How To Tell If A Bug Bite Needs Medical Attention

The Question: When does a bug bite require serious medical attention?

The Answer: Sometimes that pesky mosquito bite needs a little hydrocortisone cream and time to heal. But occasionally, it’s not so simple and instead requires serious medical attention. While most bug bites and stings are harmless, some can be dangerous if not treated properly — especially if you have an undiagnosed allergy to a particular bug venom or if that bug is a disease carrier.

The summer months seem to be stocked with extra critters crawling and buzzing around us, upping the chances that you, a friend or a family member might need a dermatologist’s expertise. Here’s how the experts determine the difference between a nuisance and a health concern that requires attention.

One of the first steps to differentiating between a minor and serious bug bite or sting is to work through some of the key symptoms. “Significant pain, swelling, and bruising are all signs that a bite may be serious,” said Joshua Zeichner, a dermatologist and assistant professor at Mount Sinai Medical Center in New York City. “Swelling that is spreading significantly beyond the initial bite may also be a sign of a serious issue.”

Of course, in extreme instances, a bug bite reaction can be grave enough to result in an ER visit. Margaret Parsons, a dermatologist and associate clinical professor of dermatology at the University of California, Davis, advises people to pay attention to symptoms like the sensation that your throat is closing, chest pain, a persistent racing heartbeat, dizziness and vomiting, and head to the emergency room if you experience any of them.

Treatment for bug bites that don’t fall into the emergency room-worthy category can run the gamut from topical ointments or an over-the-counter antihistamines to more aggressive treatments, such as antibiotics, anti-allergy medications, or even skin debridement, which is the medical removal of dead, damaged or infected skin to promote the healing of surrounding healthy skin, according to Zeichner. Debridement is only necessary if the bite or sting has turned into an open wound in which necrotic (dead) or ischemic (low oxygen content) tissue is preventing it from closing and healing properly. Necrotic tissue can also promote bacteria growth, which leads to further inflammation and increases risk of infection. You’ll need to see a doctor to determine if debridement is a viable treatment plan for you and, if so, which type.

According to the American Academy of Dermatology, the most common bites and stings in the United States come from mosquitoes, fleas, spiders, bees, wasps, hornets, biting flies, mites, ticks, fire ants and bedbugs. During the summer months, Zeichner is most cautious about tick bites due to their ability to carry lyme disease, and spider bites that can cause serious, localized skin destruction depending on the species. Several mosquito species are also a concern when it comes to carrying and transmitting the West Nile virus, malaria, dengue fever and chikungunya. If you’re spending time in a high-tick or mosquito area, here’s what you’ll need to watch out for:


If you develop a red, target-shaped rash after being bitten by a tick, Dr. Parsons warns that this symptom could indicate a Lyme disease infection, which must be treated with antibiotics. Ticks can also carry Rocky Mountain spotted fever, a bacterial infection signified by a red or black spotty rash that spreads, which also requires immediate treatment.


Malaria symptoms typically appear within a few weeks after being bitten by an infected Anopheles mosquito, which can include recurrent high fever, shaking chills and profuse sweating along with headaches, vomiting and diarrhea. Be sure to seek emergency medical attention if experiencing these severe symptoms.

Dengue fever rarely occurs in the continental United States, but when it does, it’s due to an infected Aedes mosquito. Symptoms like (but not limited to) high fever, severe headaches, pain behind the eyes, rash and mild bleeding (such a nose bleed, bleeding gums, or easy bruising) usually begin four to six days after infection and can last up to 10 days. The female Aedes mosquito specifically can also transmit chikungunya, which is characterized by symptoms similar to Dengue fever like fever, severe joint pain and muscle pain, headache, nausea, fatigue and rash.

West Nile virus is a tricky one since between 70 and 80 percent of people don’t exhibit symptoms after they become infected. But in severe cases, patients will typically experience headaches, body aches, joint pains, vomiting, diarrhea and/or rash, and hospitalization can be necessary to provide fluids intravenously and pain medication.

Minimizing the risk of suffering serious bug bites, however, is the best method of prevention and a relatively easy task.

“Wear long sleeves and pants, and in light colors so you can see if there are any bugs on your skin,” said Zeichner. “And use bug spray or citronella candles if you are going to be outside.”

To learn more, check out the video below from the American Academy of Dermatology about bug bites and stings, and when it’s important to consult with your doctor:

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