Bug Bites

Dear Lisa,

Two years ago April, my daughter was diagnosed with scabies. Unfortunately, my daughter, mother, newborn son, husband, and myself also caught this. We all did the permethrin treatments, several times in the two years because it didn't seem to work, and followed the directions on cleaning everything in our house, which included washing bedding daily and spraying everything possible with a bedding spray. We had been symptom free for almost 8 months but recently my son has been getting "bumps" again all over, not just in the common spots of scabies. He doesn't have them between his fingers like before, but some on his fingers and toes. At first I thought they were small mosquito bites but they look like the scabies bumps we all had the past two years. Some even have a head to them with light yellow or clear fluid. My mother told me she has continued getting a handful of new bumps, big and small, and I just got a handful myself. When we were all diagnosed, we had the bumps in the areas that scabies are known for. The cream seemed to work temporarily, but new bumps seemed to appear all of the time. Now we are all getting new bumps randomly on our bodies and I was wondering if there is something similar to scabies? I am at my wits end because I thought we had this thing finally conquered. I have another newborn baby and I do not want her to have to experience this.

“Please help us!!!”

Dear “Please help us!!!”,

What a couple of years you have had! No wonder you are worried that the new rashes that your family is experiencing are the Scabies too. The Scabies is very communicable which means it is easily spread from one family member to the next. It is common to spread from one person to the next in households. Sometimes just when one person seems to be clear from the problem another family member develops Scabies and it passes back and forth. That is why the recommendation is to treat everyone in the house at the same time. Typically the incubation period, or the time it takes for the infestation to spread from one person to the next, is 4 to 6 weeks. Once a person has Scabies, their body is sensitized to it. Once the body is sensitized, a person can catch Scabies quicker. After the first exposure a person can develop symptoms as quick as 1 to 4 days after repeat exposure to the mite. (1) Typically the second infestation is much milder.

The rash from Scabies is very itchy and favors the skin between the fingers, the belly button area, the belt line, the wrists, underneath the arms, the abdomen, the penis and the breast area. (1). Scabies presents as pink excoriated areas covered with scratch marks. In infants under two years old the rash takes on a different appearance. It presents as vesicles or fluid filled sacks.

Since Scabies is a hypersensitivity reaction to the mite, Sarcoptes scabiei, the rash can persist after the mite is dead. Occasionally 2 to 5 mm red-brown nodules or bumps are present, particularly in the genital area and under the arms. These nodules develop due to the body’s response to the dead mite and can persist for a long time, usually lasting weeks or even months. (1) These may have been the bumps that your family experience during your last episode.

Norwegian Scabies is a rarer form of Scabies that is harder to treat. The rash from Norwegian scabies is more intense and widespread and appears as thick crusted lesions. (1). Scabies infestations that seem resistant to therapy may be due to Norwegian Scabies.

It seems that you were very diligent with the environmental cleaning which should have killed the mites. Although, there is always the chance that your family was repeatedly exposed to the Scabies, possibly from a visitor who slept at the house. Also, the distribution of your son’s rash may be different than the classic “Scabies” rash because of his age. Infants under two years old tend to develop lesions that are distributed more on their head, neck, palms and soles. They also tend to be more vesicular (fluid filled) as compared to adult lesions. (1)

Your description of bumps that looked like bug bites with light yellow or clear fluid could also be a sign of a secondary bacterial skin infection of the Scabies rash. In order to get a definitive answer, you should see a Pediatric Dermatologist. A Dermatologist will be able to tell you if the rash is from Scabies by examining a scraping of your son’s skin under a microscope. If your son has Scabies the Dermatologist should be able to identify the mite. (1)

The Dermatologist will also be able to tell you if there is a secondary bacterial infection or if the rash is due to another cause, such as bug bites. If the rash is due to bug bites, most doctors will not be able to tell you which type of bug is the culprit. Unfortunately, the offending bug usually cannot be identified by the appearance of a child’s rash. (2) The best way to determine which type of bug causes a bite is through an inspection of the home. A house can have an animal or bug infestation without the residents ever knowing it. Houses can be infested with birds, squirrels or bats that could be hidden in the attic or behind the walls. These animals can bring different types of bugs and mites into the home with them. (2)

There has been a recent resurgence of “Bed Bugs” or Cimex Lectularius Cimicidae. “Bed bugs” are flat wingless bugs that tend to be found in people’s mattresses. Their size ranges from the size of a poppy seed to ¼ inch in length. They live off of the blood of warm blooded animals and tend to bite humans in their bed at night when they are sleeping. Their color ranges from nearly white (just after molting) or a light tan to a deep brown or burnt orange. (2) Bed bugs are difficult to find since they live hidden in cracks and crevices such as behind wall paper or the cracks in furniture. They can be found in seams of mattresses, under the box spring, in the headboard, or behind switch plates. Signs that a mattress has bed bugs include black or orange stains on the sheets or mattress and live bugs. (3) Bed bugs are prevalent in hotels, apartments, in household where family members have recently traveled, and in familis who obtained used mattresses or furniture. (3)

A child bit by “Bed Bugs” can develop a hypersensitivity reaction to the bug’s saliva. This allergic response is quite itchy and looks like a flea or mosquito bite. The rash usually occurs 1 ½ days after the bite occurs. The location of the bites from “Bed Bugs” include the parts of the body that are exposed during sleep, as opposed to flea bites which tend to occur on the ankles. (3)

Flea bites are another potential cause of bumps on the skin. They occur in the home where a pet with fleas resides. Whenever family members develop a similar rash it is a good idea to check the pets for fleas. Signs that a pet has fleas include itching and the appearance of “flea dirt” or black specs on the pet’s fur or coat. If you do discover bugs in the home, they can be identified by an Entomologist. Once the bug is identified, the services of an exterminator with experience eliminating that particular bug or animal should be utilized. (3)

It is important to not forget about Chicken Pox. Chicken pox is another childhood illness that presents with an itchy rash. The Chicken pox lesions begin as tear drop shaped fluid filled sacs that initially appear on the torso of unimmunized child. The rash tends to start on the extremities of children who are immunized. New crops of lesions develop each day and the older lesions form a scab when scratched. If you notice a rash consistent with Chicken Pox or a rash with scabbing of the lesions you should contact your son’s Pediatrician or Nurse Practitioner.

I wish you and your family a speedy resolution of this problem and good luck with the new baby.

(1)American Academy of Pediatrics. Scabies. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:468-470.
(2) Harvard School of Public health. Available at: http://www.hsph.harvard.edu/bedbugs/#examined. Accessed September 2006.
(3) University of Kentucky Entomology. Available at:http://www.uky.edu/Ag/Entomology/entfacts/struct/ef636.htm. Accessed September 2006.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Children Healthy