Insect Bites & Stings

Once you have been stung or bitten, we advise you to clean the area with water and then hold something cold onto it for at least 10 minutes (avoid putting ice packs straight onto the skin; it is best to wrap it with a thin material such as a tea towel). If you have any redness or swelling around the bite/sting, you can take an antihistamine tablet (your local pharmacist can guide you on this if you are unsure). To further help the itching we recommend applying calamine lotion or crotamiton cream to the area. You can also take painkillers such as paracetamol or ibuprofen to help with the pain.

For Bee or Stings:

Some bees can leave their stinger sticking out of the skin, which, if it has occurred, you will be able to see it and it’s important to remove the stinger as soon as possible whilst avoiding squeezing it (it’s best to scrape it out with your nail or side of a credit card). Wasps do not leave their stinger in the skin of the person.

For Tick bites:

Ticks are small brown/black bugs that like to feed on blood. Often you will be able to tell if you are bitten by a tick as they tend to stay attached to your skin after biting. You should remove a tick as soon as you find one by pulling it straight out holding it as close as you can to your skin using your nails or something such as tweezers. Most tick bites are harmless however some ticks can carry bacteria that causes something called Lyme disease which can be serious so it is important to look out for any of the following symptoms and seek medical help via an urgent visit with your doctor or 111 if you develop any of the following:

• A rash that looks like a bullseye
• A fever
• Headaches
• Fatigue
• Muscle pain

Preventing insect bites and stings is essential to avoid discomfort, allergic reactions, and potential infections. By taking proactive measures, you can significantly reduce your risk of being bitten or stung.

Insect repellents

Insect repellents are one of the most effective ways to prevent bites from mosquitoes, ticks, and other biting insects. There are several types of insect repellents available:

• DEET (N,N-Diethyl-meta-toluamide) - DEET is one of the most widely used and effective repellents, offering protection against a wide range of insects. Products with DEET are available in different concentrations, typically ranging from 10% to 50%. Higher concentrations provide longer-lasting protection but are not necessarily more effective. For most people, the NHS recommends a product containing 50% DEET offers several hours of protection.

• Picaridin - Picaridin is a less greasy alternative to DEET, offering comparable protection against mosquitoes and ticks. It is odorless and less likely to irritate the skin, making it a popular choice for those with sensitive skin.

• Oil of Lemon Eucalyptus (OLE) or PMD (p-Menthane-3,8-diol) - A natural plant-based repellent, OLE offers protection similar to low concentrations of DEET. However, it should not be used on children under three years of age.

To use insect repellents safely:

• Follow the instructions on the product label, and apply only to exposed skin and clothing. Avoid applying repellent to areas of the skin that will be covered by clothing.

• Do not apply repellent to cuts, wounds, or irritated skin, and keep it away from your eyes and mouth.

• Depending on the product, you may need to reapply after a few hours, especially if you are sweating or getting wet.

• For children, use lower concentrations of DEET or other repellents and avoid applying to their hands, as they may put their hands in their mouths or eyes.

Protective Clothing

Wearing appropriate clothing can be an effective barrier against insect bites and stings, especially in areas where insects are prevalent.

• Wearing long sleeves and pants reduces the amount of exposed skin, minimising the areas where insects can bite. Tucking your pants into your socks or boots can further reduce access to your skin.

• Insects like mosquitoes are more attracted to dark colours, so wearing light-coloured clothing can make you less attractive to them.

• Consider wearing clothing treated with permethrin, an insecticide that repels and kills insects on contact. This treatment can last through several washes and is particularly effective against ticks and mosquitoes.

Environmental Control

Creating an environment that is less inviting to insects is another key strategy in preventing bites and stings.

• Mosquitoes lay eggs in standing water, so removing sources like buckets, bird baths, and clogged gutters can reduce their breeding grounds.

• Ensure that windows and doors are fitted with insect screens to keep bugs out, especially during the warmer months when windows are more likely to be open.

• Stinging insects like wasps and bees are attracted to food, so keep food and drinks covered when eating outdoors.

• Ticks thrive in tall grass and leaf litter, so keeping your yard well-maintained can reduce the risk of tick bites. Regularly mow the lawn, clear leaves, and create a barrier of wood chips or gravel between wooded areas and your lawn.

Natural Remedies

For those who prefer natural methods, there are several plant-based repellents and other remedies that can help deter insects.

• Essential oils - some essential oils, such as citronella, lavender, eucalyptus, and tea tree oil, have insect-repellent properties. These can be used in diffusers, candles, or diluted in a carrier oil and applied to the skin. However, they generally provide shorter-lasting protection compared to chemical repellents.

• Plant-based repellents - products containing ingredients like citronella, soybean oil, or catnip oil can offer protection against certain insects. While these products are often less effective than DEET or picaridin, they are popular for those seeking natural alternatives.

• Natural barriers - planting insect-repelling plants like marigolds, lavender, and basil around your home can help keep insects at bay. Additionally, using natural insect deterrents like garlic or neem oil in your garden can reduce insect populations.

By combining these strategies—using repellents, wearing protective clothing, controlling your environment, and considering natural remedies—you can effectively minimise the risk of insect bites and stings, ensuring a safer and more comfortable time outdoors.

Healthwords pharmacists' top tips

If your insect bite or sting is localised and over a small area, a topical antihistamine cream being applied to the area for a few days, may be enough to stop the itching and swelling. If there are several bites or stings, it may be easier to take an antihistamine tablet to calm any reaction down. There are many to choose from, such as Piriton, which contains an older antihistamine ingredient (chlorphenamine. It is particularly good for skin reactions as well as other allergies, however it does need to be taken several times a day, as it has a shorter duration of action. It is also known to cause drowsiness.

Other antihistamines containing loratadine (such as Clarityn, or cetirizine (such as Piriteze are convenient once-daily tablets that have a longer duration of action, and are less likely to cause drowsiness, especially loratadine.

Using a mild steroid cream containing hydrocortisone or similar, alongside an antihistamine tablet is usually the best way to quickly bring down swelling and inflammation, and prevent further reactions.

You should not use a steroid cream on the face without speaking to your doctor, and you should not use it on broken or infected skin. If there is any weeping or thick discharge coming from the site of the bite or sting, or hardening of the skin underneath, you should see a doctor as the skin may have become infected.

Insect bites and strings can occasionally get infected and may require antibiotics, where over-the-counter treatments are not effective enough.

Typical signs to look for are:

• Redness and swelling of skin surrounding the bite that is spreading.

• Fever.

• Pain or tenderness to the area.

• The skin surrounding the bite feels hot to touch

• If there is evidence of pustular discharge at the site of bite or sting.

If you suspect the bite or sting has become infected, it can lead to cellulitis or even sepsis. You should seek help from your doctor or healthcare professional.  The NHS Pharmacy First scheme has infected insect bites as one of the priority conditions that may be treated with antibiotics if appropriate following consultation and assessment with an accredited pharmacist under certain conditions.  

In some cases where the patient's circumstances do not fit the inclusion criteria for the service for example if the patient has severe symptoms, or is immunocompromised, children under 1 year, or certain other exclusion criteria, then an onward referral to a doctor or other appropriate clinical service is necessary.

You should go seek medical attention via an urgent visit with your doctor or by calling 111 if:

• You have been stung multiple times
• You have been bitten or stung in the face or neck
• You have a widespread rash
• You suspect the bite or sting area has become infected (if the area of redness/area that is swollen is increasing in size, it has become painful or there is any pus)
• The area of redness is larger than 10cm
• You have other symptoms, such as a fever
• The bite/sting has not improved within 3 days
• You should call 999 if you have any lip/throat swelling, feel dizzy/faint or sick and any difficulty breathing or swallowing.

The doctor will ask you about your medical history and examine the bite/sting. They may prescribe an antibiotic course if the area looks infected or may prescribe you a steroid cream to help the skin inflammation.