Bites and stings

Published on 19/03/2015 by admin

Filed under Dermatology

Last modified 19/03/2015

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Bites and stings

Dirk M. Elston

Evidence Levels:  A Double-blind study  B Clinical trial ≥ 20 subjects  C Clinical trial < 20 subjects  D Series ≥ 5 subjects  E Anecdotal case reports


This chapter presents strategies for the prevention and management of bites and stings.

Management strategy

Bite reactions

DEET is effective against a broad range of arthropods. Picaridin is effective against mosquitoes. Permethrin can be used on fabric. A veterinarian should be consulted about flea infestation in pets. Antivenin is available for many arachnid toxins, but most respond to rest, ice, and elevation.

If prevention fails, second line treatments aim to improve pruritus. Topical antipruritics, such as 1/4% camphor and menthol, and topical anesthetics, such as pramoxine and lidocaine, can be helpful. For persistent bite reactions, topical or intralesional corticosteroids may be helpful.

Specific investigations

PCR assays can also be used to identify biting insects too small for conventional identification. Tryptase levels can be used in forensic investigations to confirm death from anaphylaxis

First-line therapy

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image DEET A
image Permethrin A
image Picaridin B
image Combinations of DEET and permethrin A
Flea treatments for pets  
image Lufenuron A
image Fipronil A
image Imidacloprid A
image Epinephrine A
image Immunotherapy A
Spider bites  
image Rest, ice, and elevation B
image Tetracycline or triamcinolone for brown recluse bites C
image Antivenin for brown recluse bites C
image Antivenin for black widow and red-black spider bites A
Scorpion stings  
image Antivenin for stings in Arizona B
image Prazosin for Indian red scorpion stings A
Arthropod-borne infections  
image Lyme borreliosis  
 – Tetracycline A
 – Amoxicillin in children A