Bedbugs

21/2/24, 19:49 Bedbugs - UpToDate
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Bedbugs
AUTHORS: Dirk M Elston, MD, Stephen Kells, PhD
SECTION EDITORS: Robert P Dellavalle, MD, PhD, MSPH, Ted Rosen, MD
DEPUTY EDITOR: Abena O Ofori, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jan 2024.

This topic last updated: Mar 07, 2022.
INTRODUCTION
Bedbugs are obligate, blood-feeding insects that infest human dwellings and inflict bites that
can cause local skin reactions in humans ( picture 1A-E). Management involves
confirmation and eradication of the infestation. Antipruritic agents and psychologic support
for victims also may be needed.
The clinical features, diagnosis, and management of bedbug infestations will be reviewed
here.
TAXONOMY
Bedbugs (also written as "bed bugs") are true bugs of the order Hemiptera and family
Cimicidae. Cimicids commonly infest human, bird, and bat habitats. As parasites, cimicids are
unique because they are obligate blood feeders but do not remain on the host to complete
their life cycle. Rather, they hide in the surrounding habitat. Cimex lectularius and Cimex
hemipterus are the two bedbug species that most commonly affect humans. (See 'Life cycle'
below.)
MORPHOLOGY
Correct identification of bedbugs is important for implementing proper control measures.

Bat bugs (Cimex adjunctus and other species) and swallow bugs (Oeciacus vicarius) are other
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members of the Cimicidae family that may be mistaken for bedbugs and may incidentally
bite humans ( picture 2).
Bedbugs have flat, red-brown, oval bodies and are similar in size to a dog tick ( picture 1A).
The eyes are widely separated, and the mouthparts are retroverted with the labium slender
and elongated, forming a three-segmented rostellum (rostrum). The wings are reduced to
hemelytral pads, with membranous hindwings vestigial or absent. The pronotum (a plate-like
structure covering the dorsal thorax) has a concave anterior margin where it connects to the
head. Bristles project laterally along the margins of the pronotum, starting behind the eye
and continuing along the lateral edge ( picture 2). Bristles can also be present on the
dorsal surface. The antennae have four segments, with the distal three segments long and
slender. The abdomen has eleven segments that expand during feeding, exposing
intersegmental membranes.
Adult C. lectularius range in size from 5 to 7 mm, while nymphs (juveniles) may be as small as
1.5 mm. C. hemipterus is somewhat longer than C. lectularius.
Prior to a blood meal, adult bedbugs are brown in color. After feeding, the color becomes
more dull red, and the body of the bedbug elongates and is no longer flat [1]. Smaller
nymphs are translucent prior to feeding and become bright red after feeding.
LIFE CYCLE
The bedbug life cycle consists of egg, nymph, and adult stages. The eggs hatch in 4 to 10
days. Nymphs undergo five nymphal stages, each requiring a blood meal before molting to
the next stage [2]. The fifth stage molts into an adult. The average life span of an adult
bedbug is 6 to 12 months [3].
Bedbugs spend the majority of their lives hiding in harborages, especially during the
daytime. Bedbugs seldom inhabit the resting surface of beds or chairs. Instead, they hide
peripherally in cracks and crevices of mattresses, cushions, bed frames, and other structures.
In resource-limited countries, bedbugs may inhabit the cracks and crevices of mud and daub
houses, as well as the thatched roof. The female deposits her eggs in these cracks and
crevices.
Bedbugs respond to aggregation pheromones, resulting in clustering behavior, although

solitary bedbugs may also be found as they disperse from these aggregation sites. Increased
protection from desiccation and associated growth benefits in the nymphal stages are
potential advantages of grouping [4].
Dispersal of bedbugs may be enhanced by the overcrowding of aggregation sites and the
release of alarm pheromones by bedbugs in aggregates that are disturbed. Multiple small
aggregation sites, scattered around the living spaces, is a major reason why bedbugs are
hard to detect and eradicate.
Local skin reactions related to bedbugs occur from the direct feeding of bedbugs. Bedbugs
are attracted by warmth and carbon dioxide and often feed while the victim sleeps. Feeding
also may occur when the victim is quiescent, resting, or with their attention diverted
elsewhere. Bedbugs inject an anticoagulant to aid with feeding and usually feed without
detection by the host. A complete blood meal lasts approximately 5 to 10 minutes [5]. Adult
bedbugs can survive for up to one year without feeding [3].
Bedbugs may not die in the colder winter months; some survival occurs at temperatures
above -12°C, even after one week of continuous exposure [6].
EPIDEMIOLOGY
Bedbugs are present throughout the world. C. lectularius is found in temperate climates, and
C. hemipterus is most prevalent in tropical climates, although the ranges of these species
overlap [7]. Occasionally, tropical bedbugs may appear in more temperate areas because of
international travel. In addition, C. lectularius can appear in urbanized, tropical areas.
Bedbug infestations are more common in economically disadvantaged areas but also occur
in sites frequented by travelers or in the homes of individuals who travel frequently [8].
Infestations are also common in refugee camps [9]. Other factors may influence risk for
bedbug infestation. A study of approximately 2800 call inquiries for bedbug eradication from
a pest control company in Budapest found positive associations between call inquiry rates
and urban location, lower educational status of inhabitants, smaller apartments, and timing
between March and December [10].
Within multifamily and institutional buildings, bedbugs will move among rooms or may
spread when items harboring bedbugs are moved within the building. Bedbugs are
increasingly being identified in office environments, but spread within that environment is
often limited [11].
CLINICAL MANIFESTATIONS
Bedbugs inflict painless bites on exposed areas of skin at night and are rarely seen by the
victim. Bites typically occur on the face, neck, hands, and arms.
Skin reactions — Reactions to bedbug bites vary. In some people, reactions do not occur,
and the only evidence of a bite is a small punctum [3]. Older adults may be less likely to
develop skin reactions than younger individuals [12].
The classic appearance of a bedbug bite reaction is a 2 to 5 mm erythematous papule or

wheal with a central hemorrhagic punctum ( picture 1B-E) [3,5]. Pruritus is common.
Some patients have only asymptomatic, purpuric macules at the sites of bites. Occasionally,
bullous reactions occur [1,13,14]. Bedbug bites may also appear as papular urticaria or may
mimic urticaria [15,16]. Individuals with papular urticaria may have immunoglobulin G (IgG)
antibodies against C. lectularius, Culex pipiens, and Pulex irritans [16]. (See "Insect and other
arthropod bites", section on 'Papular urticaria'.)
Reactions may be noticed upon awakening or one to several days after the bites.
Occasionally, the onset of a skin reaction is delayed for up to 10 days [17].
A linear series of bites found upon awakening suggests bedbugs but is not always present.
The linear pattern may occur as a single bedbug probes multiple times looking for a
productive capillary or may result from multiple bedbugs feeding along a zone of exposed
skin.
Course — Untreated bites usually resolve in one week [3]. New erythematous papules or
wheals can accumulate as older ones heal.
COMPLICATIONS
Occasionally, bedbug bites can become secondarily infected, producing impetigo or cellulitis.
Excoriated or impetiginized areas may take several weeks to resolve.
Extreme infestations associated with multiple repeated feedings by bedbugs may result in
anemia [18]. Rarely, bedbug feeding results in anaphylaxis [19].
Although pathogens such as hepatitis B virus [20-23], Trypanosoma cruzi [24,25], methicillin-
resistant Staphylococcus aureus (MRSA) [26,27], Francisella tularensis [28], and Wolbachia [29]
have been detected in bedbugs, transmission of these diseases has neither been clinically
demonstrated nor observed. There is little evidence to suggest bedbugs are competent
vectors for human disease [3,30].
HISTOPATHOLOGY
The histopathologic findings of bedbug bites are nonspecific. Urticaria-like skin reactions
often demonstrate edema in the upper dermis and a perivascular, inflammatory infiltrate
with lymphocytes, eosinophils, and mast cells. A small number of interstitial eosinophils may
also be present [31].
Bullous bedbug bites may exhibit intraepidermal edema, subepidermal edema, and a mixed
dermal inflammatory infiltrate [32]. In addition, histopathologic features consistent with
cutaneous vasculitis have been reported in a patient with bullous lesions [14].
DIAGNOSIS
Although clinical findings can suggest bedbug bites, the diagnosis requires detection of
bedbugs in the patient's environment. Skin biopsies yield nonspecific results and are usually
unnecessary.
When to suspect bedbug infestation — In general, bedbug bites should be suspected in

patients with recurrent, pruritic, erythematous papules or wheals that persist for several
days. Because the physical manifestations of bedbug bites are nonspecific, a careful history
and full skin examination should be performed to detect additional findings suggestive of
bedbugs or other conditions.
Features that support a diagnosis of bedbugs include:
● Potential exposure to bedbugs (recent travel, residence within building with known
bedbug infestation)
● Pruritic skin reaction characterized by erythematous papules or wheals
● Detection of new skin reactions upon waking in morning
● Skin reactions in a linear configuration
● Cohabitants with similar symptoms
The absence of any of these features does not exclude the diagnosis. If features suggestive
of other arthropod bites or skin disorders are not detected, inspection of the patient's
residence for bedbugs is prudent. (See 'Differential diagnosis' below.)
Confirming the diagnosis — The presence of bedbugs is necessary to confirm the

diagnosis. A pest control service is the preferred method for detecting bedbugs. Detection
involves careful visual inspection of typical harborages, placement of passive (physical or
adhesive) or active (heat- or carbon dioxide-emitting) traps, or deployment of trained
bedbug-detection dogs [33,34].
Bedbugs are most likely to be found near feeding sites (eg, sleeping areas) but may be found
in other locations.
Small infestations of bedbugs are difficult to detect and may be suspected if specks of feces
or blood are found on linens, mattresses, or behind wallpaper [35]. Caste skins from
moulting bedbugs also may be found.
Bedbug infestation can produce a recognizable pungent odor that supports the diagnosis
[5]. However, the odor typically occurs only with chronic and widespread infestations.
Skin biopsy results are nonspecific and do not confirm a diagnosis of bedbug bites. In
challenging cases, a skin biopsy can be performed to rule out other skin diseases. (See
'Differential diagnosis' below.)
DIFFERENTIAL DIAGNOSIS
Bedbug bites may resemble a wide variety of disorders. Examples of disorders in the
differential diagnosis include:
● Other arthropod bites – Other biting arthropods, especially bat bugs, swallow bugs,
fleas, and parasitic mites, can produce bites similar to bedbugs ( picture 3). Humans
are not the preferred food source for bat bugs and swallow bugs, but incidental bites
may occur in the setting of infestations in human dwellings. Bat bugs and swallow bugs
closely resemble bedbugs; examination of the insect by an entomologist can aid in
correct identification ( picture 2).
Scabies is a common disorder caused by infestation of Sarcoptes scabiei. Patients often

have intensely pruritic papules with predilection for particular sites, such as sides and
webs of the fingers, wrists, axillae, areolae, and genitalia ( picture 4A-B). The
detection of the scabies mite, feces, or eggs with microscopic examination confirms the
diagnosis. (See "Scabies: Epidemiology, clinical features, and diagnosis".)
Cheyletiella mites and other mite species often associated with cats, dogs, rabbits, rats,
or birds are a common cause of grouped bites. (See "Insect and other arthropod bites".)
● Primary skin disorders – Skin diseases in the differential diagnosis may include
pruritic, papular eruptions, such as prurigo nodularis and urticaria ( picture 5 and
picture 6). The papules of prurigo nodularis are firm and more persistent than
bedbug bites. The duration of individual lesions of urticaria is shorter than bedbug
bites, with lesions lasting for less than 24 hours. Urticaria lesions usually lack a central
punctum. Less common disorders, such as dermatitis herpetiformis ( picture 7),
pityriasis lichenoides et varioliformis acuta ( picture 8), and lymphomatoid papulosis
( picture 9), may also enter the differential diagnosis. Skin biopsies are useful for the
diagnosis of these disorders. (See "Prurigo nodularis" and "New-onset urticaria" and
"Dermatitis herpetiformis" and "Pityriasis lichenoides et varioliformis acuta (PLEVA)"
and "Lymphomatoid papulosis".)
● Displaced concern for infestation – Individuals may strongly believe they have
bedbug infestation in the absence of true infestation. These thoughts may be triggered
by exposure to someone with bedbugs, skin symptoms secondary to other disorders,

information from social contacts or media, or other factors.
Such beliefs may cause individuals to take unnecessary steps to eradicate bedbugs.
These individuals can often be convinced to take appropriate steps to confirm whether
bedbug infestation or another condition is responsible.
● Delusional infestation (also called delusional parasitosis or Ekbom syndrome) –

Delusional infestation is a psychiatric disorder in which patients have a fixed, false
belief that they are infected by insects or other living organisms [36]. The physical
examination may reveal excoriations or other self-induced skin injury; the
erythematous papules or wheals often associated with bedbug bites are absent.
Knowledge of or prior experience with infestation is a potential contributing factor. (See
"Delusional infestation: Epidemiology, clinical presentation, assessment, and
diagnosis".)
MANAGEMENT
Treatment of bites — Bedbug bites spontaneously resolve, and treatment of the bites is not
mandatory. However, significant pruritus is common and may be improved with a low- or
medium-potency topical corticosteroid (eg, triamcinolone acetonide 0.1%), an oral
antihistamine, or both ( table 1) [5]. Of note, antihistamines can suppress the symptoms
and signs of bites and may reduce the patient's ability to detect an ongoing infestation. (See
'Clinical manifestations' above.)
Patients should maintain good hygiene and avoid scratching to prevent infection. Secondary
infection should be treated with appropriate antibiotics. (See "Impetigo" and "Acute cellulitis
and erysipelas in adults: Treatment".)
Psychologic support — Victims of bedbug infestations may experience varying degrees of

stress, anxiety, and depression. Clinicians should inquire about such symptoms and provide
counseling, referral, or treatment, if indicated.
Examples of psychosocial effects of infestation include [37,38]:
● Patients may worry about bedbugs biting them or their family members, which can
disrupt sleep.
● Patients may be shunned by friends or others in the community.
● Patients may isolate themselves, avoiding family and friends, fearing spread of the
infestation.
● Patient or employer concerns can lead to suspension of work.
● Management of infestations can be disruptive and expensive.
● Patients experiencing significant psychologic distress over an infestation may engage in

dangerous, inappropriate practices in an attempt to eradicate the infestation (eg,
misuse of insecticides) [39].
Eradication — Once infestation is confirmed through the detection and correct identification
of bedbugs, measures to eradicate infestation can be implemented.
Eradication of bedbugs is difficult because of their continual production of new, discrete

aggregation sites (see 'Life cycle' above). Control of infestations requires an experienced pest
management professional. Victims should refrain from attempting control measures
themselves [40].
Preferred methods of eradication include application of insecticides and heat treatment.

Combinations of insecticides are generally used to avoid failure due to resistance [41,42].
Use of long-lasting residual insecticides are necessary for heavy infestations [43]. All
insecticides must be applied carefully and according to label directions.
Heat treatment involves use of equipment to heat rooms to a lethal temperature. All stages
of bedbugs can be killed at 50°C (122°F). Failure of heat treatments may result from failure to
reach a lethal room temperature in all infested areas or reinfestation [44]. The capability of
bedbugs to develop heat resistance appears to be limited [45].
When insecticides and heat treatment are not feasible, physical removal of bedbugs may
reduce the severity of infestation, although it is unlikely to completely eradicate the
infestation. A thin plastic card or a thin-bladed paint scraper can be used to dig bedbugs out
of cracks and crevices. Placement of interceptor (pitfall) traps at the base of beds and
furniture may aid in control of bedbug infestations [46]. Pyrethroid-treated bednets and
mattress encasements may reduce the number of bites, but resistance to pyrethroids is
present in some bedbug populations and is spreading [47,48].
Supplemental methods to reduce the number of bedbugs can aid in eradicating infestations
and include vacuuming and laundering or freezing bedding and other infested fabrics. Items
that are laundered should be washed and dried in a dryer on a hot setting to kill bedbugs.
The duration of freezing required is dependent on freezer temperature, with higher
temperatures requiring longer freeze durations [6,49]. For home freezers with a typical
target temperature of -18°C (0°F), freezing infested items for at least three to four days can
be sufficient [6].
Although ingestion of boric acid by bedbugs has successfully killed bedbugs in an

experimental setting, application of boric acid powder in infested areas does not appear to
be an effective method for killing bedbugs and eradicating infestations [50].
PREVENTION
Certain measures may be helpful for preventing bedbug infestation [3]:
● Visual examination of hotel rooms or other new sleeping areas for bedbugs or bedbug
feces prior to use, with particular attention to mattress cords and crevices in box
springs.
● Placement of luggage on a luggage rack or away from the bed while traveling.
Placement of worn garments in a sealed plastic bag to minimize bedbug attraction to
worn clothing [51].
● Careful examination of "used" items, such as items from garage sales or resale shops
(especially bedding items), for bedbugs or bedbug feces prior to bringing them inside
the home.
SOCIETY GUIDELINE LINKS
Links to society and government-sponsored guidelines from selected countries and regions
around the world are provided separately. (See "Society guideline links: Bedbugs".)
INFORMATION FOR PATIENTS
UpToDate offers two types of patient education materials, "The Basics" and "Beyond the
Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th
grade reading level, and they answer the four or five key questions a patient might have
about a given condition. These articles are best for patients who want a general overview
and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are
longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th
grade reading level and are best for patients who want in-depth information and are
comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to
print or e-mail these topics to your patients. (You can also locate patient education articles
on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)
● Basics topics (see "Patient education: Bedbugs (The Basics)")

● Beyond the Basics topics (see "Patient education: Bedbugs (Beyond the Basics)")
SUMMARY AND RECOMMENDATIONS
● Overview – Bedbugs are obligate, blood-feeding insects that inhabit human dwellings
and may cause skin reactions in humans ( picture 1A and picture 2). Bedbugs
closely resemble bat bugs and swallow bugs, related organisms that typically feed on
animal hosts but may incidentally bite humans. (See 'Taxonomy' above and
'Morphology' above.)
● Epidemiology – Bedbugs are present worldwide. Spread of infestation can occur

through transportation of items harboring bedbugs, as may occur with travel or
acquisition of used furniture, or through direct movement of bedbugs in multifamily
buildings or institutions. (See 'Epidemiology' above.)
● Life cycle – Bedbugs do not live on humans. Rather, they tend to inhabit cracks and
crevices of mattresses, cushions, bed frames, or other structures. Bedbugs are
attracted to the host by warmth and carbon dioxide and generally feed at night while
the victim sleeps. (See 'Life cycle' above.)
● Clinical manifestations – Skin reactions to bedbugs vary, ranging from no reaction to

pruritic papules or wheals, purpuric macules, or bullae ( picture 1B-E). Reactions are
typically noticed upon awakening or within a few days after the bites. A linear series of
bites is a potential but not consistent finding. (See 'Clinical manifestations' above.)
● Diagnosis – Confirmation of the diagnosis of bedbug bites requires detection of

bedbugs in the victim's environment. Inspection of the victim's residence by a
professional pest control service is the preferred method for detection. (See 'Diagnosis'
above.)
● Infestation management – Management of bedbug infestation consists of eradication

of the infestation through employment of a professional pest control service. The
primary methods include application of insecticides and heat treatment. When such
interventions are not feasible, physical removal of detected bedbugs may reduce the
severity of infestation but is unlikely to eradicate the infestation. (See 'Eradication'
above.)
● Patient management – Bedbug bites resolve spontaneously. Topical corticosteroids

and oral antihistamines may reduce associated pruritus. Psychologic support services
can be beneficial for some victims. (See 'Treatment of bites' above and 'Psychologic
support' above.)
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High Rates of Pyrethroid Resistance Result in Chronic Infestations of Bed Bugs (Cimex
lectularius L.) in Lower-Income Housing. PLoS One 2016; 11:e0117805.
48. Punchihewa R, de Silva WAPP, Weeraratne TC, Karunaratne SHPP. Insecticide resistance
mechanisms with novel 'kdr' type gene mutations in the tropical bed bug Cimex
hemipterus. Parasit Vectors 2019; 12:310.

49. Rukke BA, Hage M, Aak A. Mortality, fecundity and development among bed bugs
(Cimex lectularius) exposed to prolonged, intermediate cold stress. Pest Manag Sci 2017;
73:838.
50. Sierras A, Wada-Katsumata A, Schal C. Effectiveness of Boric Acid by Ingestion, But Not
by Contact, Against the Common Bed Bug (Hemiptera: Cimicidae). J Econ Entomol 2018;
111:2772.
51. Hentley WT, Webster B, Evison SEF, Siva-Jothy MT. Bed bug aggregation on dirty laundry:
a mechanism for passive dispersal. Sci Rep 2017; 7:11668.
Topic 4027 Version 29.0
GRAPHICS
Bedbugs
Bedbugs are reddish brown, have six legs, and are similar in size to a dog tick. They have flat, oval
bodies and needle-like, retroverted mouthparts. The eyes are widely separated.
Courtesy of Dirk M Elston, MD.
Graphic 60747 Version 4.0
Bedbug bites
Multiple erythematous papules on the trunk of a patient with bedbug bites.
Reproduced with permission from: www.visualdx.com. Copyright VisualDx. All rights reserved.
Bedbug bites
A bedbug bite most often appears as a wheal with a central, hemorrhagic punctum.
Courtesy of Nigel Hill, PhD.
Bedbug bites
Multiple erythematous papules on the legs.
Bedbug bites - "Breakfast, lunch, and dinner"
Rows of hemorrhagic macules and papules on this patient with bedbug bites. The phrase "breakfast,
lunch, and dinner" has been used to describe this distribution.
Bedbug versus bat bug
The lateral hairs behind the head are shorter in the human bedbug (A) than in the bat bug (B). Hairs
shorter than the diameter of the eye are present in the bedbug. Hairs longer than the diameter of the
eye are found in the bat bug.
Flea bites ankle
Four flea bites clustered on an ankle.
Reproduced with permission from: Goodheart HP, MD. Goodheart's Photoguide of Common Skin Disorders, 2nd Edition.
Philadelphia: Lippincott Williams & Wilkins, 2003. Copyright © 2003 Lippincott Williams & Wilkins.
Scabies
Erythematous papules and nodules on the buttocks.
Scabetic burrow
Erythematous, linear scabetic burrow.
Prurigo nodularis
Discrete, excoriated nodules on the leg of a patient with nodular prurigo.
Urticaria
Skin-colored wheals are present.
Reproduced with permission from: Goodheart HP. Goodheart's Photoguide of Common Skin Disorders, 2nd Edition.
Philadelphia: Lippincott Williams & Wilkins, 2003. Copyright © 2003 Lippincott Williams & Wilkins.
Dermatitis herpetiformis
Multiple erythematous papules and vesicles are present on the knees.
Pityriasis lichenoides et varioliformis acuta
Multiple inflammatory papules are present. Some lesions demonstrate necrosis and crusting.
Lymphomatoid papulosis
Multiple inflammatory papules are present on the trunk. Some lesions have overlying crust.
Comparison of representative topical corticosteroid preparations (classified

according to the United States system)
Available
strength(s),
Potency Vehicle Brand names
Corticosteroid percent
group* type/form (United States)
(except as
noted)
Super-high Betamethasone Ointment Diprolene 0.05

potency dipropionate, (optimized)
(group 1) augmented
Gel, lotion [Generic only] 0.05
Clobetasol Cream, ointment Temovate 0.05

propionate
Gel, solution [Generic only] 0.05
(scalp)
Cream Tasoprol 0.05
Cream (emollient Temovate E ¶ 0.05

base)
Lotion, shampoo, Clobex 0.05

spray aerosol
Foam aerosol Olux, Olux-E, 0.05

Tovet
Lotion Impeklo 0.05
Ointment Clobetavix 0.05
Shampoo Clodan 0.05
Solution (scalp) Cormax ¶ 0.05
Diflucortolone Ointment, oily Nerisone Forte 0.3

valerate (not cream (United Kingdom,
available in United others)
States)
Fluocinonide Cream Vanos 0.1
Flurandrenolide Tape (roll) Cordran 4 mcg/cm 2
Halobetasol Lotion Ultravate 0.05

propionate
Cream, ointment [Generic only] 0.05
Foam Lexette 0.05
High potency Amcinonide Ointment Cyclocort ¶ , 0.1

(group 2) Amcort ¶
Betamethasone Ointment Diprosone ¶ 0.05

dipropionate
Cream, Diprolene AF 0.05

augmented
formulation (AF)
Clobetasol Cream Impoyz 0.025

propionate
Desoximetasone Cream, ointment, Topicort 0.25

spray
Gel Topicort 0.05
Diflorasone Ointment ApexiCon ¶ , 0.05

diacetate Florone ¶
Cream (emollient) ApexiCon E 0.05
Fluocinonide Cream, gel, Lidex ¶ 0.05

ointment, solution
Halcinonide Cream, ointment, Halog 0.1

solution
Halobetasol Lotion Bryhali 0.01

propionate
High potency Amcinonide Cream Cyclocort ¶ , 0.1

(group 3) Amcort ¶
Lotion Amcort ¶ 0.1
Betamethasone Cream Diprosone ¶ 0.05

dipropionate (hydrophilic
emollient)
Betamethasone Ointment Valisone ¶ 0.1

valerate
Foam Luxiq 0.12
Desoximetasone Cream, ointment Topicort, Topicort 0.05

LP ¶
Diflorasone Cream Florone ¶ , Psorcon 0.05

diacetate
Diflucortolone Cream, oily cream, Nerisone (United 0.1

valerate (not ointment Kingdom, others)
available in United
States)
Fluocinonide Cream (aqueous Lidex-E ¶ 0.05

emollient)
Fluticasone Ointment Cutivate ¶ 0.005

propionate
Mometasone Ointment Elocon ¶ 0.1

furoate
Triamcinolone Cream, ointment Aristocort HP ¶ , 0.5

acetonide Kenalog ¶ ,
Triderm
Medium potency Betamethasone Spray Sernivo 0.05

(group 4) dipropionate
Clocortolone Cream Cloderm 0.1

pivalate
Fluocinolone Ointment Synalar 0.025

acetonide
Flurandrenolide Ointment Cordran 0.05
Fluticasone Cream Cutivate ¶ 0.05

propionate
Hydrocortisone Ointment Westcort ¶ 0.2

valerate
Mometasone Cream, lotion, Elocon ¶ 0.1

furoate solution
Triamcinolone Cream Kenalog ¶ , 0.1

acetonide Triderm
Ointment Kenalog ¶ 0.1
Ointment Trianex, Tritocin 0.05
Aerosol spray Kenalog 0.2 mg per 2

second spray
Dental paste Kourzeq, Oralone 0.1
Lower-mid Betamethasone Lotion Diprosone ¶ 0.05

potency dipropionate
(group 5)
Betamethasone Cream Beta-Val ¶ , 0.1
valerate Valisone ¶
Desonide Ointment DesOwen ¶ , 0.05

Tridesilon ¶
Gel Desonate, DesRx 0.05
Fluocinolone Cream Synalar 0.025

acetonide
Flurandrenolide Cream, lotion Cordran, Nolix 0.05
Fluticasone Lotion Beser ¶ , Cutivate ¶ 0.05

propionate
Hydrocortisone Cream, lotion Locoid, Locoid 0.1

butyrate Lipocream
Ointment, [Generic only] 0.1

solution
Hydrocortisone Cream Pandel 0.1

probutate
Hydrocortisone Cream Westcort ¶ 0.2

valerate
Prednicarbate Cream (emollient), Dermatop ¶ 0.1

ointment
Triamcinolone Lotion Kenalog ¶ 0.1

acetonide
Ointment Kenalog ¶ 0.025
Low potency Alclometasone Cream, ointment Aclovate ¶ 0.05

(group 6) dipropionate
Betamethasone Lotion Beta-Val ¶ , 0.1

valerate Valisone ¶
Desonide Cream DesOwen, 0.05

Tridesilon
Lotion DesOwen ¶ , 0.05

LoKara ¶
Foam Verdeso 0.05
Fluocinolone Cream, solution Synalar 0.01

acetonide
Shampoo Capex 0.01
Oil Δ Derma- 0.01

Smoothe/FS Body,
Derma-
Smoothe/FS Scalp
Triamcinolone Cream, lotion Kenalog ¶ , 0.025

acetonide Aristocort ¶
Least potent Hydrocortisone Cream Ala-Cort, Hytone ¶ , 2.5

(group 7) (base, ≥2%) Nutracort ¶
Ointment Hytone ¶ 2.5
Lotion Hytone ¶ , Ala 2

Scalp, Scalacort
DK
Solution Texacort 2.5
Hydrocortisone Ointment Cortaid ¶ , 1

(base, <2%) Cortizone 10,
Hytone ¶ ,
Nutracort ¶
Cream Ala-Cort, Cortaid ¶ , 1

Cortizone 10,
Hytone ¶ ,
KeriCort,
Synacort ¶
Gel Cortizone 10 1
Lotion Aquanil HC, 1

Cortizone 10,
Sarnol-HC
Spray Cortaid ¶ 1
Solution Cortaid ¶ , Noble ¶ , 1

Scalp Relief,
Scalpicin
Cream, ointment Cortaid ¶ 0.5
Cream Instacort 0.5
Hydrocortisone Cream MiCort-HC ¶ 2.5

acetate
Cream Vanicream HC 1
Lotion Nucort 2
* Listed by potency according to the United States classification system: group 1 is the most potent,
group 7 is the least potent. Other countries use a different classification system with only 4 or 5
groups.
¶ Inactive United States brand name for specific product; brand may be available outside United
States. This product may be available generically in the United States.
Δ 48% refined peanut oil.
Data from:
1. Lexicomp Online. Copyright © 1978-2024 Lexicomp, Inc. All Rights Reserved.
2. Tadicherla S, Ross K, Shenefelt D. Topical corticosteroids in dermatology. Journal of Drugs in Dermatology 2009;
12:1093.

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21/2/24, 19:49 Bedbugs - UpToDate

Official reprint from UpToDate®

Literature review current through: Jan 2024.

Correct identification of bedbugs is important for implementing proper control measures.

Bedbugs respond to aggregation pheromones, resulting in clustering behavior, although

The classic appearance of a bedbug bite reaction is a 2 to 5 mm erythematous papule or

When to suspect bedbug infestation — In general, bedbug bites should be suspected in

Features that support a diagnosis of bedbugs include:

Confirming the diagnosis — The presence of bedbugs is necessary to confirm the

Scabies is a common disorder caused by infestation of Sarcoptes scabiei. Patients often

by exposure to someone with bedbugs, skin symptoms secondary to other disorders,

● Delusional infestation (also called delusional parasitosis or Ekbom syndrome) –

Psychologic support — Victims of bedbug infestations may experience varying degrees of

Examples of psychosocial effects of infestation include [37,38]:

● Patients may be shunned by friends or others in the community.

● Patient or employer concerns can lead to suspension of work.

● Management of infestations can be disruptive and expensive.

● Patients experiencing significant psychologic distress over an infestation may engage in

Eradication of bedbugs is difficult because of their continual production of new, discrete

Preferred methods of eradication include application of insecticides and heat treatment.

Although ingestion of boric acid by bedbugs has successfully killed bedbugs in an

Certain measures may be helpful for preventing bedbug infestation [3]:

SOCIETY GUIDELINE LINKS

INFORMATION FOR PATIENTS

● Basics topics (see "Patient education: Bedbugs (The Basics)")

SUMMARY AND RECOMMENDATIONS

● Epidemiology – Bedbugs are present worldwide. Spread of infestation can occur

● Clinical manifestations – Skin reactions to bedbugs vary, ranging from no reaction to

● Diagnosis – Confirmation of the diagnosis of bedbug bites requires detection of

● Infestation management – Management of bedbug infestation consists of eradication

● Patient management – Bedbug bites resolve spontaneously. Topical corticosteroids

Use of UpToDate is subject to the Terms of Use.

1. Liebold K, Schliemann-Willers S, Wollina U. Disseminated bullous eruption with systemic

hemipterus. Parasit Vectors 2019; 12:310.

Courtesy of Dirk M Elston, MD.

Graphic 60747 Version 4.0

Multiple erythematous papules on the trunk of a patient with bedbug bites.

Graphic 75123 Version 8.0

Courtesy of Nigel Hill, PhD.

Graphic 79870 Version 3.0

Multiple erythematous papules on the legs.

Graphic 97911 Version 3.0

Bedbug bites - "Breakfast, lunch, and dinner"

Graphic 62345 Version 7.0

Bedbug versus bat bug

Graphic 66148 Version 2.0

Flea bites ankle

Four flea bites clustered on an ankle.

Graphic 78799 Version 1.0

Erythematous papules and nodules on the buttocks.

Graphic 75169 Version 9.0

Erythematous, linear scabetic burrow.

Graphic 53715 Version 9.0

Discrete, excoriated nodules on the leg of a patient with nodular prurigo.

Graphic 53475 Version 6.0

Skin-colored wheals are present.

Graphic 50151 Version 2.0

Multiple erythematous papules and vesicles are present on the knees.

Graphic 86751 Version 2.0

Pityriasis lichenoides et varioliformis acuta

Graphic 83096 Version 6.0

Graphic 77791 Version 6.0

Comparison of representative topical corticosteroid preparations (classified