Preventing and Treating Severe Mosquito Bites

Many kids develop large local reactions to mosquito bites. There's usually some reaction within hours of the bite, which progresses over 8 to 12 hours or more. The reactions can be quite dramatic, and occasionally even blister or bruise.

Question

My three-year-old son has a tendency toward major localized swelling following mosquito bites. I wonder if there is anything I should do to prevent or treat the swelling? Will he outgrow this? No one in our family has allergies, so we are mystified by this situation and worry that we will have to keep him in some kind of mosquito netting for the rest of his life.
New York, NY

Dr. Greene's Answer

Many kids (including my daughter Claire) develop large local reactions to mosquito bites – charmingly called Skeeter Syndrome. It’s a reaction to proteins in mosquitos’ saliva. There’s usually some reaction within hours of the bite, which progresses over 8 to 12 hours or more, and then disappears within 3 to 10 days. The reactions can be quite dramatic, and occasionally even blister or bruise; however, thankfully they rarely become infected or cause serious problems.

The most common age for reactions to start is somewhere between age 2 and age 4, and (good news!) once it develops, most kids only have this for a few summers before the reactions disappear. It takes a few extra years to go away for kids who live in Alaska, northern Canada, and the Nordic countries.

In the meantime, the keys are preventing mosquito bites and dealing with bites that do occur.

New Mosquito Bite Prevention

For prevention, there is an exciting repellant created by the CDC and registered with the EPA in August 2020 – the first new, effective treatment in over a decade. It’s as effective as DEET or other strong repellants, but safe enough to drink! The active ingredient was isolated from cedar (the Alaskan Yellow Cedar. Think Grandma’s cedar chest keeping her clothes safe from moths). It’s also found in grapefruit zest and is used in our food to impart the aroma and taste of grapefruit. The active ingredient is called nootkatone, after the scientific name for the cedar. It’s effective against ticks, bedbugs, and other biting insects, in addition to mosquitos. I’m eagerly awaiting products containing nootkatone to appear on the market.

As we await the exciting newcomer, my favorite repellants are DEET-free and use picaridin as the active ingredient. Picaridin is a compound similar to that found naturally in black pepper. I prefer using one with 20% picaridin — long-lasting, at least as effective as DEET, and without the safety concerns. Two brands that meet these criteria are Natrapel and Sawyer.

Natrapel has been consistently listed as a top recommended natural insect repellent by Consumer Reports for many years.  It is widely available and comes in a couple of different forms including wipes and sprays. 

Oil of lemon eucalyptus is another effective ingredient (like that found in Repel Plant-Based Lemon Eucalyptus Natural Insect Repellent). The ingredient also goes by the less memorable name PMD (P-methane-3,8-diol). It can be as effective as DEET, but only lasts 2-5 hours.

Many mosquitoes bite most actively at dawn and dusk and especially near wetlands or grass. If your son tends to get large reactions to bites, try timing your outdoor activities to avoid dawn and dusk. This can make a big difference in the number of bites he may get. 

In some regions, other environmental control measures make sense, including mosquito nets, treated fabrics, and draining standing water.

When you know your is likely to be bitten, an antihistamine like Claritin or Zyrtec once a day, taken before the bite, can reduce reactions.

Mosquito Bite Treatment

After the bite, an anti-itch cream containing hydrocortisone can have a good benefit-to-risk ratio if he is uncomfortable, as well as an antihistamine like Benadryl or Zyrtec (by mouth, not topically). There are stronger medicines if the bite happens to be in a spot that interferes with vision, eating, drinking, or walking.

It is possible, but not common, for these bites to get infected.   You won’t typically see swelling or redness from infection within hours of the bite; and most of these reactions recover on their own without any need for antibiotics. However, if the bite does not progressively improve, or he develops fever, pain, or worsening redness and swelling, a visit to your pediatrician is warranted.

References and Resources

Clinical Pediatric Dermatology. Saunders; 1993.

Nguyen QD et al. Insect repellents: An updated review for the clinician. J Am Acad Dermatol. 2018;S0190-9622(18)32824-X 2018.  

Environmental Protection Agency: Mosquito Control

Last medical review on: September 18, 2014
About the Author
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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Recent Comments

I am 69 years old from South Louisiana, mosquito country. I had the insects enter my house recently and my back and butt are covered. A head doctor put me on an antipsychotic (I am not and never been psychotic, just lifelong depressive) for a sleep aid and I reacted with severe hives (Forearm swole to 3 x and turned purple. Itched like hell. Took a week to go away). I got off the bad drug this week. Since then, I developed severe skeeter syndrome. I’ve been unable to sleep or relax for 3 days. Last night I took temazepam (heavy narcotic) and am finally almost human feeling. I used aloe leaves, Cortisone cream, alocane, epson salts baths, showers, rubbing alcohol, and prayer. Nothing worked for a while. Today the screaming itching is less. I feel almost sane. To anyone that must endure this, my deep condolances and more prayer. This is serious shit.

Susan,

I am so sorry. This sounds horrific.

Thanks for sharing your experiences and may you recover steadily from here.

Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

Susan,

I am so sorry. This sounds horrific.

Thanks for sharing your experiences and may you recover steadily from here.

Best, @MsGreene
Note: I am the co-founder of DrGreene.com, but I am not Dr. Greene and I am not a doctor. Please keep that in mind when reading my comments and replies.

I was outside for a bit and I got eaten alive by mosquitoes. I told my husband that I’m allergic to mosquito bites and he didn’t believe me until he saw the nickle/quarter sized welts. I’ve been getting them since I was a kid and I still react to the bites to this day. While I’m not enjoying my legs burning and itching, I’m glad I get to say “I told you so” to my husband as I ice my legs and pray.

Howdy there,
My name is Arianna and recently I woke up in the middle of the night to see these weird swollen bumps in my arms and hands. Being worried and all I check online to see what type of bed bugs or any type of insect that might have bite me and how to treat it. Turns out that I’m having a “severe allergic reaction” to multiple mosquito bite. However, I’m still worried because the bite itself is huge and does not look good at all.What should I do next?

Great advice! I’ve recently leaned (after years of suffering) that avoiding to scratch significantly decreases the symptoms.

I don’t know if this will help or not, but I have learned from personal experience, that if I can avoid scratching the bite, especially immediately after getting bitten, that my reaction is wayyy less severe and resolves rather quickly. I don’t know why this is, but this has been my recent experience.

Sounds like you need to get out of your current mosquito-rich environment so you can get some relief. Is that possible? Can you go stay with a friend who lives somewhere without mosquitoes?

Hello. I am writing this at 3:36 am. I have had several mosquito bites. My first round of bites, I scraped and itches until the skin broke and I know have scabs. My second round of bites, I basically coated my legs with anti itch bug cream. My 3rd round wasn’t as bad only about 6 bites total. I used the cream but put bandaids over to avoid scratching. Most recently (2 days ago) I went outside in a long sleeved shirt, leggings, socks, and a hat. When I get back inside and check my body for bites, I now have 11 bites on my lower butt cheek/the crease between thigh and butt. Now I am walking around the house with most of my freezers ice down my pants. Please help

Sounds like you need to get out of your current mosquito-rich environment so you can get some relief. Is that possible? Can you go stay with a friend who lives somewhere without mosquitoes?

Hi, I am a 34 year old female, I live in MN, every time I am bitten by a mosquito I develop a circular red rash with raised edges, this one time the circular rash is developing smaller bumps that look like additional bites; may years ago (about 9-10) I was tested positive to lymes, I am cured but ever since mosquito bites are very severe. The itch is severe but not always present, the only times it itches is when the rash expands, currently the bite is about 2 inches in diameter, warm to the touch and the area is also swollen. This has happened in the past and at one point I was seen and referred to rheumatologist, dermatologis and allergist, had all kinds of tests done and none gave me an answer to the reaction, then I learned about skeeter, my question is, is it possible that after a disease such as lymes that the immune system reacts aggressively to foreign bacteria such as bug bites? I was told there were a lot of white blood cells in the biopsy area indicating my immune system was over reacting to something.
your answer is greatly appreciated.

I don’t know if this will help or not, but I have learned from personal experience, that if I can avoid scratching the bite, especially immediately after getting bitten, that my reaction is wayyy less severe and resolves rather quickly. I don’t know why this is, but this has been my recent experience.

Hi I’m 25yrs old and ever since my Bone marrow transplant I’ve been super sensitive to bites, they swell up and make my entire body ache afterwards I drink 3ml of benadryl and put a little on the actual bite and its gone within an hour. I have also tried benadryl insect bite gel and works amazing but burns on site.