Fighting Bed Bugs and Their Bites

Eileen K. Carpenter, MD

Eileen K. Carpenter, MD, an internal medicine physician at Penn Medicine Washington Square, discusses how to win the battle against bed bugs.

Aaaack! Insects that fly into your house to suck your blood in the night, leaving itchy red skin bumps, and carrying multiple potentially deadly diseases!

Actually, that paragraph was describing mosquitoes. Bed bugs don't carry diseases, only fly via commercial airlines, and can be successfully eradicated from your home.

You've been living with mosquitoes your whole life and have learned to cope with them, and bed bugs aren't nearly as bad. One of the reasons bed bug infestations cause so much difficulty is that people panic, take unnecessary steps to get rid of them, and end up making things worse.

Know your enemies

Bed bugs are here to stay, and most people are going to make their acquaintance from time to time. Take a few deep breaths, get to know their habits and weaknesses, and you will have more success avoiding, containing and eliminating them. Most mistakes are made within the first 24 hours after people first see a bed bug, so have a response plan ready in advance.

Basic facts about bed bugs: They start as eggs, glued tightly to a surface near where their moms have been feeding. They hatch as tiny transparent critters and get their characteristic brown color after they've had a meal of blood. They grow by shedding their skins until they reach adult size. They never go through a pupa (cocoon-like) stage the way mosquitoes do, and they never develop wings.

Bed bugs can live for several years, looking for a meal the whole time. They commonly bite three times before getting full for the night, leaving three itchy, red bumps in a group on the skin. But they can also live long periods without feeding - maybe even an entire year - in a cool place.

Don't create a bed bug migration!

Bed bugs may not fly, but those suckers can run like ants. You can't get away from them by moving out of the room where you saw them. They'll follow you, and then you'll have them in two rooms. Exterminators charge by the room, so changing bedrooms or sleeping on the couch is a newbie mistake.

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But because bed bugs will always try to find a human (or pet) at night, you can contain the infestation by continuing to sleep in the same room. Bed bugs are attracted by the carbon dioxide in your breath. They will find you if you move, but they'll stay where there’s food. Bed bugs also don't like light and will run for cover when lights are on. If the infested room is dark, and the uninfested rooms are lighted all night, it discourages them from wandering. They tend to bite exposed areas of the body, permitting a quick get-away when lights come on. They are also less likely to bite the head – they're good at not waking sleeping people.

There is no bug spray or bug bomb you can buy without a license that will cure a bed bug problem. You're just going to annoy them, drive them into new hiding places, and end up paying the exterminator to treat more rooms. However, it is safe to use diatomaceous earth, a dust composed of dried, microscopic, spiny sea creatures, which is available in home and garden stores. It kills insects without repelling them, and it isn't poisonous. Use it around the legs of the bed and around the edges of rooms to kill bugs that are moving back and forth from their daytime hiding places. You probably won't completely eliminate your bed bug problem, but if your finances don't permit hiring a professional exterminator immediately, it will help keep the problem from exploding.

It’s important to remember that bed bugs will travel from house to house by hiding in objects like clothing, purses, backpacks or luggage. When those objects are left in dimly lit places, the bed bugs will come out to look for a new place to hide. They then ride in that new object to another home. Movie theaters, kids' sleepovers, booths in diners, the space under the seats in buses, or shared storage lockers/drawers for purses and coats are all good places for bed bug transfer to occur. When you or your belongings have been someplace dark, think about the possibility of bed bugs when you return to your home.

Bed bugs are absolutely ecstatic when you drag your mattress out to the street, by the way. Please don't do it! They and their eggs will just drop off in your living room and infest your couch and chairs, and they'll go home with the sanitation workers – except your town's sanitation workers probably no longer pick up mattresses without covers, so the bugs will just walk back into you and your neighbors' homes when it gets dark.

Avoid getting bitten

So you're thinking, “This crazy doctor is telling me to keep sleeping with the bed bugs?” Here's where knowing bed bug habits will help during the time between finding the first bug and getting the exterminator in. By taking advantage of their predictable behavior, you can continue to sleep peacefully.

Bed bugs love rough surfaces and skinny crevices. Cloth, wood, paper and plaster are good surfaces for them to climb. But they don't do well on smooth surfaces like plastic, tile, chrome or glass. You can keep them from climbing into uninfested/disinfected beds by putting the legs of the beds in empty plastic food containers (like Tupperware®) or by rubber-banding plastic bags around the legs. Just make sure the sheets and blankets don't drag on the ground. And pull the bed away from the walls. They'll spend the night walking 'round and round, trying to figure out how to get to you. Look around the next morning and kill any that haven't gone into hiding.

Bed bugs spend their days as close to where you sleep as they can get away with. They love the little folds on the edges of mattresses, between the mattress and box spring, inside the stuffing of the box spring, under the plastic guard at the edge of the box spring, or between the box spring and the metal frame. The bed frame and headboard can be scrubbed and vacuumed, but you'll never get them out of the stuffing of the box spring. Once they're in there, you can only seal them inside with a zippered cover. You'd much rather keep them out in the first place, right? Get bed bug covers for all your mattresses and box springs before you get an infestation, and your life will be much easier once it happens. Be sure to get the kind made of zippered fabric; plastic tears too easily. You're going to want the covers to stay in place for years.

Once you see evidence of bed bugs, nothing should leave any room except in a plastic bag. Run all clothes and bedding through the washer and a long, hot tumble in the dryer (at least 30 minutes at high heat). Then leave the clothes in plastic bags until the exterminator has declared your home bed-bug-free. Clean out all bedroom drawers and closets.

Bed bug elimination involves repeatedly scrubbing and vacuuming every couple days to eliminate the eggs and hatchlings as they appear. Alcohol only works if you really get things wet, so it's really not practical for large areas. Vacuum cleaner bags have to be thrown away outside every day, sealed in a plastic bag or trash container. Even with a professional exterminator coming, you will have to do these types of environmental controls yourself.

Also, be sure to keep all pets out of your bedrooms while in the process of controlling bed bugs.

How do you know a rash is due to bed bugs?

If you're waking up with itchy red bumps, particularly in groups of three, suspect bed bugs. The only sure way to know is to find evidence of the bugs, droppings or eggs. But don't assume that you don't have bed bugs just because you can't find any in your bed. They can crawl into the other furniture, into the cracks at the edges of your walls, into your electrical outlets, or occasionally into appliances like clock radios. Even professional exterminators with bed-bug-sniffing dogs don't find the bugs 100% of the time. And don't assume you can't have bed bugs if only one person is getting bites. The bites themselves are painless, and not everyone is allergic to the chemical they inject to numb you while they are biting. A tiny red dot may be the only sign.

Finally, do your best to avoid scratching the bites, as it can lead to scarring. Try pressing on each one with an ice pack until the itch stops. Hot showers make the itching worse, and alcohol can dry your skin and cause more itching, too. Over-the-counter antihistamine pills, like cetirizine or diphenhydramine, help itching.

Hopefully you can get started on effective control measures the first day you see a bug, so you don't actually have to deal with many bites.

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