Mosquito Bites on the Face: When to Worry

Image via WikipediaMosquito Bites on the Face:  
When to Worry

A warm hot summer has yielded an explosion of mosquitos in our area, and with the jump in the number of mosquitos has come a dramatic jump in the number of mosquito bites.

Recent reports document this is happening and that we can anticipate a big jump in the number of mosquito bites through October.

At the office, we have seen the beginning of this big jump, with a large increase in the number of calls about mosquito bites.

Families have expressed two types of concerns about mosquito bites, are the infected, and is it really just mosquito bites or possibly chickenpox.

Mosquito Bite Basics
As the picture above shows, mosquitoes are tiny insects that live on the blood of animals they bite.  To make their living, they must slide a tiny tube into a blood vessel and suck some blood out the tube, all without you noticing in time to smash them.
Aside from being noticed and killed, their other challenge is to make sure your blood does not clot while their snout is in your capillary.
Here is why most people get a reaction.  To keep your blood from clotting during their visit, the mosquito first injects a little anticoagulant.  This material has an impact on your immune system, and this impact leads to inflammation at the site of the bite.  It's this inflammation that causes the very familiar sight of a mosquito bite, namely, a red bump, often with a tiny dot in the middle where the bite occurs, and surrounding redness:



Another basic to keep in mind is that the younger you are, the more vigorous your immune system, and so the more dramatic inflammation from mosquito bites can be.  Think of how young children can easily generate fevers to 105, but adults rarely go past 102.  Just so with mosquito bites.  Young children can get quite big red areas from even one bite.

Chickenpox
Now, take a look at this picture of the rash of chickenpox, and you can see why it makes sense for people to wonder if their child gets a bunch of mosquito bites, whether it really is mosquito bites or chickenpox:


But there is a difference.  Notice that chickenpox nearly always ends up having three types of rash:
starts with red spots which become blisters, which become scabs.  The red spots of chickenpox and small mosquito bites look about the same, really quite similar.  That makes the two conditions confusing to sort out.

In a few days the red spots of mosquito bites are still red spots, or gone, or scratched to scabs; but the red spots of chickenpox become tiny yellow-filled blisters that we call vesicles.  These vesicles then turn into scabs without any scratching.

Of course, if you are not sure that your child's mosquito bites are not chickenpox, feel free to call.
Hopefully this guidance will help, but should not stop you from inquiring.

Is the bite infected?
The other major concern that mosquito bites cause is whether the bites are infected.  This is most commonly feared when the mosquito bites are on the eyelids.
Take a look:

What do you think, is this eyelid infected?  Let's talk about mosquito bites and infections, then you decide.

The skin of the eyelid is very loose and capable of rather impressive swelling.  Even a simple mosquito bite can cause swelling enough to close the eyes shut.  The inflammation of a mosquito bite causes a lot of fluid to accumulate in the eyelid, especially if you lie down for a night's sleep or a nap.  The swollen eyelid has a pale pink color, is not warm, often only involves one lid- just the upper or lower.  The redness of the swollen eyelid from a mosquito bite is pale, not deep red, and the swelling is soft, like a partially inflated water balloon.  The eyelid feels a little bouncy, not hard.  The eyelid can be itchy, not typically painful, and often there is a red dot where the bite occurred.

When an eyelid is infected, all those properties of the eyelid are different.  Infections almost always spread to both eyelids, the redness is deep not pale, the eyelid feels hot and often hurts, and there can be pus.  The whole look is more like an angry red, hot appearance, and not the soft watery pale red of a mosquito bite.

Now with that in mind, what do you think of the picture of the swollen eyelid, mosquito bite or infection?
The answer is mosquito bite- only one lid, the upper is swollen, the redness is faint, the swelling is soft looking.

One last clue, swelling from mosquito bites almost always gets worse after lying down for awhile, since most of the swelling is simply water accumulating in the area.  Sitting or standing helps the fluid move and the swelling gets better.  This is why when young children get a mosquito bite on their eyelid, they frighten parents after sleeping- their eye is swollen shut!  But ofter after an hour or so of getting up, the swelling is much less.
Swelling from infections almost never shrinks after getting up.

Again, these tips are meant to help.  Of course, if questions still remain feel free to call us.


BOTTOM LINE
The key points to keep in mind are:

1. This looks like a big year for mosquitoes.  Expect lots more bites, more swollen eyelids, more patches of great numbers of bites.
2. Chickenpox and mosquito bites look alike early on, but mosquito bites stay looking like mosquito bites and chickenpox rashes become tiny blisters and scabs.
3. Mosquito bites on the eyelid typically cause big swelling, but the redness is fainter, the pain is less, the spread is limited, compared to actual infections.
4. Call if you are concerned.

Dr. Arthur Lavin

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