Mosquitos Come Out at Night
The weather in Miami during the holidays is much like the weather during all the other times of the year: uncomfortably warm and humid. This means that we get mosquitoes and their bug bites year round. Unfortunately, I happened to be the recipient of many, many mosquito bites at the annual Christmas Eve party held at a family member’s backyard. The pig roast was the center of attention in the yard– of course – but seeing as the backyard also faces a canal the mosquitos were out in full force that night. I wish I’d had the good sense to prevent bug bites that day.
The next day I woke up with an untold number of bites on my body and a whopping 4 mosquito bites on my face. One sat prominently, right in the middle at the top of my nose, and the rest were scattered along the right side of my face. At first, I thought they might be pimples, but I have never broken out that much in my life so I quickly put two and two together that they must be insect bites. I was alarmed at the cosmetic implications; here I am during the holidays with big red bumps on my face. I was also feeling very itchy, especially at night. However, mosquitoes can also carry many diseases, like West Nile virus, dengue fever, and St. Louis encephalitis. Unlikely in my case, but mosquito bites should still be avoided.
The Search for How To Prevent Bug Bites
Being the budding dermatologist that I am, I decided to search for the best ways to prevent and quickly get rid of my bites before the New Year’s Eve party that was around the corner. Here are my top tips for avoiding bug bites in the first place and how to treat them after the fact.
An ounce of prevention is worth a pound of cure.
Prevention is the best way to avoid bug bites in the first place. This has happened to me many a time before. A big outdoor party that faces a body of water is a breeding ground for mosquitos, literally. To prevent mosquito or other bug bites you may have to wear insect repellent with DEET.
Mosquitos Hate DEET
DEET works because insects hate the smell of DEET. (1) They like the smell of you and your human sweat, but they dislike DEET so much that they will leave you alone if you wear it. If you don’t like the idea of spraying yourself down with the chemicals in a bottle of insect repellent, you can opt for long sleeves and pants. You can also stay indoors, especially at night, or stay within a covered patio area. Installing netting in the sitting areas that keeps out bugs may be a good idea if you plan on being outdoors often.
Don’t scratch bug bites!
Why do mosquito bites itch?
Mosquito bites are itchy because the mosquito pumps its saliva into the skin while it’s sucking out blood. The mosquito’s saliva causes an allergic reaction in your skin that leads to the red, raised bump. Mast cells – the cells involved in allergic reactions – recognize the mosquito saliva as foreign and release histamine in response. This leads to the sensation of itching.
Scratching breaks down the skin barrier further and can introduce bacteria into the site. This can lead to secondary skin infections because the bacteria have found an easy entry point into your body. Excessive scratching can also lead to scarring and thickening of the skin as it attempts to heal itself.
I didn’t touch the bites on my face at all because I was so worried about causing more damage. The ones on my legs, however ,were fair game to be scratched, especially in the dead of night when the urge to scratch can be most intense.
How to Stop Scratching Bug Bites
If you can’t help scratching, you will need to use methods other than willpower to stop yourself. There are two options that can be used in combination. These are topical creams and oral anti-histamines.
The topical creams most commonly available for stopping the itch are calamine lotion and topical steroids such as hydrocortisone. Both can be found over the counter at any drug store.
Calamine is essentially made of zinc oxide (same ingredient found in sunscreen) and a small percentage of ferric oxide. Zinc inhibits the release of histamine from mast cells and soothes irritated skin. (2)
Topical steroids reduce inflammation and inhibit the cascade of molecules needed to propagate an allergic reaction. Since mosquito bites are essentially an allergic reaction to mosquito saliva, topical steroids can stop many mediators of inflammation in that reaction.
Oral anti-histamine medications, like Benadryl (generic diphenhydramine), block the histamine receptor. (3) This receptor would normally bind the histamine released by the mast cells and cause itching. With the receptor unable to bind histamine, there is no way for histamine to cause its final effect.
Unfortunately, we all know that Benadryl can also cause drowsiness because it is an old drug that was made without much specificity for only the histamine receptor. Because it can cross the blood-brain barrier and bind other receptors, you can get other side effects such as sleepiness, dry mouth, constipation, and urinary retention.
How I Treated My Bug Bites
I used a combination of Benadryl at night and hydrocortisone cream whenever I was feeling particularly itchy to keep my symptoms at bay. Now one week later, my bug bites are noticeably smaller but still visible. I guess I’ll have to give it a few more days, but I can assure you it would’ve been much worse if I had been constantly scratching and picking.
If you suffer from a severe allergic reaction from a bug bite, make sure to go to the emergency department or call your doctor right away. (4)
What do you think is the best way to prevent bug bites?
- Wikipedia. DEET. https://en.wikipedia.org/wiki/DEET
- Gupta, Mrinal, et al. “Zinc therapy in dermatology: a review.” Dermatology research and practice 2014 (2014).
- Wikipedia. Diphenhydramine. https://en.wikipedia.org/wiki/Diphenhydramine
- American Academy of Dermatology. Bug bites and stings: When to see a dermatologist. https://www.aad.org/public/skin-hair-nails/injured-skin/bug-bites-and-stings