Self-Checks
It is difficult to tell bedbug bites from those of mosquitoes, fleas, or other insects. You likely won’t feel bedbugs biting as they inject an anesthetic and anticoagulant when they bite. You may develop bite marks one to 14 days after being bitten. As with mosquitoes, their saliva can provoke an allergic reaction at the site of the bite. Some people have no reaction, others have a mild one, while some can have significant swelling.
The bite marks may be in a straight line, cluster, or a random pattern. One classic pattern is three bites in a line—breakfast, lunch, and dinner. Bedbugs are not picky eaters when it comes to location—any exposed skin will do—but they won’t necessarily go farther than they have to. Bites typically occur on the face, hands, and feet.
Environmental Checks
The only way to know for sure if your symptoms are, in fact, a result of bedbugs, is to find the bed bug infestation in your room or furniture.
You can check bedding, mattresses, furniture, and crevices in walls for bedbug infestation. Do your inspection just before dawn, which is when they are the most active. The bugs will be larger and slower after feeding. Bedbugs will quickly flee from light, so live bugs are best located in the folds and seams of mattresses and sheets. Bedbugs are about the size of an apple seed, about 1/4 inch long. They change from light brown to purple-red after feeding. You may also see their eggs, which are about the same size as the adults. The eggs will often be in seams, cracks, or crevices.
You are more likely to find their molted exoskeletons and dark specks of their feces. Also look for rust-colored blood spots on bedding and mattresses, which can come from the blood in their feces or from having crushed a bedbug who was feeding. A room with a heavy bedbug infestation might have a sweet, musty odor.
Differential Diagnoses
Most of the time you won’t go to a healthcare provider for bedbug bites. However, the bites can mimic other rashes or you might develop a skin infection from scratching, and those factors may send you to the healthcare provider.
Your healthcare provider will perform a physical exam and take your medical history. This is usually enough to make the diagnosis or rule out other causes.
Some diagnoses your healthcare provider will consider due to your bite reactions include:
Mosquito, flea, chigger, tick, or spider bites: These can look very similar in appearance to bedbug bites and it may not be possible for a healthcare provider to tell the difference. Scabies: This is a parasitic mite that is spread by skin-to-skin contact. It lays eggs under the skin and an itchy rash develops when the larva hatch. Lice: Body lice and head lice can lead to scratching, with inflamed or infected scratch marks. Antibiotic reaction Eczema Fungal skin infection Hives Food allergy Chickenpox
Environmental Diagnosis of Bedbug Infestation
If you are unsure whether what you find are traces of bedbugs, the National Pesticide Information Center lets you search for local resources that can help with identification of photos or samples you collect. You may want to enlist a professional pest control expert to determine whether or not you have bedbugs in your home and what rooms might be infested.
