July is prime “biting season” for insects, whether they are mosquitoes, gnats, ticks, chiggers, or other biting insects. There are very few people who have not experienced the discomfort of incessant itching from a bug bite.
Despite this extremely common occurrence, there are some situations when seeking medical treatment for a bug bite is appropriate. Skin reaction to bug bites can be so robust that it can mimic a bacterial infection. These lesions are characterized by red, “angry”-appearing skin that is swollen, hot to the touch, and often more painful than itchy. Such robust bite reactions are typically much larger than the usual mosquito bite, and can have a large surrounding area of redness that covers most of the arm or leg when it involves these areas. In these cases, further medical evaluation is appropriate, both to rule out infection as well as to treat the lesions with prescription steroids. These are usually in the form of a topical superpotent steroid cream, but on occasion may include oral steroids.
Other situations where it is appropriate to seek medical help for a bug bite include any time the skin is turning dark in color. This may be a sign of compromised blood supply, which can lead to death of the involved skin. This type of reaction is far more common with a venomous spider bite, such as that by a brown recluse, rather than an insect bite. A skin rash caused by a tick bite should also be evaluated by a physician. Such a rash can represent Lyme disease, which is a disease that affects multiple body systems and is transmitted by ticks. The classic rash of Lyme disease is an expanding pink or red area with a surrounding pink or red ring at the site of the bite, which lends a characteristic "bulls-eye" appearance. This lesion is known as erythema migrans, and is one of the earliest signs of Lyme disease.