective ways of reducing UV exposure. Sure, they do involve making lifestyle changes to some degree, but in some cases, these changes could be lifesaving. So, keep in mind that the main ways in which one can limit UV damage is by seeking shade, avoidance of peak hours of sun exposure and wearing clothing, sunglasses and hats to shield the skin. Even if it is hot outside, wearing a light breathable garment can be quite cool when you are partaking in outdoor activities. Lastly, sunscreen is always worn on exposed areas and reapplied as directed on the bottle.
I hope everyone has a wonderful summer, free of burns and bites!!!