Insect Bites and Stings: Scrape, Don't Squeeze

In short

Most bites settle in a few days. The things worth getting right are how you remove a sting, how you remove a tick, and knowing the difference between a big local swelling and a reaction that needs emergency treatment.

Emergency if: Swelling of the lips, mouth, throat or tongue, difficulty breathing or swallowing, blue or grey skin, sudden confusion or fainting — use an adrenaline auto-injector if prescribed and call emergency services now.

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On this page

The usual course

Insect bites and stings are not usually serious and get better within a few days. The immediate pain, redness and swelling are the body reacting to injected venom or saliva, not an infection, and they need nothing more than time and something to take the sting out of it.

Two things change that picture: the bite becoming infected over the following days, or a serious allergic reaction in the first minutes. The rest of this page is really about telling those two apart from an ordinary bite, because everything else looks after itself.

Removing a sting

If the sting is still in the skin, brush or scrape it sideways with a fingernail or the edge of a bank card. Do not use tweezers or your fingertips to pull it out: gripping it squeezes the attached venom sac and pushes more venom in. Speed matters more than technique, because most of the venom is delivered within the first seconds.

A bee leaves its sting behind and can sting only once; a wasp keeps its sting and can sting repeatedly, which is why one insect can produce several stings. Once the sting is out, wash the area with soap and water.

What actually helps

Put an ice pack wrapped in a cloth, or a clean cloth soaked in cold water, on the area for at least twenty minutes if it is swollen, and keep the part raised where you can. Paracetamol or ibuprofen helps if it is painful, an antihistamine helps the itch, and a hydrocortisone cream reduces itching and swelling. Take off rings and anything tight near the bite before the swelling builds.

Do not scratch it, which is the main route to infection and scarring. Skip the home remedies — bicarbonate of soda and similar kitchen treatments are not recommended. Do not use an antihistamine cream if caterpillar hairs are involved, and never apply a tourniquet.

A big swelling is not the same as anaphylaxis

A large local reaction is swelling that spreads well beyond the bite — it can exceed ten centimetres and take up to a week to settle. It is alarming to look at, but it is confined to the area around the sting, and it is treated with cold, elevation and antihistamines rather than emergency care.

Anaphylaxis is a whole-body reaction and it is fast, usually starting within minutes. The distinction that matters is not how big the swelling is but where the symptoms are: breathing, throat, circulation and consciousness. A reaction affecting those needs adrenaline and an ambulance, whatever the bite looks like.

Ticks

Use fine-tipped tweezers or a tick-removal tool and grasp the tick as close to the skin as you can. Pull slowly upwards with steady pressure, taking care not to squeeze or crush it or leave mouthparts behind, then clean the bite with antiseptic or soap and water. A tick bite is often painless, so after finding one it is worth checking the rest of the body for others.

Afterwards, watch for a rash. A spreading circular or bullseye rash usually appears one to four weeks after the bite, though it can take up to three months. It is not usually hot or itchy, may have a lighter or darker centre, and on brown and black skin can look more like a bruise than a red ring. That rash, or flu-like symptoms in the weeks after a bite — fever, headache, aching muscles and joints, unusual tiredness — means seeing a doctor, because Lyme disease is treated with a course of antibiotics.

When to get it looked at

See a pharmacist or doctor if the skin around the bite feels hot, looks red or swollen, is painful, or is leaking pus or fluid — those suggest infection rather than the bite itself. Get advice the same day if symptoms are worsening rather than settling, if you were stung in the mouth or throat or near the eye, if you feel dizzy or sick with abdominal pain, if you have a temperature with swollen glands, if you were stung many times, or if you have had a serious reaction to a sting before. A bite in a baby under a year should be checked.

If you have been prescribed an adrenaline auto-injector, use it at the first sign of a serious reaction rather than waiting to see how things go, call emergency services, and lie down with your legs raised — or sit up slowly if you are struggling to breathe — rather than standing or walking. If there is no improvement after five minutes, a second injector is used. Carry two at all times.

When to act

Routine — see a doctor

An itchy, swollen bite in a well adult: cold pack, elevation, antihistamine and no scratching, expecting it to settle over a few days.

Same-day — call promptly

Spreading heat, redness, pain or pus around the bite, a sting in the mouth, throat or near the eye, a bite in a baby under a year, or a bullseye rash after a tick bite.

Emergency — act now

Swelling of the lips, mouth, throat or tongue, difficulty breathing or swallowing, blue or grey skin, sudden confusion or fainting — use an adrenaline auto-injector if prescribed and call emergency services now.

Values mentioned in this story

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Total IgE Absolute Eosinophil Count WBC / Total Leukocyte Count CRP Absolute Neutrophil Count