Bedbugs

Bedbugs: Overview

Bedbugs 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.

Bedbug bites: Most people who are bitten by bedbugs have welts that look like these shown above.

Bedbugs can be a problem in the cleanest of homes. These insects need only human blood to survive, so having an immaculate home will not keep them away. And it’s easy to bring bedbugs home. They can crawl into luggage, clothing, and even furniture, unnoticed.

Once inside your home, bedbugs will find a hiding place. Favorite hiding places include a mattress, box spring, headboard, couch, and tiny cracks and crevices.

Having bedbugs can cause a great deal of anxiety and some restless nights. Most people want to get rid of bedbugs as soon as possible, so they buy bug sprays and foggers. These will not get rid of bedbugs.

Leaving your home for a few weeks will not get rid of bedbugs. Although these insects need human blood to survive, they can live for a year or longer without blood. During this time, they remain in hiding.

Getting rid of bedbugs can be difficult. Most people need the help of a pest-control company. Make sure the company has experience eliminating bedbugs. Several treatments may be necessary to get rid of bedbugs completely. You also will need to follow the guidelines that your pest-management professional recommends.

If you have many bites or a bite looks infected, you should see a dermatologist. A dermatologist can treat an infection and help relieve the itch.

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.

Bedbug bites: The bites often appear in a zigzag pattern as shown here.

Bedbugs: Signs and symptoms

Having bite marks on your body is the most common sign of bedbugs. 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 bedbugs living on your body. Unlike lice and the mites that cause scabies, bedbugs do not live on humans. Bedbugs come out of hiding to feed on human blood. Feeding lasts about 4 to 12 minutes. After a bedbug feeds, it returns to its hiding place.

Serious and life-threatening reactions to bedbug bites

Although less common, it is possible to develop a serious or even life-threatening reaction to bedbug 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 bedbug 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.

Bedbugs: Who gets and causes

Who gets bedbugs?

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

How do you get bedbugs?

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

Places that can have bedbug infestations include:

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

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

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

A female bedbug lays between 200 and 500 eggs during its lifetime.
The bedbug’s lifespan ranges from 6 to 24 months.
A bedbug 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. “Bedbugs: 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.

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.

Bedbugs: Diagnosis and treatment

How do you know if you have bedbugs?

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

Bites on your body.
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.

How to check for bedbugs

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

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:

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 bedbug infestation in the room. Bedbugs 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 bedbug infestation. You should also check for specks of blood on all upholstered furniture, including couches and headboards.
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?
Tiny, blackish specks: If you see blackish specks on the bedding, mattress, headboard, or beneath couch cushions, it could be bedbug excrement.
Eggs: After mating, female bedbugs lay white, oval egs in cracks and crevices. Keep in mind that these will be small, as a bedbug is only about the size of an apple seed. The photo below shows a bedbug near eggs. The photo was magnified so that you can see the bedbug and eggs.

If you do get bedbugs 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 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.

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

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.

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.

References:
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.

Travel tip: To prevent bedbugs from coming home with you, inspect the room before you unpack.

Bedbugs: Tips for preventing

You can reduce your risk of bringing bedbugs home by taking these precautions:

Avoid secondhand beds and other furniture

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

Traveling: Check for bedbugs when you check in

Many people get bedbugs when they bring the bugs home after a trip. Bedbugs can crawl into your suitcase or clothing while you’re staying at a hotel, motel, or hostel. People even pick up bedbugs on a cruise ship.

To prevent bringing bedbugs home, follow these quick and easy tips:

Place your luggage on the luggage rack, not the floor or the bed. If bedbugs are in the room, the bugs can crawl into luggage placed on the bed or floor.
Pull back the sheets and check the mattress for signs of bedbugs. Look for:
Check the box spring, headboard, couch, and any other upholstered furniture for signs of bedbugs.
If you see any sign of bedbugs, immediately grab your belongings and ask for another room. The new room should not be next door or immediately above or below the infested room. Bedbugs might be in these rooms, too.

Traveling: Check your luggage when you return home

If you are concerned that you might have picked up bedbugs, you should inspect everything that you bring home (luggage, purse, and other belongings) for signs of bedbugs.

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

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

Wash all the clothing that you brought home in a washing machine. Even clothes that were not worn must be washed. Use the hot setting on the washing machine.
After washing, dry all the clothes in a dryer, using the hot setting.
If you cannot wash some clothing in a washing machine, place it in the dryer and run the dryer on the hot setting.
Use a hand steamer (or vacuum) to clean your luggage. According to the National Pest Management Association, a garment steamer will kill bedbugs and their eggs.

Related resources:

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

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.

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