When you have a patient presenting to the ED with multiple small bites from a presumed insect you might presume that it is scabies. You could certainly be right and you can read more about scabies here. The appearance of the painless bites from bed bugs varies widely. They can look like hives;

Courtesy Children’s Hospital Colorado: https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/symptoms/bed-bug-bite/

Or they can also look like more “traditional” insect bites;

Courtesy WebMD – https://www.webmd.com/skin-problems-and-treatments/picture-of-bedbug-bites

What are bed bugs?

Cimex lectularius, is the common bed bug. The name sounds like a Harry Potter spell. These little parasites feed exclusively on blood. They are small (5mm) and oval shaped. They have an oval body, no wings and 6 legs.

This is a bed bug – Courtesy Wkipedia – https://en.wikipedia.org/wiki/Bed_bug

They love to live in warm, dark areas – like mattresses and furniture. Bed bugs crawl out and bit at night because they like our warm bodies and CO2 emissions.

Tell more more about the lesions

OK, sure. As seen above the lesions vary, but they are classically 2-5mm erythematous and maculopapular. They result from a reaction to the bed bug’s saliva. The rash is super itchy and more so in the AM. Secondary bacterial infection is the most common complication. They take anywhere from 3-10 days to resolve. Oral antihistamines are effective enough for the itching. You can also recommend cool compresses. Oral steroids are rarely needed, and should be reserved  for significant reactions – like around the eyes.

Patients may present with 2 to 5mm pruritic maculopapular erythematous lesions, often in a linear pattern as the bed bug feeds (these are reactions to the bug’s saliva). The lesions are often extremely pruritic (worst in the morning), and subsequent scratching can lead to local skin breakdown and secondary bacterial infection.

Can kids with bed bug bites go back to school or daycare

Yes, move on.

How does one get rid of them?

If you want to know if you have bed bugs you have to look for them. This might mean waking up at 3 or 4AM and looking for tell tale signs on mattresses and sheets;

  • Red-brown stains
  • Tiny dark flecks of excrement
  • The actual bugs themselves

There are some recommended eradication techniques – see the reference below, but a pest management company may be warranted for significant infestations and to ensure complete eradication.


McMenaman KS, Gausche-Hill M. Cimex lectularius (“Bed Bugs”): Recognition, Management, and Eradication. Pediatr Emerg Care. 2016 Nov;32(11):801-806.