Summertime and the Bugs are Biting, Part II
By Dr. Scott Norton
This is the second half of our summer bug series. In Part 1, we explored outdoor biters and stingers like mosquitoes, bees, fire ants, and ticks. If you’ve already been scratching from those, get ready — in this post, Part 2 we will look at the pests that live closer to home (or in our homes): the ones in our hair, our beds, and sometimes just in our imagination.
Part 2: Head Lice, Bed Bugs, Scabies & More
Head Lice: Tiny Bugs in the Hair
Head lice are small insects that live only on people (not pets). They’re common in kids aged 6 to 10 and spread among healthy children mostly through head-to-head contact.
Female lice lay eggs (nits) on hair shafts near the scalp. The eggs hatch in about 10 days. Both newly hatched baby lice and adult lice feed on human blood.
Lice bites cause itching and are especially common behind the ears and neck. But many things that look like nits are harmless things, like dandruff or lint. It’s important to find a live louse before starting treatment.
Special shampoos are available over the counter to treat lice. Permethrin and malathion can treat head lice. If those shampoos don’t work, stronger treatments like ivermectin may be needed.
The CDC and the American Academy of Pediatrics no longer support “No Nit” school policies, because lice aren’t dangerous and don’t justify keeping kids home.
Bed Bugs: Tiny Insects, Giant Problems
Bed bugs don’t transmit disease, but they cause extremely itchy bites and psychological distress. They hide in cracks of bed frames, seams of mattresses, furniture, picture frames, walls, and loose wallpaper. At night, they emerge for a blood meal.
First-time bites may go unnoticed, but repeat bites often cause itchy red bumps in clusters. Dermatologists can help with the itching, but getting rid of bed bugs requires a pest control professional.
Scabies: The Itchy Skin Mite
Scabies is caused by a tiny, tick-like mite that lives only on humans and is spread through skin-to-skin contact. Females burrow into the skin to lay eggs. After a week, the eggs hatch, and the baby mites crawl away to burrow elsewhere.
Scabies spreads through skin-to-skin contact, so if someone has scabies, it typically spreads to most or all of their household contacts. If scabies occurs in a group setting, such as daycare centers or nursing homes, it can be difficult to control. And it causes a great deal of anxiety among everyone involved. Although people rarely get scabies from sharing clothes or bedding, we still treat potentially contaminated fabric items with hot water washings and heated dryings.
Scabies symptoms appear weeks after first exposure. They are often intensely itchy at night and can cause itchy red bumps or tiny blisters. Dermatologists generally confirm a diagnosis of scabies by examining skin scrapings using a microscope. Most other doctors make the diagnosis based on a patient’s symptoms.
Scabies treatment usually includes permethrin cream (which is applied over nearly every body surface) and sometimes oral medicine. Even after a person’s mites are gone, the itching can persist for weeks. Everyone in close contact should be treated, and their bedding should be washed in hot water.
Spider Bites: Often Blamed, Rarely Guilty
There are thousands of spider species, but only a few can hurt humans. Many people wrongly blame spider bites for skin sores.
Key point: Brown recluse spiders do not live in the DC area. In places like Arkansas, Missouri, and Oklahoma – yes. But not here. Painful skin sores in our area are usually due to bacterial infections, especially Staphylococcus aureus. If you observe a spider biting you, try to capture it in a plastic bag or take clear photos to help with identification.
Concern for Infestation
Everyone gets itchy skin. Most people scratch some part of their skin many times each day. Sometimes a person finds that all of their skin is itchy and may perceive crawling sensations … even when no bugs or other creatures are present. This is a very complicated and frustrating situation. The patient may believe that some sort of bug has infiltrated their body.
Many patients in this situation collect bags of lint or skin flakes, believing they contain bugs. Although there may be no evidence of infestation, the sensations and distress are real. This concern may become all-consuming and cause additional problems at home, interactions with others at home and beyond, and constant fear of being singled out. Doctors must investigate the possibility of a true infestation and must also look for other medical causes. Sometimes the problem is not a bug, but how their skin or nervous system processes ordinary, unremarkable skin sensations.
Final Thoughts
From head to toe, indoors and out, bugs can cause irritation and illness. But most of the problems they cause can be prevented or treated. If you’re not sure what’s biting you, or your skin just isn’t right, don’t scratch your head – go see your dermatologist.
Reference:
Norton SA. Ectoparasite infestations and arthropod injuries, in Harrison’s Principles of Internal Medicine (21st ed.) Holland S et al (eds). New York: McGraw-Hill, 2025.
