Bed bugs occur around the world.[36] Before the 1950s about 30% of houses in the United States had bedbugs.[2] Rates of infestations in developed countries, while decreasing from the 1930s to the 1980s, have increased dramatically since the 1980s.[3][4][36] Before the 1980s they were common in the developing world but rare in the developed world.[4] The increase in the developed world may have been caused by increased international travel, resistance to insecticides, and the use of new pest-control methods that do not affect bed bugs.[37]
Bed bugs were first mentioned in Germany in the 11th century, in France in the 13th century, and in England in 1583,[50] though they remained rare in England until 1670. Some in the 18th century believed bed bugs had been brought to London with supplies of wood to rebuild the city after the Great Fire of London (1666). Giovanni Antonio Scopoli noted their presence in Carniola (roughly equivalent to present-day Slovenia) in the 18th century.[52][53]
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
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Once an infestation is confirmed, an integrated pest management strategy should be employed. Promoted by the Environmental Protection Agency (EPA) and the Centers for Disease Control and Prevention, an integrated pest management strategy is a multi-faceted, comprehensive strategy that relies on knowledge of bedbug biology and habits, and the most up-to-date pest control methods.3 An integrated pest management strategy minimizes economic, environmental, and health hazards, and is most effective for small bedbug populations.
In the case of beds, a more economical option is to encase both the mattress and box spring in a protective cover like those used for allergy relief. Encasements specifically designed to help protect against bed bugs are available through retail or pest control firms. Higher quality ones tend to be more durable and comfortable to sleep on. Once the encasement is installed and zipped shut, any bugs which happen to be inside are entombed and eventually will die. Encasements also help protect newly purchased beds, and make it easier to spot and destroy any bugs residing on the outer surface during subsequent examination. Encasements will not, however, keep bed bugs from crawling onto a bed and biting a sleeping person.

The size of bed bug bites varies with a number of different factors. Bed bugs inject an anti-coagulant along with their saliva when they pierce the skin to take a blood meal. This anti-coagulant is mostly responsible for how a person reacts to the bite and determines the size of the bug’s bite. Since people will have various sensitivities to the bed bug’s bite, the size of the bite will vary, as well. Another factor that influences the size of a bed bug reaction is the number of times a person is bitten. Bite reactions of people bitten many times are also variable, and their response may be either more or less intense as the number of bites increases.
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