Insect Bites And Stings

Overview

Insect bites and stings are small injuries to the skin caused by insects and other small creatures. A bite happens when an insect pierces the skin to feed — for example, a mosquito, flea, bedbug or tick. A sting happens when an insect or creature injects venom through a sharp point — for example, a bee, wasp, hornet, ant or scorpion. Most bites and stings cause a red, itchy or sore lump that settles on its own within a few days.

Very common. Almost everyone gets bitten or stung at some point, especially in spring and summer or when spending time outdoors.

Anyone can be bitten or stung. Children tend to get more bites because they play outside and may react with bigger swellings. People who work or spend a lot of time outdoors, campers, gardeners, travellers to warm or wooded areas, pet owners, and people with an allergy to insect venom are more likely to be affected.

Symptoms

Common symptoms

• A small red, itchy lump at the site of the bite
• Swelling and warmth around the bite, which may grow over a day or two
• Pain, burning or a sharp prick at the moment of a sting
• A small pale or fluid-filled blister, or a tiny puncture mark
• Itching that is worse at night or in warm conditions
• A patch of redness that fades when you press it

Symptoms in children

• Larger swellings than adults get from the same bite, especially with mosquito bites
• Fussiness, poor sleep or crying more than usual because of itching
• Scratching until the skin bleeds, which raises the risk of infection
• A hard, warm, red lump that lasts several days
• Fever or general irritability in young children — worth checking with a doctor

Symptoms in older adults

• Thinner, more fragile skin that bruises or breaks more easily
• Bites that take a little longer to heal
• Bigger bruising around a sting
• Higher chance of infection, especially if the skin is already damaged
• More noticeable reactions if you take medicines that thin the blood or affect the immune system

Causes

Main causes

• Bites from mosquitoes, midges, fleas, bedbugs, ticks, horseflies and sandflies, which pierce the skin to feed
• Stings from bees, wasps, hornets, ants and scorpions, which inject venom
• Spider bites, which are usually mild in cooler climates
• Reactions to the insect's saliva or venom, which is what causes the itch and swelling
• Occasionally, an infection picked up from the bite itself, such as a tick-borne illness

Risk factors

• Spending time outdoors, especially at dawn and dusk when many insects are most active
• Warm, humid weather and travel to tropical or wooded areas
• Camping, hiking, gardening, farming or other outdoor work
• Standing water, flowering plants, rubbish and uncovered food or sugary drinks nearby
• Perfumes, scented toiletries and bright or dark clothing that can attract insects
• Having pets, which can bring fleas into the home
• A previous allergic reaction to a sting, which makes future reactions more likely
• A weakened immune system or medicines that affect the immune system

When to see a doctor

See a doctor urgently if:

• Signs of infection — increasing redness, heat, swelling, pain, pus, or a fever
• Any breathing difficulty, throat swelling or feeling faint after a sting — call emergency services first
• A tick bite with a spreading rash or flu-like illness
• A sting in the mouth or throat, or around the eye
• Many stings at once, or feeling unwell after several stings
• A bite that keeps getting bigger or does not start to settle after about a week

Book a routine appointment if:

• Bites that keep itching and interrupting sleep
• A large local reaction that is uncomfortable but not spreading
• Repeated reactions to stings and you would like advice about allergy testing
• You are unsure whether a mark is a bite or something else
• You are planning travel to an area where insects carry disease and want advice before you go

Diagnosis

A doctor or nurse can usually tell what it is by asking what happened and looking at your skin. They will check the size, warmth and tenderness of the area, and ask about travel, time outdoors, pets, and any previous reactions. In most cases no tests are needed.

Tests that may be done

• Usually none — the diagnosis is made from your story and an examination
• A skin swab if the area looks infected
• Blood tests if a tick-borne or travel-related infection is suspected
• Referral to an allergy clinic for testing if you have had a severe reaction to a sting

What to expect at your appointment

The appointment is usually short and simple. Your doctor will look at the bite and ask a few questions, then explain what to do at home and when to come back. If they think the area is infected, they may offer treatment and ask you to return if it is not improving in a few days.

Treatment

Most bites and stings heal on their own with simple home care. The aims are to ease itching and pain, keep the skin clean, and watch for signs of infection or a severe allergic reaction.

Self-care at home

• Wash the area gently with soap and water.
• If a bee has left its stinger in the skin, scrape it out sideways with a fingernail or the edge of a card — do not squeeze it.
• Hold a cold pack wrapped in a cloth against the area for 10 to 15 minutes at a time to reduce swelling and pain.
• Keep the skin clean and dry, and cover any open area with a light dressing.
• Try not to scratch — keep nails short and consider covering the bite at night, especially for children.
• Ask your pharmacist about suitable over-the-counter options to ease itching or pain, including what is safe for children and what suits you alongside any other medicines you take.
• Raise the limb if the swelling is uncomfortable.
• Watch the area for a few days for signs of infection.

Medical treatments

If the skin looks infected, a doctor may prescribe a medicine to treat the infection, and you may be asked to come back for a check. For a large, uncomfortable local reaction, a doctor may suggest a short course of treatment to calm the swelling and itch. If you have had a severe allergic reaction, you will be treated in hospital straight away and may be given emergency medicines and a follow-up plan. People with a confirmed venom allergy may be referred to a specialist allergy clinic, where treatments to reduce sensitivity over time may be discussed. Always ask your own healthcare team what is suitable for you.

When is surgery considered?

Surgery is almost never needed. Occasionally, if a bite becomes a painful collection of pus (an abscess), a doctor may need to make a small opening to drain it.

Living with this condition

Most people carry on as normal. Keep the area clean, resist scratching, and check it once a day for increasing redness, heat, pain or pus. If you have had a bad reaction before, tell family, friends or colleagues what to do in an emergency and keep any emergency plan your doctor gave you close by.

Lifestyle tips

• Cover up with long sleeves and trousers when outdoors, especially in the evening.
• Use an insect repellent suitable for your age and circumstances — ask your pharmacist for advice.
• Keep food and sweet drinks covered, and check open cans before drinking.
• Use screens or nets on windows and sleep under a net when travelling to areas where insects carry disease.
• Check yourself, children and pets for ticks after time in long grass or woodland, and remove any tick promptly and correctly.
• Keep pets treated for fleas and wash bedding if fleas are in the home.

Diet and exercise

No special diet is needed. Eating well and staying active support general healing and wellbeing. If a sting or bite makes exercise uncomfortable, take it easier for a day or two and return to your normal routine as it settles.

Mental health and emotional wellbeing

A severe reaction can be frightening, and it is common to feel anxious around insects afterwards. Some people develop a strong fear of bees or wasps, or find themselves avoiding parks and gardens. These feelings usually ease with time, but they are worth mentioning to your doctor if they affect your daily life. If you ever feel overwhelmed or in crisis, contact your local emergency number or a crisis support service in your country straight away — you deserve help and you do not have to cope alone.

Prevention

You cannot avoid every insect, but you can greatly reduce your chance of being bitten or stung. Covering up, using repellent, avoiding nests and flowering areas where insects gather, and checking for ticks after being outdoors all help.

Vaccines

There is no routine vaccine against insect bites or stings. However, some vaccines are recommended for travel to certain parts of the world where insects spread serious diseases. If you are planning a trip, ask a travel health service or your doctor well in advance.

Screening programmes

There is no screening test for insect bites or stings. Checking your skin after time outdoors is the most useful thing you can do.

Complications

If left untreated

• Skin infection, where the area becomes red, hot, swollen, painful, or leaks pus
• An abscess — a painful pocket of pus that may need draining
• A severe allergic reaction (anaphylaxis), which is rare but life-threatening and needs emergency treatment
• Diseases spread by ticks or mosquitoes in some parts of the world
• Persistent itchy lumps that last weeks, especially in children
• Scarring or dark marks left where the skin was scratched

Long-term outlook

For the great majority of people, a bite or sting is a short, minor nuisance that settles within a few days with simple home care. Serious reactions are uncommon, and when they do happen, modern emergency care is very effective. Learning the warning signs and knowing when to get help means you can deal with most situations calmly and confidently.

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