By Mark Oswell
WRNMMC Command Communications
After a day
outdoors, you reach down to scratch an itch on your leg and notice a red bump.
Tick? Poison ivy?
Summer brings not
only hot muggy days to the Mid-Atlantic region, but also a litany of bumps and
bites ranging from ticks to jellyfish stings.
“Some of the more
common pests include mosquitos, hymenoptera (wasp, bee, hornet, yellow jacket,
fire ant), ticks, blackflies, sandflies, and mites (or chiggers),” according to
Navy Lt. Cmdr. (Dr.) Diana Lindsey, Walter Reed National Military Medical
Center allergist/immunology fellow.
you cannot always identify what type of bug has bitten you,” according to Army
Capt. (Dr.) Casey Chern, WRNMMC staff dermatologist. In the United States, it’s
common to experience a bite or sting from mosquitoes, fleas, bedbugs, mites,
spiders, ticks, fire ants, bees, wasps and hornets.
“Most bug bites
and stings can be safely treated at home with topical medication, such as
hydrocortisone cream or ointment, or an oral antihistamine to reduce the itch,”
explained Chern. “However, sometimes a bug bite or sting could turn into
something serious, particularly if you have been bitten or stung by many
insects at the same time.”
Bed bugs - Summer
trips to new places or familiar haunts are a staple for many people. As such,
they sleep in unfamiliar places – a tent, a hotel bed, a friend’s guest room,
etc. And while most of these places are free and clear of creepy crawlies, bed
bugs remain an issue nationwide. Last year, numerous news articles noted an
uptick in bed bug incidents.
“Bed bug bites
may be more prevalent in the summer,” explained Army Maj. (Dr.) Martin Evans,
Walter Reed Bethesda staff allergist/immunology fellow. “It is not clear that
bed bugs are dormant in winter or whether people are more likely to travel in
summer. It does appear that people are more likely to receive bites in the
According to the Federal Trade Commission, bed
bugs are visible to the naked eye, but often hide in cracks and crevices. Other
signs of bed bugs are small dark spots and rusty or reddish stains on bed
sheets or mattresses caused by bed bugs being crushed.
recommends the best ways to prevent bed infestation while traveling are:
• Use luggage
racks to hold your suitcases when packing and unpacking
• Check the
mattress and headboard before getting into bed
• When you get
home, unpack directly into a washing machine, and wash and dry on the highest
• Inspect and
then vacuum all luggage, and empty the vacuum outside
can be found at: https://www.ncbi.nlm.nih.gov/pubmed/?term=Seasonal+variability+in+bed-bug
Although not poisonous, the bite from these mite larvae are known to create
severe itching and hives. The primary treatment for the itching is through the
use of antihistamines and corticosteroid creams or lotions, according to the
National Institutes of Health’s U.S. National Library of Medicine.
Heat Rash (aka
Prickly Heat) – According to Chern, heat rashes are caused by blocked sweat
glands. “Because the sweat cannot get out, it builds up under your skin, causing
a rash and tiny, itchy bumps. When the bumps burst and release sweat, many
people feel a prickly sensation on their skin.”
“Anything you can
do to stop sweating profusely will help reduce your risk,” said Chern.
Tips to help
sweat less and decrease the risk of getting prickly heat include: wearing
light-weight, loose-fitting clothes made of cotton; exercising outdoors during
the coolest parts of the day or moving your workout indoors where you can be in
air-conditioning; and keeping your skin cool by using fans, cool showers or
air-conditioning when possible.
ants - Although typically seen in the South, imported fire ants are an invasive
species that have recently crossed the Potomac into Maryland.
According to the
NIH’s National Institute for Occupational Safety and Health, “Fire ants bite
and sting. They are aggressive when stinging and inject venom, which causes a
burning sensation. Red bumps form at the sting, and within a day or two they
become white fluid-filled pustules.”
care is to rub off ants briskly, as they will attach to the skin with their
jaws. Antihistamines may help those with mild symptoms, but injectable
epinephrine might be necessary for severe allergic reactions. If the sting
causes severe chest pain, nausea, severe sweating, loss of breath, serious
swelling, or slurred speech – take the victim to an emergency medical facility
Jellyfish - There
are more than 2,000 types of jellyfish found in the world, with approximately
70 being harmful to humans. Jellyfish tentacles can still sting even after they
have washed up onto shore. According to the Smithsonian Institute, jellyfish
have special cells along their tentacles called cnidocytes. Within these cells
are harpoon-like structures full of venom, called nematocysts which shoot out
when triggered by touch and can penetrate human skin.
a myth about urine relieving jellyfish stings, that not the case. Pouring
freshwater—including urine—on the area will change the composition of the
solution surrounding the remaining cells and may actually trigger the release
of more nematocysts and venom.
management will vary according to the severity of symptoms and can include
medications, such as diphenhydramine, steroids, pain medication, and
antibiotics, according to the Centers for Disease Control and Prevention.
Ticks - According
to the CDC, Americans will get more tick bites and tick-borne diseases between
May and July than any other time of year. And while each year, more than 30,000
new cases of Lyme disease are reported, ticks are also carrying more diseases.
Ticks flourish during summer months with more warm-blooded humans venturing
into the woods and parks.
of tick-borne disease have doubled in the 13-year analysis period, with Lyme
disease accounting for 82 percent of cumulative reported tick-borne disease,”
explained Chern. “The combined incidence of reported anaplasmosis and
ehrlichiosis, which are tick-borne bacterial diseases, rose almost every year,
as did spotted fever; babesiosis, a tick-borne parasitic infection that has
been notifiable since 2011.”
To avoid being
bitten by a tick, the U.S. Forest Service recommends wearing long pants and
long-sleeved shirts, staying out of tall grass and checking for ticks
immediately after being outdoors. Additional tick prevention and removal advice
can be found at:
– The genus Toxicodendron includes poison ivy, poison oak and poison sumac, all
of which produce a clear liquid compound called urushiol.
popular belief, the rash will occur only where the plant oil has touched the
skin, so a person with poison ivy can’t spread it on the body by scratching,
according to the U.S. Food and Drug Administration’s website. It may seem like
the rash is spreading if it appears over time instead of all at once, but this
is either because the plant oil is absorbed at different rates on different
parts of the body or because of repeated exposure to contaminated objects or
plant oil trapped under the fingernails. Even if blisters break, the fluid in
the blisters is not plant oil and cannot further spread the rash.
recommends that if you do come into contact with one of these poisonous plants
to wash your skin in soap and cool water as soon as possible if you come in
contact with a poisonous plant. And not to scratch the blisters as bacteria
from under your fingernails can get into them and cause an infection.
To relieve the
itching from urushiol, the FDA / CDC and others recommend using a wet
compresses or soaking in cool water; applying over-the-counter topical
corticosteroid preparations or taking prescription oral corticosteroids.
Applying topical OTC skin protectants, such as zinc acetate, zinc carbonate,
zinc oxide, and calamine dry the oozing and weeping of poison ivy, poison oak,
and poison sumac can also be beneficial. Protectants such as baking soda or
colloidal oatmeal relieve minor irritation and itching. Aluminum acetate is an
astringent that relieves rash.
Vespidaes – Paper
wasps, European hornets and Yellow jackets are just a few of the vespids found
in the Mid-Atlantic region. These brightly-colored flying insect are known
perpetrator of numerous stings throughout the summer months.
majority of people are not at risk for life-threatening allergic reactions from
insect stings,” according to Evans. Most commonly people will have a local
reaction. Typically, an area of redness and painful swelling at the site of the
sting develops. This may resolve in hours or occasionally over a few days.
Uncomplicated local reactions may be treated with cold compresses.
explained that people with a history of anaphylaxis to bee/wasp/hornet stings
should carry injectable epinephrine with them at all times and inject
themselves with epinephrine at the first sign of anaphylaxis.