Bedbugs: Diagnosis, treatment, and outcome

Bedbugs: Diagnosis, treatment, and outcome

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                bedbug bites

Bedbug bites: When bedbugs bite, you often see clusters of bites. Each cluster usually contains 3 to 5 bites that appear in a zigzag pattern.

How do you know you have bedbugs?

To find out if you have bedbugs, you need to look for two things:

  1. Bites on your body.
  2. Signs of bedbugs.

Bites on your body: If you have bedbugs, you’re likely to have bites. Bedbug bites usually cause itchy welts. These welts usually appear in a zigzag pattern as show in the photo above.

You’ll seldom see bedbugs, so many people mistakenly believe that mosquitos, fleas, or spiders bit them. Sometimes people mistake bedbug bites for a common skin condition such as an itchy rash, hives, or chickenpox.

To make sure you have bedbugs, you’ll need to look for signs of bedbugs.

Signs of bedbugs: This step is important. If you have a bedbug infestation, you need to find out so that you can get rid of the bedbugs. Getting rid of the bedbugs is the only way to stop the bites.

If you have a large number of bedbugs, you may see the bugs. Most people, however, only see signs of bedbugs. To look for signs of bedbugs, check the places that people sleep for the following:

  • Sweet, musty odor: Take a deep breath. You may notice a sweet, musty odor because bedbugs produce chemicals to help them communicate. Not everyone will notice this odor.
  • Specks of blood on bedding, the mattress, or upholstered furniture such as couches and headboards: First, check blankets, sheets, and mattress pads. Next, check the mattress and box spring. Are there specks of blood anywhere, especially near the seams?
  • Exoskeletons: Bedbugs have an outer shell that they shed and leave behind. Do you see shell-like remains on the mattress, mattress pad, or beneath couch cushions?
  • Blackish specks: Do you see these on the bedding, the mattress, headboard, or beneath couch cushions? Blackish specks could be bedbug excrement. 
  • Eggs: The photo below shows a bedbug near eggs. The photo was magnified so that you can see the bedbug and eggs. A bedbug is about the size of an apple seed. 
                bedbug with eggs

Bedbug with eggs: A bedbug is a tiny insect with broad, oval body. If it has recently eaten, it has a reddish-brown color.

If you see bedbugs, they will likely scurry toward the closest hiding place. Any dark place such as inside a mattress or even a picture frame makes a good hiding place.

As you watch bedbugs move, it can look like they are flying or jumping because they can crawl quickly. Bedbugs cannot fly or jump; they can only crawl.

If you find signs of bedbugs, call a pest-control company or your property manager. You should not use bug spray or a fogger. These products have little effect on bedbugs.

Treating bedbug bites

You should see a dermatologist for treatment if you have:

  • Many bites.
  • Blisters.
  • Skin infection (bites feel tender or ooze discharge such as pus).
  • An allergic skin reaction (skin red and swollen or hives).

Your dermatologist may prescribe the following to treat bedbug bites:

Allergic reaction: Some people may require an injection of an antihistamine, corticosteroid, or epinephrine (adrenaline) for a severe allergic reaction.

Infection: An infection may require an antibiotic. If the infection is mild, your dermatologist may recommend an antiseptic medication that you can buy without a prescription. Your dermatologist will tell you which one to use. Your dermatologist also may recommend an antiseptic to prevent a skin infection.

Itch: A prescription antihistamine pill or liquid can help. You also can apply a corticosteroid to the bites. Your dermatologist will tell you which is best for you.

Bedbugs bites can be intensely itchy, so treat the itch to prevent scratching. Scratching can cause a skin infection.

At-home treatment

If you do not have any signs of an infection or a serious reaction, you can often treat the bites at home.

To treat bedbug bites:

  • Wash the bites with soap and water. This will help prevent a skin infection and help reduce itchiness.
  • If the bites itch, apply a corticosteroid cream to the bites. You can get a weak form of this medicine without a prescription at your local drugstore. Stronger corticosteroids require a prescription.

Bedbug bites usually heal and go away within a week or two.

Learn more about bedbugs:


Leverkus M et al. “Bullous Allergic Hypersensitivity to Bedbug Bites Mediated by IgE against Salivary Nitrophorin.” J of Invest Dermatol. 2006;126:2364-2366.


Liebold K et al. “Disseminated bullous eruption with systemic reaction caused by Cimex lectularius.”  J Euro Acad of Dermat and Vener. 2003;17:461-463.

Steen CJ, Carbonaro PA, Schwartz RA. “Arthropods in dermatology.”  J Am Acad Dermatol 2004; 50:819-42.