Flea Image

Mosquito Image

Of course, you can get bitten at any time of the year, but summers are worse. The most common offenders are mosquitoes, mayflies, fleas and black flies especially up north in New Hampshire). We have separate concerns about tick bites and spider bites (see below).

"The insects love me!!" Some people do seem more prone to bites than others. Why? It's probably a combination of factors. Perfumes and foods attract insects. Some people also react more to bites than others. When a mosquito bites someone, it actually injects a little of its saliva (yucchhh!). What we all a "bite" is actually a reaction to this saliva, and some people are more allergic to it than others.

Can you tell what is biting? Usually not, unless you see the insects. When the bites are in a cluster, it suggests flea bites. Certain ant bites have a very characteristic appearance.

Prevention
Insect repellents containing DEET are still considered the best, reports about other products including catnip notwithstanding. If used correctly, DEET is safe. (The reports of toxicity have all been cases where it was used to excess, where it was abused). For small children, a lower strength (10-15%) is preferred. I prefer the drops to the sprays. It's also a good idea to avoid the use of fragrance when exposed to biting insects and to be sure any food is cleansed off the skin.

Appearance
Most of us know what bites look like. There is a central point (or puncta) within the bump. Sometimes the reaction may get very large or even blister.

Treatment: for mild reactions, soothing products such as calamine lotion or anti-itch products, such as one we carry in the office or many others available at pharmacies are enough. We do not recommend the use of topical Benadryl (diphenhydramine) products because of their risk of sensitization reactions. For more severe reactions, we may prescribe steroid creams.

Ticks

Deer Ticks

Unfortunately, Rhode Island and the neighboring states have a very high incidence of Lyme disease. This is transmitted by the deer tick, which is very small. The disease is caused by bacteria called Borrelia which are transmitted by the tick bite. Around here the deer tick is carried not only by deer but by the white-footed mouse, which lives in everyone's backyard.

When to suspect Lyme: If you've had a tick bite (or think you might have had) and a rash develops at the site which keeps enlarging (they say 8 cm. which is more than 3 inches). Then you should see us. If we suspect Lyme, we'll order a blood test and may do other evaluation. You can get Lyme without a rash. If you've had a tick bite and develop muscle or joint aches, you should probably be evaluated by someone expert in Lyme, such as an infectious disease specialist. Lyme is treated with antibiotics. Ticks may transmit diseases other than Lyme.

How to remove a tick: It is generally recommended to grasp the tick with a forceps near the head and lift it gently away from the skin. If the mouth parts break off, they should also be removed.

Brown Recluse Spider

Black Widow Spider

Spider Bites

Spider bites can look just like insect bites (spiders are not insects). However, they may sometimes be more severe and result in skin breakdown (necrosis). If this happens, you should consult us.

There are two types of spider around here which are venomous, the black widow spider and the brown recluse spider. We recommend that you try to know what these look like (it's quite easy to pull up pictures of these spiders online). If you do get bitten by a spider and are able to capture it for identification, this might be helpful. The black widow spider is jet black with a red "hourglass" shape on its abdomen. The brown recluse spider is smaller and brown with a light brown violin-shaped form on it. If you do get bitten by a black widow spider or a brown recluse spider, or if you are not sure, or for any severe bite reaction, you should consult us immediately. For extremely severe reactions, trouble breathing or massive swelling, you should go at once to the emergency room. There is an antivenin available for the black widow bite. The brown recluse bite reaction may be extremely debilitating and cause massive tissue breakdown (necrosis), needing hospital admission, - and this may come several days later - so it is important not to delay in seeking help. The attached illustrations show the severity of tissue breakdown that may occur. They are extremely graphic and not for the faint-of-heart, so please use your judgment before viewing them. Early intervention may help prevent this awful situation.

Bee Stings

Bee Image

The two most important things to know about a bee sting are these. First, if you know you are allergic to bee stings, you should consult your primary doctor or an allergist about it before you are exposed to bees again, and should probably equipped with an emergency source of epinephrine, such as an Epipen, as delays in treatment may be life-threatening. The allergists sometimes offer desensitization protocols. If you did not previously know you were allergic and start to develop severe symptoms, such as wheezing, trouble breathing, feeling faint or massive swelling, you should get emergency treatment ASAP. The second concern is how to remove the stinger of a bee. When a bee stings, it leaves the stinger behind in you (then dies). This stinger is full of venom. You do not want to inject more venom into you in the process of removing it. So the best way to do it is to grasp the tip of the stinger firmly with a forceps (or two wooden sticks, if there is no forceps available) and pull it gently out. Icepacks may then be helpful until you seek more care.

Contact us or your physician if you have any questions or concerns about bug bites.