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).
Blood spots found on one’s sheets, bites and the presence of bed bug feces and cast skins are some of the indications of a bed bug infestation. Bites are commonly found on the parts of the body that are more likely to be exposed to bed bugs during sleep – the hands, neck, face, shoulders, legs and arms. While not always the case, bed bug bites are often grouped together in a small area and at times may occur in a line or a zigzag pattern. Bites normally look like small, flat or raised areas that may become inflamed, itchy, red or blistered. Bed bug bite reactions don’t always appear immediately after you’re bitten and may take a few days to begin causing symptoms. However, not everyone reacts to bed bug bites in the same manner.
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