By Faraz Yousefian, DO and Liliana Espinoza, BS

Treatment Guidelines for Common Insect Bites Encountered in the Pediatric Population

By Faraz Yousefian, DO and Liliana Espinoza, BS

ne of the most common ailments affecting the pediatric population is insect bites. Dermatologic eruptions can manifest in a variety of ways, depending on the severity and toxicity of the specimen that inflicted the bite. Because the resultant dermatological conditions can induce not just physical but also psychosocial discomfort to the patient, it is of paramount importance that physicians implement the appropriate standard of care procedures. The Texas pediatric population spends an appreciable amount of time in outdoor settings, making the likelihood of being in contact with insects unavoidable. The body's reaction to a given insect’s saliva, secretion and/or remains can widely manifest from benign to life-threatening conditions. The most common benign cutaneous findings include localized swelling, burning, pruritus and pain.1-5 However, in immunocompromised individuals, symptoms might also include bullae or pruritic papule-like eruptions.1,6 Arthropods are the primary culprits of these dermatological conditions, and can be classified as venomous (e.g., bees and fire ants) and nonvenomous (e.g., mosquitos, ticks, mites, flees, chiggers, scabies, spiders, scorpions and body lice).2-3 Venomous or stinging insects can also trigger systemic constitutional reactions such as anaphylaxis.2-3 The first line recommendation to reduce the likelihood of an arthropod bite is wearing insect repellent products containing DEET; protective, non-bright colored clothing; and unscented skin and hair formulas.2 After an insect bite, however, a patient may find relief by applying a cool 25% menthol and camphor product compress and topical pramoxine or lidocaine anesthetics over the area.3 Topical diphenhydramine and benzocaine should not be advised, for they might trigger contact dermatitis.3 The inflammatory reaction can be relieved with sedative oral antihistamine (e.g., hydroxyzine 25 mg every 68 hours, as needed), non-sedative antihistamine (e.g., fexofenadine 60 mg every 12 hours) or psychotherapeutic agents (e.g., doxepin 25 mg every 24 hours at bedtime).2-3 In addition, high potency (class 1-2) topical steroids can be applied to the lesions on the trunk and extremities every 12 hours to relieve the inflammation and itch.2-3 In the case of severe anaphylaxis, treatment typically consists of vasoactive medications, fluids and systemic steroids to prevent the progression of the illness and stabilize the patient.2-3 It should be noted that specific treatment options are available for certain arthropods. For instance, scabies is preferably treated with permethrin; lice with permethrin or malathion; Lyme disease with antibiotics; and spider bites, such as those involving the brown recluse spider, which can be treated with dapsone or non-steroidal antiinflammatory drugs (NSAIDS).2-4 Additionally, in cases where a tick bite is detected, a tick remover tool or tweezers must be used immediately to remove the tick from the skin, and the area should be washed with soap and water.7 Given the likelihood of insect bites in the pediatric population, it is important that the appropriate measures be taken to prevent and treat the resultant dermatological conditions. Prophylactic measures are most effective; however, therapeutic options are available for a wide variety of arthropod-induced skin lesions. Still, given that symptoms can range from mild to severe, medical attention should be sought out in the most severe cases involving anaphylactic shock. References: 1. Powers J, McDowell RH. Insect Bites. In:

StatPearls. StatPearls Publishing; 2021.

Accessed August 8, 2021. http://www. ncbi.nlm.nih.gov/books/NBK537235/

O2. Juckett G. Arthropod bites. Am Fam Physician. 2013;88(12):841-847. 3. Steen CJ, Carbonaro PA, Schwartz RA. Arthropods in dermatology. J Am Acad Dermatol. 2004;50(6):819-842, quiz 842-844. doi:10.1016/j.jaad.2003.12.019 4. Casale TB, Burks AW. Clinical practice. Hymenoptera-sting hypersensitivity. N Engl J Med. 2014;370(15):1432-1439. doi:10.1056/NEJMcp1302681 5. Goddard J, Jarratt J, de Castro FR. Evolution of the fire ant lesion. JAMA. 2000;284(17):2162-2163. doi:10.1001/jama.284.17.2162 6. Biting Insects | JAMA Dermatology | JAMA Network. Accessed August 8, 2021. https://jamanetwork.com/journals/jamadermatology/articleabstract/533062 7. Ackerman AB, Metze D, Kutnzer H. Erythematous papules and nodules after tick bite. Am J Dermatopathol. 2002;24(5):427-428. doi:10.1097/00000 372200210000-00010

Faraz Yousefian, DO is an intern at the Texas Institute for Graduate Medical Education and Research (TIGMER) in San Antonio, Texas. He is very passionate about mentoring nascent physicians and educating the general populous about skin diseases and the steps they can take to prevent them. Dr. Yousefian is a member of Bexar County Medical Society.

Liliana Espinoza, BS is currently a PhD candidate in the field of neuroscience at UT Health San Antonio where she studies the early effects of a high fat diet on the motor neurons that innervate the heart. She will be pursuing a medical degree upon completion of her doctoral degree.