Bed bugs

  • Overview

    Bed bugs: Overview

    bed_bugs_landing.jpg
    Bed bug bites: Most people who are bitten by bed bugs have welts that look like this.

    Bed bugs are tiny insects that feed on human blood. They hide in dark places close to where humans sleep and usually crawl out to feed while people are fast asleep.

    If you have bed bugs in your home, it's unlikely that you'll see one unless you look for them. Bed bugs hide in the crevices of mattresses, box springs, headboards, couches, and other places. They only come out to feed.

    While a bed bug is feeding on you, you're unlikely to notice. Most people are asleep when they get bit. Also, before a bed bug draws your blood, it injects you with a substance that prevents you from feeling the bite. When you wake up, you may notice itchy welts.

    To find bed bugs, you usually have to look carefully. An adult that is full of blood can be the size of an apple seed. Hungry bed bugs and younger ones are about the size of a poppy seed.

    Bed bugs can be hard to find because they’re often about the size of a poppy seed.

    bedbugs-size-poppy-seed.jpg

    If you unsure of what’s biting you, a board-certified dermatologist can often look at the bites and tell you whether bed bugs are the cause.

    As for getting rid of bed bugs, it often requires professional help. Pesticides are usually necessary to kill bed bugs and their eggs, but using these on or near your bed can be hazardous to your health. This is why the Centers for Disease Control recommends using a professional pest control company that has experience treating bed bugs.

    To complicate matters, many pesticides and foggers cannot kill bed bugs because bed bugs have developed a resistance to the active ingredients in these products. It takes a bit of knowledge to know what will work.

    If this news makes you want to leave your home for a few weeks, well, that won’t get rid of bed bugs either. Bed bugs can survive one year or longer without eating.

    Another good reason to get professional help is to make sure you actually have bed bugs. Many insect bites cause itchy welts.

    You’ll find other signs that bed bugs may have bit you at:

    Bed bugs: Signs and symptoms


    Images
    iStock and Getty Images

    References
    Centers for Disease Control and Prevention and U.S. Environmental Protection Agency. “Joint statement on bed bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA).” Atlanta: U.S. Department of Health and Human Services; 2010.

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


    Bed bugs
  • Symptoms

    Bed bugs: Signs and symptoms

    Bed_bug-symptoms_bites_2.jpg
    Bed bug bites: The bites often appear in a zigzag pattern as shown here.

    Having bite marks on your body is the most common sign of bed bugs. Most people are bitten while they sleep and do not know that they have been bitten until the next day when they notice one or more of the following:

    • Several welts, often appearing in a line that zigzags.
    • Welts that itch intensely.
    • Specks of blood on the bedding.

    The first time you are bitten, the bites may not itch right away. It can take time for your body to develop a reaction to the bites. Some people develop itchy welts within a few days of the first bites, but it can take as long as 14 days before the bites itch.

    People tend to become increasingly sensitive to bedbug bites. If you have a bedbug infestation and the bugs bite repeatedly, you may get itchy welts within seconds.

    You will not see bed bugs living on your body. Unlike lice and the mites that cause scabies, bed bugs do not live on humans. Bed bugs come out of hiding to feed on human blood. Feeding lasts about 4 to 12 minutes. After a bed bug feeds, it returns to its hiding place.

    Serious and life-threatening reactions to bed bug bites

    Although less common, it is possible to develop a serious or even life-threatening reaction to bed bug bites. These reactions include:

    • Breathing is difficult.
    • Heartbeat is irregular or forceful.
    • Tongue swollen.
    • Blisters, especially large blisters.
    • Fever.
    • Feeling very sick.
    • Infection from scratching.
    • Anemia (rare, but can develop when a person gets numerous bed bug bites).

    Serious reactions require immediate medical care.


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


    Bed bugs
  • Causes

    Bed bugs: Who gets and causes

    Who gets bed bugs?

    Anyone can get bed bugs. An infestation can happen even if your home is spotless. Getting bed bugs has nothing to do with good hygiene and housekeeping.

    How do you get bed bugs?

    People get bed bugs when they bring bed bugs home with them. It’s easy to do, and you probably won’t notice until you get a few bed bug bites. The bugs can crawl into luggage, clothing, and onto other personal items without anyone noticing.

    Places that can have bed bug infestations include:

    • Hotels, motels, and cruise ships.
    • Apartment buildings and condominiums.
    • Shelters.
    • Hospitals and nursing homes.
    • Dormitories.
    • Buses and trains.

    You also can bring bed bugs into your home in a secondhand mattress or other piece of used furniture.

    Bringing home just a few bed bugs can quickly turn into an infestation because:

    • A female bed bug lays between 200 and 500 eggs during its lifetime.
    • The bed bug’s lifespan ranges from 6 to 24 months.
    • A bed bug can survive for 12 months or longer without feeding.

    References
    Centers for Disease Control and Prevention and U.S. Environmental Protection Agency. “Joint statement on bed bug control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA).” Atlanta: U.S. Department of Health and Human Services; 2010

    Fallen, RS, Gooderham, M. “bed bugs: an update on recognition and management.” Skin Therapy Lett. 2011; 16:5-7.

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


    Bed bugs
  • Treatment

    Bed bugs: Diagnosis and treatment

    Bed_bug_treatment_bites.jpg
    Bed bug 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 if you have bed bugs?

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

    1. Bites on your body.
    2. Signs of bed bugs.

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

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

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

    How to check for bed bugs


    Although bed bugs don’t usually require serious medical attention, they can cause a great deal of anxiety and restless nights. To help find bed bugs before they find you (and your belongings), dermatologists recommend looking for the following signs near places where you sleep.

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

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

    • A sweet, musty odor: Take a deep breath. If you notice a sweet, musty in your hotel room, cruise ship cabin, or other sleeping area, there may be a heavy bed bug infestation in the room. Bed bugs produce chemicals to help them communicate, although not everyone will notice the smell.

    • Specks of blood on bedding, mattresses, or upholstered furniture such as couches and headboards: Look carefully at your blankets, sheets, and mattress pads and then check the mattress and box spring. Are there specks of blood anywhere, especially near the seams? If so, there could be a bed bug infestation. You should also check for specks of blood on all upholstered furniture, including couches and headboards.

    • Exoskeletons: Bed bugs 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?

    • Tiny, blackish specks: If you see blackish specks on the bedding, mattress, headboard, or beneath couch cushions, it could be bed bug excrement. 

    • Eggs: After mating, female bed bugs lay white, oval egs in cracks and crevices. Keep in mind that these will be small, as a bed bug is only about the size of an apple seed. The photo below shows a bed bug near eggs. The photo was magnified so that you can see the bed bug and eggs.

    If you do get bed bugs and have many bites or a bite that looks infected, see a board-certified dermatologist. A dermatologist can treat an infection and help relieve the itch.

    If you see bed bugs, 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 bed bugs move, it can look like they are flying or jumping because they can crawl quickly. Bed bugs cannot fly or jump; they can only crawl.

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

    Bed_bug_treatment_eggs.jpg
    Bed bug with eggs: A bed bug is a tiny insect with broad, oval body. If it has recently eaten, it has a reddish-brown color.

    Treating bed bug 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 bed bug 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.

    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 bed bug 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.

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


    References
    Leverkus M et al. “Bullous Allergic Hypersensitivity to Bed bug 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.


    Bed bugs
  • Tips

    Bed bugs: Tips for preventing

    You can reduce your chance of bringing bed bugs home by following these dermatologists' tips when traveling and shopping for furniture.

    How to prevent picking up bed bugs while traveling

    Most people get bed bugs while traveling. Bed bugs are tiny insects that feed on human blood. They can crawl into a suitcase or onto clothing unnoticed.

    Here's how you can find bed bugs before they find you and your belongings.

    When checking into a hotel, cabin aboard a cruise ship, or elsewhere, you want to check your room before unpacking.

    Here's what you want to do:

    bedbugs-travel.jpg
    When you enter your room or cabin for the first time, place your suitcase on the luggage rack. If the room has bed bugs, they can crawl unnoticed from the bed or floor to your suitcase.
    1. When you walk into the room or cabin, take a deep breath. Do you notice a sweet or musty odor? If there is a heavy infestation, you may notice this smell. Bed bugs produce chemicals to help them communicate.

    2. Next, check the bed. Look carefully at the blankets, sheets, pillows, and mattress pad. Then, check the mattress and box spring. Do you see:

    • Blackish specks on the bed, mattress, or headboard? Blackish specks could be bed bug excrement.

    • Are there specks of blood anywhere, especially near the seams?

    • Do you see shell-like remains on the bed, bedding, or furniture? Bed bugs have an outer shell that they shed and leave behind as they grow.

    1. You'll also want to check all upholstered furniture. While checking, you may see bed bugs or their eggs. A bed bug is about the size of an apple seed.

    If you find signs of bed bugs, you should immediately request another room or cabin. The other room should not be near the current room.

    How to prevent bringing bed bugs into your home after traveling

    If you are concerned that you may have picked up bed bugs, you should inspect everything that you bring home (luggage, purse, and other belongings) for signs of bed bugs. You want to look for blackish specks, drops of blood, and shell-like remains.

    If possible, inspect everything before you bring it inside your home.

    If you see signs of bed bugs or strongly suspect that you might have brought bed bugs home, you should immediately:

    • Wash all the clothing that you brought home in a washing machine. Even clothes that you didn't wear must be washed in hot water. If you cannot wash something in a washing machine, you can either place it in a hot dryer or seal the items in a plastic garbage bag. If you seal items in a  garbage bag, leave the bag securely closed in an extremely cold or hot place for a few months.

    • Dry your clothes after washing them in a clothes dryer, using the hot setting.

    • Use a hand steamer to clean your luggage. According to the National Pest Management Association, a garment steamer will kill bed bugs and their eggs.

    How to prevent bed bugs when buying secondhand beds and other furniture

    Bed bugs can be hard to find in secondhand beds and other furniture. If the bed bugs have not eaten for some time, you may not see signs of them. Bed bugs can live for about a year without eating.

    You can prevent picking up bed bugs from secondhand furniture by not bringing secondhand furniture into your home.

    Additional related resources

    National Pest Management Association
    This association provides information to help you avoid and get rid of bed bugs.


    References
    National Pest Management Association, “Bed Bug Prevention.” Last accessed June 2012.

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


    Bed bugs