I have various skin lesions which might or might not be bed-bug bites–small, raised, sometimes red, sometimes itchy. The problem is I live right next door to a large park and get all kinds of insects in summer, may small enough to get through my window-screen. Also, I have Parkinson’s disease, and the meds I take for it can produce hives and itching as a side-effect. And, my bedding and mattress are all dark colored, so I likely would not see fecal stains or shed bed-bug skins.
The diagnosis of a bedbug infestation should be based on the clinical history and appearance of bites. A thorough inspection of sleeping quarters by the patient, a family member, or a pest control expert may demonstrate the telltale signs of an infestation15 (i.e., specks of blood-tinged insect feces and exoskeleton casts [Figure 5]). With the aid of a magnifying glass, special attention should be given to cracks and crevices of furniture, baseboards, electrical boxes, curtains, carpet, luggage, bed frames and headboards, picture frames, wall hangings, mattress and box spring seams, peeling wall paper, clothes, and linens.37 Live bedbugs can sometimes be caught by turning on a flashlight just before dawn, when bedbugs are most active, larger in appearance, and slower to scatter because of recent feeding.40
Bed bug eradication is challenging and it’s prudent to hire a professional when resources allow. However treatment can be expensive, often costing hundreds or thousands of dollars. Those who cannot afford this often must cope with the problem themselves. A useful step that anyone can take to combat bed bugs is to install bed encasements. Covering the mattress and box spring can help eliminate a substantial portion of the bed bug population -- especially if discovered early while most of the bugs are still confined to the bed area. Extra care should be taken when installing budget encasements since these can tear easily, especially on metal bed frames. Ideally both the mattress and box spring should be encased. If only one encasement is possible it’s often best to cover the box spring which is harder to subsequently inspect.

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.