INSECT BITES -------------------------------------------------- ---------- REPELLENTS ---------- What insect repellent would you recommend for babies who are highly responsive to mosquito bites-or any other tactic (besides staying home inside). Diane Thaler ------------ Try this: 2 cups witch hazel, one tablespoon citronella, one tablespoon white vinegar. Combine in a pump spray bottle. You can increase the potency by adding 900mg cleocin HCL (just dump in the capsule powder) Mosquitoes dont like the taste any better than humans do. This formulation works great for nail biters too. The stuff on kids fingers will keep them out of the mouth. Haines Ely ---------- Southern Dermatologists deal with these problems fairly frequently, so I'll take a shot at this one. For mosquito bites in babies: if you don't want to use the usual insect repellents that contain various concentrations of DEET (don't ask me to spell out the full chemical name), try Skin-so-Soft, a moisturizer that has a reputation in the South of being able to repel mosquitos. I forget the manufacturer, but it can probably be obtained in any reasonable stocked American supermarket. Atopic children (and adults, for that matter) may have exaggerated responses to mosquito bites. An excellent prophylaxis is Zyrtec (doesn't prevent the bites, but they don't have such severe reactions)^A[1]^A. For infants, try hydroxazine syrup. Mark Naylor, M.D. ----------------- Skin so soft is an avon product; as one who is prone to severe insect bite reactions, I have never found it to be a good repellant. My personal favorite is pennyroyal oil applied to shoes, patches of clothing and hats. (Just don't consume it.) If the smell is overpowering, add a few drops of citronella, lemon oil, lime oil, lavendar oil or peppermint oil. Daniel Mark Siegel MD, MS ------------------------- One could try giving Vitamin B (Thiamine) orally. Usually we give 300 mg OD for adults, 150 mg for children OD and 75 mg for babies OD. It works by altering the scent of the individual too make them less attractive to mosquitoes. Jonathan Yu, MD ---------------- Do you think certain DEET concentrations would be a problem ? Skin so Soft, by Avon, doesn't work as well as the myth would have it, and, atleast in its old formulation, was very greasy. Maybe full clothes, with spraying the clothing with decent DEET would be less problematic. I have used the non sedating antihistamines for several years, both for the atopic insect bite reaction and the "no see ums" that bite us Cheeseheads and Flatlanders who venture to Florida every winter. Do you think Cetirizine is mo bettah? Actually, have you been more successful with Cetirizine in any diseases? Diane Thaler ------------ Can humans smell the scent change as well? Diane Thaler ------------ DEET in any concentration, is toxic. Given the decreased barrier function of baby skin and the increased surface area to weight ratio in a baby (compared to adults), I would stay naway from DEET in any form. Rick Sharpe ------------ I thought kids' barrier function was essentially the same as adults. The surface area is an important consideration, though. Eliot Mostow ------------ We've had cetirizine here in Canada for a long time, and now its OTC. In my experience it IS the best antihistamine for insect bites, probably because of its effect on eosinophils rather than because of its antihistamine effect. Also can be useful for atopic dermatitis at 40 mg / day. Don't let them make it OTC in the States, because once its OTC the drug plans won't pay for it, making it hard to use at 40 mg / day long term for eczema. KC Smith MD FRCPC ------------------ It is interesting that Skin-So-Soft is receiving such mixed reviews. Back during my days as a Naval Flight Surgeon most of the members of my squadron swore by Skin-So-Soft, especially when conducting flight operations out of Puerto Rico where they have some really nasty "no-see-ums". Of course, this is just anecdote, but squadron personnel definitely seemed to prefer the original formulation of SSS over navy-issue insect repellent (DEET) which they could have had gratis. Perhaps insects in various locales have differing tastes and aversions. For what its worth, there is a formulation of SSS currently available that contains citronella 0.05% as well as sunscreens (octyl methoxycinnamate, benzophenone-3, and octyl salicylate). My wife just happened to have a bottle of this laying around. It does have a caution on it that it should be used on "children under 6 months of age only with the advice of a physician". It seems to me that such a warning was not warranted. I guess you could always try garlic (just kidding!). Thiamine as suggested by Dr. Yu sounds very interesting and should be fairly benign. Re: cetirizine. It has become first-line treatment for chronic urticaria in my practice. It is very effective and patients love the qd dosing. John Kaiser, MD --------------- Treo, which is made for children. Yelva Lynfield, MD ------------------ I tell people to ease into it - 10 mg hs for a few days or a week, then 20, and eventually up to 20 bid. Like most antihistamines the soporific effect stops being a problem after a week or two. Kevin C. Smith MD FRCPC ----------------------- As far as I know there is no good controlled study. A couple of years ago I was involved with the development of a topical and we compared flux in human skin from circumcisions (newborns) to human skin from late 20's to late 30's, female breast reduction skin. The flux was always greater (in paired samples) with the newborn skin. However, the sample size was limited and the anatomical site is probably also a significant variable. P.S. If you have data or reference to data on this subject I would be interested. Rick Sharpe ------------ re: insect bites and thiamine - there was a great deal of research done on insect bites by the army during the vietnam era and one of the results, as i recollect, was that thiamine was not useful in humans (as versus dogs, cats). perfumes and sweat seemed to attract insects. Steven D. Emmet, M.D. --------------------- An unblinded two-arm study performed three years ago at Kiawah Island revealed that skin so soft effectivly repelled no-see-ums, but not mosquitoes, on the two arms of your correspondant. DEET worked on both. Guy Webster ----------- Skin So Soft contains, if I am not mistaken, Citronella, and is made by Avon. A similar product, Skintastic, made by OFF, and other newer products are available, although I cannot find any references for absorption and toxicity in babies from Citronella. Warren Winkelman, MD, FRCPC --------------------------- Skin-So-Soft, by Avon, works well for my patients with no-see-um bites, as well as mosquito bites. Elimite would do well also. I considered coming out with a line of sports clothing impregnated with pyrethrum. The Army has experimented with battle uniforms and the UN with tents so treated and found them effective. Anyone interested ? Michael Fetterman ----------------- If DEET and Skin So Soft are contraindicated for toddlers, pyrethrum deserves a lot of consideration. Besides Elimite, it is available OTC as NIX and I was looking into concentrate from the maker for impregnating fabric with. The Army and UN trials were quite successful. Interestingly, pyrethrum derived from chrysanthemums and used as insect repellent was the original basis of the U.S.-China trade in the 1800s. Michael Fetterman ----------------- Here in the "lowcountry" of South Carolina, that has been our experience as well. "Skin-so-Soft" works great for sand gnats (no-see-ums, but certainly-feel-ums), but is worthless for mosquitoes, dogflies, horseflies, etc. DEET works for the latter batch of critters, but seems worthless for sand gnats, at least in the form of Deep Woods Off or Cutter. Not sure about 100% DEET, which is available. Need both. Dan Mitchell, MD ---------------- In response to Diane Thalers' further inquiry and other comments regarding mosquito bite therapy suggestions: I don't vouch for the efficacy of Skin So Soft (Avon--thanks Daniel) as an effective repellent. It is just a reasonably harmless thing to recommend for those squeamish about putting "CHEMICALS" on their skin (or more commonly on their babies' skin). Honestly, I wouldn't hesitate to spray some OFF on my 21-month old (who is very reactive to mosquito bites). It seems reasonable to me to do this even for a 1-month old as long as you are not using frequent applications (say, more than once a day, or for more than two days in succession just to be on the safe side) or using a high concentration product. DEET (N,N-diethyl-m-toluamide--I looked it up) has proven to be reasonably safe and quite effective in the concentrations generally found in consumer preparations in the U.S. Upping the concentration of DEET may not help efficacy that much (Regular OFF vs. DEEP WOODS OFF). Rick Sharp's comments notwithstanding, I don't think the literature supports the viewpoint that DEET is very toxic if used as directed. Anything can be dangerous if used inappropriately. By comparison, DEET is much less dangerous in my opinion than Kwell (lindane), which can be quite neurotoxic if used inappropriately. However, if you're worried about it, his recommendation is a safe one for infants, if erring a bit on the conservative side. I'm not sure I'm going to let my 1-month old suffer if more conservative protection measures prove inadequate. I do think the non-sedating antihistamines are an improvement over older agents, both because they are more avid H1 blockers and perhaps more importantly because they are better tolerated (e.g., less sedation). Cost is the only real issue. If you can afford it, Zyrtec (cetirizine) works very well. I would imagine that Claritin (loratadine) and Hismanal (astemizole) would probably help to suppress mosquito bite reactions, it's just that cetirizine was actually studied for this property [1]. Generic hydroxyzine is dirt cheap by comparison, and is a cost-effective alternative if you are prescribing for a young mother who is paying "out of pocket". Incidently (?Anecdotally), I do think these drugs are better than older antihistamines for treatment of urticaria and I now use them as "first line" treatment. I have not had much luck with Seldane (terfenadine) for this indication though. Most adults I have used it in have tolerated 40 mg/day of cetirizine with less sedation than would be expected from 50-75 mg/day of hydroxyzine (anecdotally, of course). 1. Reunala T, Brummer-Korvenkontio H, Karppinen A, et al.: Treatment of mosquito bites with cetirizine. Clinical & Experimental Allergy 23(1):72-75, 1993. Mark Naylor, M.D. ----------------- My bottle of Skintastic II by OFF (SC Johnson) has 7.5% N,N-diethyl-meta toluamide and related isomers (I think that's DEET), but no citronella. It works well for my wife who urticates dramatically and immediately from mosquito bites. This year is one of the worst mosquito years in history in Colorado. On a recent hike in Rocky Mountain National Park, one could see and swat thick clouds of the beasts. Paul S. Gillum -------------- I could never find references for absorption of ppt of sulfur in babies , or Eurax. What will happen to the patients with compositae sensitivity? Diane Thaler ------------ I do not know if that happens with pyrethrum ot pyrethrins. Michael Fetterman ----------------- My family loves the stuff. A recent outbreak of head lice in 9 of my 12 nieces and nephews, not treated by me (I'm learning to not treat family; see my posting on cetirizine), which did not respond to Rid, Nix, Kwell Shampoo, was miraculously resolved with Skin-so-soft according to their mothers. As far as mosquitoes, personally, I have no experience with the stuff. If you like Consumer Reports, see 7/93 pg 451. They found DEET products effective and that "nondeet products couldn't ward off aggressive mosquitoes for even half an hour. Avon's Skin-So-Soft, despite the folklore, was equally ineffective." Has the formula changed in the past three years? There is no mention of citronella in this article. Michael J. Yunakov, MD ---------------------- Doesn't sound like pyrethrum is a sesquiterpene, so they shouldn't react. Any pharmacologist out there? Mychael Luu ----------- Sorry, I haven't checked recently. I liked the product when they sent me samples last year; it worked; I wonder why it went off the market. Maybe it couldn't compete with Avon. I will look for it next time I'm in a drug store. Yelva Lynfield -------------- It is possible Skin-so-Soft worked for the head lice because of its oil formulation. I was in charge of ridding my son's school of its second epidemic, and got to know quite a lot about lice. There is actually a Society which educates and researches the subject, based on the East Coast, a very dedicated bunch. Anyway, a non-interventionist type pediatrician was recommending the use of olive oil immersion on the hair and scalp, overnite, sleeping in a cap. One of the moms got into a wee bit of difficulty as she picked up her screaming infant with her olive oiled arms and hands and the kid flew. You must make sure they have Dawn Detergent around to get the stuff out, or else they end up at the grocery dripping olive oil in their shower caps. Diane Thaler ------------ Sorry I am not but we have the Rietschel/Fowler's "contact dermatitis", 4th edition, at hand. See p. 475: "Sesquiterpene lactones appear to be the specific sensitizers in chrysanthemum, pyrethrum, ragweed, and other weeds." Hans J. Kammler --------------- Re recent discussion regarding the possible cross reaction of synthetic pyrethrins and ragweed and crysthanthemum relatives I ave seen contact dermatitis to both elemite and other pyrethrin compounds like those found in many flea shampoos for animals. Some of these people claimed to be ragweed sensitive but I did not do patch testing to confirm this. L.J. Gregg,MD ------------- --------- TREATMENT --------- I too sent my kids off to camp with tubes of Temovate for bug bites, and they did very well. Kevin C. Smith MD FRCPC --------------------