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Bed Bugs | What you need to know

Updated: Jan 31

It is so challenging to really understand how difficult it can be to detect bedbugs. Most people believe they should be very obvious to see. Many people have commented that they have been told by several exterminators that they have no evidence of bedbugs only to discover them at some point on their own. Read more...



bed bugs

Photo: Wix

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What are bedbugs?

Bedbugs, Cimex lectularius, are nocturnal blood-feeding insects or ectoparasites. These tiny critters feed on the blood of humans and animals, often while they sleep.

Can you see bed bugs? What size are bed bugs?

It is challenging to understand just how difficult it can be to detect bedbugs. Most people believe they should be very obvious to see however this is not always the case. Many of my patients have commented to me during their patient visits that they have been told by several exterminators that no evidence of bedbugs has been found in their home only to discover the bugs at some point on their own.

Adult bed bugs are the size of a sesame seed or apple seed. They are flat and a reddish brown color.

Nymphs or younger bed bugs are nearly invisible. They can be translucent or slightly yellow and much smaller. They only have a color to them once they have had a feed on blood from a host. Bed bug eggs are pinhead-sized and whitish making them very difficult to see.

Video: Techei

Are bedbugs always found in beds?

Bedbugs can live anywhere in the home, preferring crevices of materials of bedding, upholstery, or furniture to hide in during the day. When buying used furniture I often advise patients to take a disinfectant wipe or cloth and wipe through all surfaces of the furniture to dislodge or remove any potential eggs or bugs. I tend to advise patients to think about areas with clutter as areas to clear to avoid providing too many hiding places for these critters. According to the CDC, bed bugs can travel up to 100 feet but are most likely to reside within 8 feet of where you sleep. There have been cases of bed bugs spreading between apartments, hotel rooms, and duplexes which shows that they do have the potential to get around even without a human host to travel on.

Do bedbugs transmit disease?

Bedbugs have not been shown to transmit infectious agents. (Thank goodness given how easily they can spread in hotel rooms and other travel sites.)

What attracts bedbugs to humans?

Bedbugs are drawn to the warmth of humans and carbon dioxide. I often find that compared to other bite reactions from mosquitoes, fleas, or chiggers, bedbugs will prefer to bite along waistbands or covered areas if they can gain access. Interestingly they can live well over a year without a human host. This becomes a challenge for vacant apartments and homes where bedbugs may still reside for a length of time.

Do bedbugs only come out at night?

Bedbugs tend to preferentially come out between 1 am to 5 am based on studies. They do not necessarily come out every night only requiring a feed every few days.

What are some signs of bedbugs?

Bedbug bites may only manifest in about 70% of people bitten. In other words, not everyone reacts to the bite to even know that there is an issue. Bedbug bites look like any other type of insect bite. These are slightly swollen pink papules usually with a central crust. One article suggested that the "eyelid sign", bite reactions found along the eyelid, may point to bedbugs as the cause.

A better way to detect bedbugs is to seek signs that they are around. This is extremely difficult in the early days of an infestation. As time progresses, reddish brown pin head size spots representing bed bug excrement, live bugs, and perhaps even eggs can be found as an infestation progresses.

How should bedbug bites be managed?

The bites themselves are managed similarly to any bite reaction such as mosquitoes, fleas, and chiggers. The bite itself is a form of a localized hypersensitivity reaction that is treated symptomatically. Anti-itch products such as cooling the skin, pramoxine, antihistamines, and/or topical steroids can be attempted. The focus of the intervention should be addressing the bedbug infestation itself.

What are the different ways to treat a bedbug infestation?

Approaching a bedbug infestation has proven itself to be a challenging task for many of my patients. It's a process as opposed to a single step. It's worth going over the different modalities available to help tailor a process that suits your needs.

Direct reduction in the population of bedbugs

 The first step in managing an infestation is to recognize that bedbugs can linger in various areas of your home and need to be directly removed. Although you can try to directly visualize bedbugs, I would recommend simply treating all areas that have bedding, carpet, upholstery, and curtains.

  • Remove bedding and an upholstery that can be potentially cleaned in the laundry.

  • Remove clutter.

  • Do not go out and buy a new mattress. If you are inclined to, wait until the full extent of the infestation is addressed.

  • Vacuum the mattresses, vacuum the carpets, and vacuum the upholstery.

  • When the vacuum cleaner bag or canister is full, remove and trash the contents, and seal the bag.

  • Wipe down all furniture, in the crevices, and bed frames. I recommend Clorox Free and Clear Compostable Wipes.

  • Any clothing worn should be laundered. A study demonstrated that soiled clothing tends to be attractive to bedbugs. I recommend using a fabric rinse in addition to laundry detergent to lift residues that bedbugs could adhere to.

  • Clothing and other items that cannot be cleaned can be bagged and not opened for over 6 months. There is not a clearly specified time for bedbugs to survive off the human body but is thought to be about 3 to 6 months.

  • If there are items that cannot be cleaned and remain infested, DO NOT just throw them out at the curb. There have been cases of bedbugs spreading in a neighborhood from infested furniture on the curb. Contain the furniture in a sealed cover and mark it as "bedbug infested" to avoid the risk of someone else trying to pick up the tossed furniture.

  • If there are any cracks in the walls, consider caulking or resealing to seal hiding places for bedbugs.

  • Do not move items from one room to another, you will just be moving the bedbugs from one area to another.

Detecting persistent infestations

Consider bedbug traps in varying locations around the home to keep tabs on any persistent evidence of an infestation.

bed bug detector

Chemical treatment

There are several insecticides used to address bedbugs. The range of insecticides for bedbugs includes chemicals and essential oils. Please use insecticides with caution and per manufacturer instructions. Please be cautious if you have pets or small children. I prefer my patients consider chemical treatment only in the hands of professional exterminators to reduce the chances of toxicities associated with treatments and understand the risks of resistance. There is increasing evidence of bedbug resistance to insecticides making combination approaches important to consider.

There is a study that evaluated the efficacy of essential oils against bed bugs. Silicone (dodecamethylpentasiloxane and 3-[hydroxy (polyethyleneoxy) propyl] heptamethyltrisiloxane) oils and paraffin oils tended to be the most effective with the essential oil blood orange following in terms of effectiveness.

What is the most important first step to tackling a potential bedbug infestation?

The most important first step if you suspect potential bed bug bites is to verify the diagnosis with your Dermatologist. There are a variety of clinical manifestations and ruling out other triggers is important. There is a lot of stress and anxiety this diagnosis can have and it is very overwhelming. It can also be costly to address.

Do not forget your rights if you are a tenant. Many states and locales have laws requiring landlords to hire a professional to treat the unit. Here is an example of Philadelphia's policy.

bed bugs


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