Bedbugs: An Update on Recognition and Management

From Skin Therapy Letter Robyn S. Fallen, BHSc; Melinda Gooderham MD, MSc, FRCPC Posted: 08/17/2011; Skin Therapy Letter. 2011;16(6) © 2011 SkinCareGuide.com http://www.medscape.com/viewarticle/745992?src=mp&spon=9 Abstract and Introduction Epidemiology Entomology Psychological Consequences Cutaneous Manifestation Diagnostic Considerations Disease Transmission Management Conclusion ABSTRACT The common bedbug (Cimex lectularius) is increasingly prevalent and a source of concern and questions for patients. In addition to a range of cutaneous presentations and potential for serious sequelae, bedbug bites cause significant psychological distress and create an economic burden associated with infestation control. Recognition of characteristic entomology, clinical presentation, diagnostic features and differential diagnosis can support expedient identification of patients exposed to infestations and support their appropriate management. Introduction The common bedbug, Cimex lectularius (C. lectularius), is a hematophagus arthropod. A pest to mankind for centuries, bedbug populations in industrial nations declined steadily with the advent of novel pesticides, improved sanitation practices, and economic conditions. In contrast, infestations in developing countries have persisted.However, pest control companies in Canada and the United States are reporting overwhelming increases in the number of new bedbug encounters compared with 10 years ago. This recent bedbug resurgence has been attributed to evolving pesticide resistance coupled with increased rates of international trade and travel, as travellers can bring the insects home in their clothing and luggage.Bedbugs have since established more widespread infestation of environments serving transient populations such as hotels, dormitories, hospitals, cruise ships, and homeless shelters. In addition to this increased prevalence, bedbugs are also widely discussed in popular media and may be presented as a concern by patients. Awareness of the entomology, diagnosis, and management of bedbugs can assist physicians in detecting affected individuals and providing concerned patients with education on this topic. Management Uncomplicated bedbug bites usually resolve within 1–2 weeks and are self-limited. Although the evidence base is weak, management is otherwise symptomatic. Topical or oral antipruritic agents combined with an intermediate corticosteroid can bring some relief. For some patients, having prescription topicals compounded with menthol and camphor can be soothing. Superinfection can occur, especially in cases with significant excoriation, and can be treated with topical or oral antibiotics.[16] Systemic reactions to bedbug bites are treated with intramuscular epinephrine, antihistamines, and oral corticosteroids, as in insect-induced anaphylaxis.[16] In tandem with the control of symptoms, eliminating the infestation must be aggressively pursued to prevent further bites. Goddard et al. (2009) have outlined several steps that are useful in successful eradication of bedbugs:[16] Proper identification of the bedbugs species Education of the patient, other dwelling occupants, and landlord, as applicable Thorough inspection of both infested and other nearby areas Implementation of pesticide and non-chemical control measures Follow-up to ensure control of the infestation