Bedbugs are back. This is likely due to increased international air travel and pesticide resistance.

It isn’t something many people like to talk about, as it seems, erroneously, to be associated with poor hygiene. However, reportedly up to 5 percent of hotels are infested. So while traveling, you can take some of these unwanted pests home. Chicago and New York’s Upper East Side seem to suffer extensively, and successful litigation has been brought in some instances against hotels.

Recently, an unfortunate patient was suffering from skin rashes mostly on her upper torso and arms. She thought they were from fleas, but I thought otherwise. She volunteers in a recycled clothing and housewares shop for a local charity where people bring in old clothes, mattresses, furniture and such. The bites were characteristic of Cimex lectularius, the bedbug, a reddish brown, oval shaped critter under 5 mm long.

When bedbugs move in, they’re hard to get them out. DDT and other toxins were effective at eliminating them in the past, but have been restricted due to environmental concerns, so bedbugs are on the rise again.

They’re group feeders, bloodsuckers, so bites occur in groups or in rough rows (“breakfast, lunch, and dinner” bites) usually on face, neck, upper torso, arms and hands. The bites may be easily mistaken for scabies, an allergic reaction, certain skin rashes or other kinds of insect bites. They may appear as red spots, blisters or hives. Scratching can lead to secondary bacterial infections although bedbugs don’t transmit disease. Some folks can even be overwhelmed with anxiety and develop secondary delusional parasitosis, long past when the bedbug infestation has been successfully eliminated.

Bedbugs hide in cracks in furniture and mattresses, and come out to feast on your gentle flesh. Heat can be used to destroy them such as washing clothes and drying them at high temperatures, steaming the mattresses or even putting bedclothes in a bag and leaving them in a hot car for a few hours to bake the heck out of the annoying creatures and their eggs. Vacuuming carefully, repeatedly, can remove them physically. Many effective chemical pesticides are available including pyrethroids, dichlorvos and malathion. Re-treatments are often needed, no matter what method you use.

Some folks have a significant allergic reaction to the bites and the saliva, anti-coagulants and other yuck they secrete. Bites are best treated with topical steroids or antihistamines though herbal therapies like aloe and lavender can be useful.

To prevent bedbugs, inspect secondhand items, especially used mattresses or upholstered furniture carefully before bringing it inside your home. If you’re traveling, check mattresses for bedbug droppings and don’t put your luggage on the floor. Long pajamas can keep them off as they don’t tend to burrow under clothing. Mainly, be aware of them and see your doctor if you have questions about the typical skin rash.

As momma used to say, “Good night, sleep tight, don’t let the bed bugs bite.”

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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