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Scabies are currently in the news in St. Louis. As fall turns into winter and temperatures drop even further, our children and families are often forced to stay inside. Unfortunately, being indoors doesn’t protect our families from some unwelcome itchy skin conditions that are rare but have been more recently become more common in the US.  Two rash diagnoses most parents cringe with (and start to itch!) when they first hear are bed bug infestation and scabies.

Bed bugs are a non-flying insect the size and color of an apple seed that can live in your home and create a lot of problems as it bites humans in order to feed.  For years these parasites were well controlled with pesticides in common use such as DDT, however since DDT has been banned, there has been an increase in cases in the United States.   Typically, families will not know their home or a recent place they have visited is infested with bed bugs until they have an unexplained rash.  The rash may have the following traits:

  • Red, flat lesion the size of an M&M candy with a central dark spot
  • These will last 1 to 2 weeks, with new lesions forming over time
  • A line of lesions on the skin as the insect crawls to eat
  • Minimal to mild itch, or even hives if a person is sensitive to the bite
  • Parents should especially be aware that bed bugs could be the cause of this type of rash if the child has been at  a recent sleep over,  gets “mosquito bites” during  the wrong season,  the family lives in an apartment,  or a recent visit to a foreign country or stay at a hotel on vacation.   The insects live in beds and furniture, but are fast crawling and often spread to luggage and clothes left on the floor in hotels, homes or dormitory rooms.   Not the souvenir you want to bring home from vacation or college!

You can often spot the following signs in your home or bed if bed bugs infest:

  • Empty shells of bug skin as the molt, often in the corners of bed frames or drawers
  • Dark powder flecks, or bug feces, in mattress and cushion seams
  • Small dop-size blood smears on sheets when you unwittingly crush them as you move

Luckily, according to the Center for Disease Control (CDC), no human diseases are spread by bed bugs in the way that ticks and mosquitoes can spread serious conditions such as Lyme disease or malaria.  And, in general, the rash is a benign and short-term irritation to most people.  Those with itchy reactions can usually be well treated with over the counter hydrocortisone 1 percent cream and oral antihistamines such as diphenhydramine (Benadryl).

What should you do once you discover bed bugs in your home?

  • Vacuuming is not very helpful as these bugs live in crevices and cracks
  • Wash clothing and bedding in water 120 degrees or hotter
  • Turn the dryer heat on high for 20 minutes to kill the insects and eggs
  • Discard likely infested mattresses or furniture
  • Ultimately though, most parents who have experienced a bed bug infestation find it necessary to have a professional exterminator treat the home with safe, effective insecticides to fully kill the unwelcome visitors

In a very similar fashion, scabies infestation can present with an itchy rash in family members that can be very frustrating to diagnose and treat.  Scabies is the itchy rash caused by a microscopically small mite that can burrow into the outer layers of our skin.  The parasite can easily spread from person to person contact in places like school, daycare centers, and among family members in a home.  The rash may have the following traits:

  • Small red skin bumps that are elevated and pimple-like
  • Located between fingers, wrists, behind the knees in older children and adults
  • Located often on the trunk, arms, legs, head, palms and soles of young children
  • Very prominent scratches on the skin from intense itching

The most common symptom people experience from scabies infestation is the intense itching, often worse at night, and the spreading nature of the rash as the body’s immune system has a very local allergic reaction to the burrowing creature. This reaction can even start many weeks after one first becomes exposed to the scabies mite and this can make patients unsure of what the rash is and where it came from. The rash is more than a nuisance as the itching and scratching can break the skin open and allow bacteria to infect the skin. Antihistamines and topical steroids provide minimal temporary relief to the affected person and it is best to contact your physician or healthcare provider for prescription cream to kill the mites and prevent spread to other people.  Some treatments include:

  • Permethrin cream prescribed (most commonly used)
  • Crotamiton cream prescribed
  • Oral anitbiotic if bacterial skin infection is also suspected

Even with proper treatment to kill the mites the intense itching and leftover rash may continue for weeks. Mites cannot survive longer than 2-3 days off a human host and are killed by hot water washing and the heat of a clothes dryer. Therefore, good environmental clean up with vacuuming carpets and washing of clothes and bedding is very helpful to avoid further cases in the home.

While neither bed bug or scabies infestations are serious medical conditions with long-term health consequences, they both can be a significant nuisance and expense to families when you consider potential doctor’s visits for diagnosis, treatment, and home eradication costs. Theses guests are definitely unwelcome.

For more information about Esse Health and our providers, please visit

0249By Dr. Peter Putnam, Esse Health Pediatrician
Esse Health Pediatric & Adolescent Medicine at Watson Road
9930 Watson Road, Suite 100
St. Louis, MO 63126
Phone: 314-965-5437