Are Over-the-Counter Bug Bite Treatments Useless?

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Mosquitoes, chiggers, fleas — oh my! As warmer days approach, so do the biting bugs, which means plenty of itching and irritation to go around. Most people use over-the-counter creams or antihistamine pills to relieve their discomfort, but a new report questions whether such salves do as much good as we think.

The Drug and Therapeutics Bulletin (DTB) released a report on Wednesday finding that after reviewing the evidence, there was little support for the use of over-the-counter remedies for bug bites. “We didn’t find much published evidence for the various medicines that are used to treat simple insect bites,” says David Phizackerley, the deputy editor of the DTB. “Guidance on the management of simple insect bites is based on expert opinion rather than direct evidence from clinical trials.”

Further, the authors concluded that in many cases the symptoms from bug bites are self-limiting and no treatment may be needed.

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The DTB looked at popular remedies including antihistamine tablets, oral and topical steroids, creams containing painkillers and anesthetics such as lidocaine and benzocaine, or combined with antihistamines and antiseptics, and the prescription anti-itch lotion Crotamiton.

Antihistamine tablets are widely recommended to stop itching, but the DTB says there is little evidence to support their use. The researchers claim that topical antihistamines are also “only marginally effective, occasionally cause sensitization, and…use for longer than three days is not recommended.”

Oral and topical steroids, which are often used to treat the inflammation that accompanies bug bites, also lack supporting evidence, the DTB says. They warn that steroid creams should not be used on broken skin — which is hard to avoid after so much itching and scratching — and recommend them only for the treatment of with eczema.

Patients won’t feel much relief from Crotamiton either. The report says there is “no hard evidence” for its use and cites the opinion of the British National Formulary — a medical and pharmaceutical reference book — that it is “of uncertain value.”

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It is important to note that while the DTB report sheds light on a medical evidence deficit, it doesn’t state that treatments do not work, and it does not recommend that people stop using medicines prescribed by their physicians, especially if they’re experiencing an allergic reaction. By all means, treat that.

Here’s how the DTB advises treating insect bites:

For mild local reactions, the area should be cleaned and a cold compress applied. Oral analgesics can be given for pain, and a mild corticosteroid cream applied to reduce inflammation and itching. Large local reactions can be treated with an oral antihistamine. Non-sedating antihistamines are preferred during the day, but a sedating antihistamine can be of use at night if sleep is disturbed. Antibacterial treatment is not required for simple insect bites, but secondary infections should be treated with an oral antibacterial agent in accordance with local guidelines.

The report was published in the British Medical Journal.

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