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12:36 PM

'Skeeter Syndrome': Is My Kid's Bug Bite Infected?

When to see your pediatrician after an insect bite, including mosquitoes and ticks

School’s out for summer! It’s time for playing at the park, swimming and catching lightning bugs. Unfortunately, it’s also the time when I see many office visits related to insect bites and their complications. It seems like no matter how hard I try to prevent them, my kids always end up with at least a few itchy bug bites. Parents are often concerned about whether or not a big red swollen spot is infected and if it needs antibiotics.

Most people develop some redness and itching after a mosquito bite. Unfortunately, some children will have what’s known as a large local reaction, or “Skeeter syndrome.” This happens due to an allergy to mosquito saliva. These patients develop redness and swelling within hours of a mosquito bite. The swelling can be very large (like an entire arm or leg) and typically worsens over 1-2 days. In the worse reactions there can be bruising and even blistering!

It’s not always easy even for your doctor to tell the difference between “Skeeter syndrome” and a skin infection. One of the big differences is the timeline. Skin infections usually happen several days after a bite or an injury, but “Skeeter syndrome” usually starts within a few hours of a bite. Most often children with a large local reaction will complain about intense itching. Only in the more severe cases are pain and fever seen with allergy. It’s not common, but some even develop severe allergic reactions to mosquito bites that lead to difficulty breathing.

Large local reactions are best treated with oral antihistamines (Benadryl or Zyrtec) and topical over-the-counter steroid cream (hydrocortisone 1 percent). Fingernails need to be trimmed very short, because scratching causes local skin damage that can become infected. Cold compresses several times a day help alleviate some of the discomfort. In patients who have a history of this type of reaction, I recommend daily antihistamines such as Zyrtec during the time of the year when bites are difficult to avoid. This doesn’t totally prevent the reaction, but can help keep the swelling from being as extreme. I don’t recommend topical antihistamines (Benadryl cream) because some people develop a contact allergy that actually worsens the problem

So, when should you come to the doctor? 

Any child with significant eyelid swelling or swelling that is limiting activity or skin blistering deserves an office visit because they require further evaluation and sometimes even need oral steroids or more potent prescription topical steroids. Red/swollen/hot areas of skin that are associated with pain or fever should also be examined to rule out a bacterial infection.

Tick bites don’t usually cause itching like mosquitos, but are more of a concern due to infections they can transmit. Ticks are predicted to be more prevalent this summer due to the winter being relatively warm. Ticks can transmit several infections with Lyme being one that is often discussed.

If you find a tick on your child it should be removed with tweezers by grasping the tick as close to the skin as possible and pulling straight up. Different types of ticks spread different infections. For example, infected deer ticks can spread Lyme after being attached for 36 hours or longer. Certain areas of the country have a much higher rate of local tick infection than others. Texas is not a part of that area, but cases of Lyme do occur every year.

It is best if children bathe after coming in from playing outside to wash off ticks prior to attachment. It’s a good idea to look in hidden areas such as behind the ears and on the scalp. Remove ticks if you find them and watch for a rash. Certainly, a rash that looks like a bull’s eye or a target (erythema migrans) is concerning for Lyme infection and needs to be seen for further testing.

Insect bite avoidance is important (and hard)! The large local reactions are definitely very uncomfortable, but infections transmitted by mosquitos such as West Nile or Lyme from ticks are potentially very dangerous. Using DEET containing insect repellant and wearing long sleeves during peak mosquito times are helpful.

As always, see your pediatrician if you are worried about a bite or rash and we are happy to help.



Get to know Devona Martin, M.D.

Dr. Devona Martin joined the Willow Park practice in 2016 after working as a hospitalist at Cook Children's Medical Center since 2012. She grew up in East Texas and attended Baylor University. There she was a University Scholar, spent a semester in The Netherlands studying the history of medicine, and graduated with honors. Her medical training was at Texas Tech University Health Sciences Center in Lubbock where she was inducted into the Alpha Omega Alpha honor society. Pediatric residency training was also completed at Texas Tech where she served as chief resident. She is a member of the American Academy of Pediatrics and is a board-certified pediatrician. To make an appointment with Dr. Martin, call 817-567-2114 or click here. Follow Willow Park's Facebook page by clicking here.

Comments 1 - 5 (5)
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My one and a half year old daughter was outside playing and she got bit by something I would assume it was a mosquito the next day we saw very large welts on her back in 2 spots!
I have to go through this awful cycle with mosquito bites ever summer, and being an avid hiker and swimmer, it’s lousy. No matter how much DEET spray I use, if there is one tiny section of my body that I miss with the spray, a mosquito will find it! Wearing long sleeves and pants is not practical, since it’s usually 90+ degrees during these summer excursions.

At first I didn’t know why every single bite seemed to get infected, but apparently I’m more sensitive to mosquito saliva than most. Many times I’ve had to visit the doctor to get antibiotics and steroid cream for them, because the small half inch bite would morph into this gigantic weeping red puffy splotch with a 2 inch diameter, within a few days. A few times, they began to resemble ringworm or Brown Recluse bites, and they would often form large blisters. The odd part is, this only began happening around age 35 – previous to that, the bite would just be a small red bump that would heal on its own.

Throughout this 5 year battle, I’ve found a few things that help. 1) The morning before an outdoor adventure, thoroughly cleanse your body with soap that contains chlorhexidine gluconate, which is an ingredient found in soaps that doctors for surgery prep, because it provides 24 hours of continual bacteria prevention on the skin. The one I use is called Hibiclens, and is available for about 10 bucks at most drug stores. This has been instrumental for infection prevention, and I would say has decreased the reaction by about 70 percent. The soap is designed to kill bacteria for 24 hours. Online, you can also find chlorhexidine wipes, which are perfect if you’ll be camping for a few days or weeks, and don’t have regular access to showers. I always carry the wipes with me, that way if I do get any type of bug bite, I can wipe down the area immediately.

2) My other savior has been an essential oil mixture called Thieves Oil. It contains oils of clove, lemon, cinnamon, rosemary, and eucalyptus. I make my own mixture, but you can buy a premade one online. This is also my go-to for any type of skin injury from paper cuts to acne, as it seems to be an ace at killing bacteria. Just dab some on the bite – it tingles a bit, but does relieve itching pretty well. If you have sensitive skin and don’t want to use it full-strength, mix it with 1 part witch hazel. After it dries, I like to apply some calamine lotion as well, for extra itch control.

These two simple steps have spared me from having to visit a doctor to get these bites resolved. I had some that got all the way up to 4 inches in diameter, and I had to do a 10 day antibiotic course. No thanks!! Hopefully these tips can help prevent suffering for my fellow mosquito magnets out there :)
Brooks Wade
For the last 8 years, once the mosquitos start biting, my arms look so bad I feel like a junkie trying to cover track marks. If the skin breaks from scratching, the sores won’t heal until winter. If you pull a scab, it’s covered with white “spikes” and the area under the scab is too. These things are frustrating and I don’t know where to turn.
Thank you in advance.
Jane Woods
Every summer brings an increased threat of diseases spread by ticks, mosquitoes, and other insects. As the mercury climbs and people spend more time outdoors, we are more exposed to bug bites and the illnesses they can bring. That danger has never been greater, and it looks like it will only get worse. According to one of the articles in everydayhealth numbers on some of these diseases have gone to astronomical levels. Also to the latest CDC figures, the number of so-called vector-borne diseases transmitted by bug bites more than tripled between 2004 and 2016. Reported cases surged from 27,388 to nearly 100,000 annually for a total of 642,602 cases — and those numbers may be vastly under reported. You can also refer to this article which states all the necessary details about bug bites
Scott Frankfather, MD
Nice article Devona! Very concise.