臭虫叮咬通常是自限性的,不经治疗也可在 1~2 周内消退。[2]Goddard J, deShazo R. Bedbugs (Cimex lectularius) and clinical consequences of their bites. JAMA. 2009;301:1358-1366.http://jama.jamanetwork.com/article.aspx?articleid=183643http://www.ncbi.nlm.nih.gov/pubmed/19336711?tool=bestpractice.com[9]Kolb A, Needham GR, Neyman KM, et al. Bedbugs. Dermatol Ther. 2009;22:347-352.http://www.ncbi.nlm.nih.gov/pubmed/19580578?tool=bestpractice.com主要的治疗目标是缓解症状。一旦做出臭虫侵染的诊断,应实施预防措施,包括环境清洁(例如,清洗衣服和寝具、家具吸尘、检查床垫)。[2]Goddard J, deShazo R. Bedbugs (Cimex lectularius) and clinical consequences of their bites. JAMA. 2009;301:1358-1366.http://jama.jamanetwork.com/article.aspx?articleid=183643http://www.ncbi.nlm.nih.gov/pubmed/19336711?tool=bestpractice.com[9]Kolb A, Needham GR, Neyman KM, et al. Bedbugs. Dermatol Ther. 2009;22:347-352.http://www.ncbi.nlm.nih.gov/pubmed/19580578?tool=bestpractice.com[23]Davis RF, Johnston GA, Sladden MJ. Recognition and management of common ectoparasitic diseases in travelers. Am J Clin Dermatol. 2009;10:1-8.http://www.ncbi.nlm.nih.gov/pubmed/19170405?tool=bestpractice.com人们制造了一些臭虫检测仪,可帮助探测轻度臭虫侵染。[24]Wang C, Tsai WT, Cooper R, et al. Effectiveness of bed bug monitors for detecting and trapping bed bugs in apartments. J Econ Entomol. 2011;104:274-278.http://www.ncbi.nlm.nih.gov/pubmed/21404868?tool=bestpractice.com然而,出现侵染时,通常需要专业杀虫。[2]Goddard J, deShazo R. Bedbugs (Cimex lectularius) and clinical consequences of their bites. JAMA. 2009;301:1358-1366.http://jama.jamanetwork.com/article.aspx?articleid=183643http://www.ncbi.nlm.nih.gov/pubmed/19336711?tool=bestpractice.com[11]Doggett SL. A code of practice for the control of bed bug infestations in Australia. May 2010. http://medent.usyd.edu.au (last accessed 11 May 2016).http://medent.usyd.edu.au/bedbug/cop_3ed_final.pdf
对症治疗
轻度病例的初始治疗包括口服抗组胺药和止痒剂。口服抗组胺药(如安泰乐)能最大程度减少瘙痒,但不能改变皮疹的持续时间和外观。[5]Thomas I, Kihiczak GG, Schwartz RA, et al. Bedbug bites: a review. Int J Dermatol. 2004;43:430-433.http://www.ncbi.nlm.nih.gov/pubmed/15186224?tool=bestpractice.com[9]Kolb A, Needham GR, Neyman KM, et al. Bedbugs. Dermatol Ther. 2009;22:347-352.http://www.ncbi.nlm.nih.gov/pubmed/19580578?tool=bestpractice.com[25]Scarupa MD, Economides A. Bedbug bites masquerading as urticaria. J Allergy Clin Immunol. 2006;117:1508-1509.http://www.ncbi.nlm.nih.gov/pubmed/16751024?tool=bestpractice.com止痒效应主要源自它们的镇静作用。局部用止痒剂(如,普莫卡因/樟脑/炉甘石软膏或多塞平乳膏)可缓解症状。
对有更明显不适的患者,外用低效至中效的糖皮质激素可加速皮疹消退并减轻瘙痒。[5]Thomas I, Kihiczak GG, Schwartz RA, et al. Bedbug bites: a review. Int J Dermatol. 2004;43:430-433.http://www.ncbi.nlm.nih.gov/pubmed/15186224?tool=bestpractice.com[9]Kolb A, Needham GR, Neyman KM, et al. Bedbugs. Dermatol Ther. 2009;22:347-352.http://www.ncbi.nlm.nih.gov/pubmed/19580578?tool=bestpractice.com药物包括曲安西龙或氢化可的松。外用糖皮质激素通常不应超过 2 周。如果患者有更加严重/范围更大的反应(例如弥漫性皮疹伴无法忍受的瘙痒),应考虑口服糖皮质激素。仅当患者出现超敏反应时使用肾上腺素。
继发感染
由于炎症和抓挠会破坏皮肤屏障,可继发葡萄球菌感染(通常是金黄色葡萄球菌)或链球菌感染(通常是化脓性链球菌)。[12]Burnett JW, Calton GJ, Morgan RJ. Bedbugs. Cutis. 1986;38:20.http://www.ncbi.nlm.nih.gov/pubmed/3731861?tool=bestpractice.com口服抗生素或外用抗菌药物治疗是有效的。