4 times daily for up to 7 days safety very dangerous

4 times daily
for up to 7 days
Safety Very dangerous if ingested
Keep out of reach of children
Pharmacologic Treatment of
Insect Bites: Counterirritants

Trade Name Primary Ingredients
Blue Star Ointment Camphor 1.24%
Sarna Anti-itch Lotion Original Camphor 0.5%; menthol 0.5%
Pharmacologic Treatment of
Insect Bites: Counterirritants
(Table 37-3)

• Example: Topical hydrocortisone 1%
• Indication: temporary relief of minor insect bites
• Dosing: Apply to the bite area up to 3 – 4 times daily for up to 7
days
Pharmacologic Treatment of
Insect Bites: Corticosteroids

Trade Name Primary Ingredients
Aveeno Maximum Strength
Anti-itch Cream
Hydrocortisone 1%; aloe vera
Cortaid Intense Therapy
Cooling Spray
Hydrocortisone 1%
Cortizone-10 Easy Relief Liquid Hydrocortisone 1%; aloe vera
Pharmacologic Treatment of
Insect Bites: Corticosteroids
(Table 37-3)

• Examples: zinc oxide, calamine, and titanium dioxide
• Dosage forms: lotions, ointments, and creams
• MOA:
• Protectant, tend to reduce inflammation and irritation
• Zinc oxide  mild astringent with weak antiseptic properties
• Zinc oxide and calamine  absorb fluids from weeping lesions
Pharmacologic Treatment of
Insect Bites: Skin Protectants

• Dosing: Apply to affected area as needed
• Safety: minimal adverse effects
• Recommended for adults, children, and infants
Pharmacologic Treatment of
Insect Bites: Skin Protectants

Trade Name Primary Ingredients
Aveeno Anti-Itch Concentrated Lotion Pramoxine HCl 1%; calamine 3%; dimethicone
Caladryl Clear Lotion Pramoxine HCl 1%; acetate 0.1%; camphor
Campho-Phenique Gel Camphor 10.8%; phenol 4.7%; eucalyptus oil
Chigarid External Analgesic Camphor 2.8%; phenol 1.5%; menthol 0.1%;
eucalyptus oil 0.5% in collodion
StingEze Insect Bite Relief Benzocaine 5%; phenol 1.35%
Sting-Kill Swabs Benzocaine 20%; menthol 1%
Pharmacologic Treatment of
Insect Bites: Combination
Products
(Table 37-3)

• Use and overuse of local anesthetics  sensitization, contact dermatitis
• Lowest adverse effects  pramoxine, benzyl alcohol
• Highest adverse effects  dibucaine, phenol
• Prolonged use of topical antihistamines  allergic or photoallergic
contact dermatitis
• Scabies / bacterial infections / fungal infections  do NOT use
hydrocortisone without medical supervision (masks these disorders)
• Children  avoid camphor due to risk of accidental ingestion
Pharmacologic Treatment of
Insect Bites: Product Selection

• Bees
• Wasps
• Hornets
• Yellow jackets
• Fire ants
Pathophysiology of Insect
Stings

• Pain, itching, and irritation at the site following an insect
sting
• Insect sting allergy  hives, itching, swelling, and burning
sensations of the skin
• Severe allergy  fall in blood pressure, light-headedness,
chest tightness, dyspnea, and even loss of consciousness
Clinical Presentation of Insect
Stings

• Hives, excessive swelling, dizziness, weakness, nausea, vomiting,
difficulty breathing
• Significant allergic response away from site of sting
• Previous sting by honeybee, wasp, or hornet (need to evaluate possible
development of hypersensitivity)
• Previous severe reaction to insect bites
• Personal or family history of significant allergic reactions (e.g., hay fever)
• < 2 years of age
Exclusions for Self-Treatment of
Insect Stings