Cutaneous reactions to bedbug bites can vary widely and are easily confused with other conditions (Table 1).15–19 A typical lesion is a 2- to 20-mm, pruritic, erythematous maculopapule with a central hemorrhagic crust or vesicle.5,8 Macules, papules, wheals (Figure 3), vesicles, bullae, and nodules have all been reported,20 as have asymptomatic lesions with a barely visible punctum as the only evidence of a bite.8 Bites vary in number and are preferentially distributed in unclothed areas (e.g., face, neck, extremities). Unlike many other arthropod and insect bites, bedbug bites are rarely located in the popliteal fossae or axillae.21 Lesions can be noticeable immediately when waking up or several days later, with the reaction often progressing from delayed to immediate with subsequent exposures22–26  (Table 2). The classic bedbug rash is referred to as “breakfast, lunch, and dinner” because it commonly presents as several bites in a row or cluster 20 (Figure 4).

Three days after the initial “feeding” the sores hurt really bad. They itch like no other. By the way, none of my roommates have experienced this. I started panicking and washed all my clothes and sheets. I checked every corner of my room. Nothing. I couldn’t find anything, so them things must be hiding pretty well. Unless it isn’t bedbugs. Today I woke up and realized I had three more bites on my arm just above my elbow in the “breakfast, lunch, and dinner” pattern this site talks about.
Bedbug bite reactions are self-limited and typically resolve within one to two weeks without intervention.15 There is no evidence that any treatment alters the natural history of bedbug dermatitis.8 If pruritus is present, nonprescription topical antipruritic preparations containing the active ingredient doxepin, or intermediate potency corticosteroids may be beneficial. Mupirocin (Bactroban) and/or systemic antibiotics should be considered in the treatment of superinfected bites.8

3. Centers for Disease Control and Prevention; National Center for Environmental Health; Environmental Protection Agency. Joint Statement on Bed Bug Control in the United States from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Environmental Protection Agency (EPA). Atlanta, Ga.: National Center for Environmental Health; 2010.

Unlike those of other insects, bed bug bites may sometimes appear in tight lines of multiple, small, red marks where multiple bed bugs have fed along an exposed area. Bed bug bites can cause itchiness. Initially, a victim may detect a slight burning sensation. The burning area then develops red bumps, known as papules or wheals (rash). In extreme cases, bites may swell dramatically or turn into blister-like skin inflammations.
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