Bug Bites, Ticks, Rashes.  Family fun needn't be cut short by poison ivy or other summer bummers.*
by Karyn Repinski, Family Circle.

(Click highlight to see pictures)

Mosquito Bites

What to look for:   Small, swollen, itchy bump.
First aid:  Ice or a cold compress will relieve swelling.  To stop the itch, apply OTC hydrocortisone.  Covering bites with bandages limits scratching and helps prevent infection.
Seek medical attention if:  You have multiple bites around the eyes or if you experience severe headaches, fever, nausea and vomiting, disorientation, chills, muscle aches, pain or stiffness, all of which may be early symptoms of West Nile Virus, a serious and sometimes deadly disease that is carried by some mosquitoes.  Though rare, it can be especially dangerous to the elderly, to children, and to those with compromised immune systems.

Jellyfish Stings

What to look for:   Symptoms range from a painful, itchy, red rash to nausea, low blood pressure and shortness of breath.
Warning:  The venom from a poisonous jellyfish retains its potency even after the tentacles have been severed and the jellyfish is dead.
First aid:  Rinse area with sea-water (fresh water will worsen reaction) and remove tentacles with forceps, tweezers or gloved hands only.  Apply white vinegar or rubbing alcohol for 30 minutes to neutralize venom.  Make a paste with baking soda, mud or sand, or cover area with shaving cream, and shave with a sharp instrument to remove remaining tentacles.  Apply hydrocortisone cream twice a day and control itching with a antihistamine.
Seek medical attention if:  You're stung on the face or genital area, have many stings or you're having a systemic reaction--severe pain, worsening of the swelling, nausea, difficulty breathing or swallowing.

Spider Bites

What to look for:   Bite marks are usually too small to be easily seen yet can be painful.  Most leave small puncture wounds and result in redness, itching and swelling, which can last a couple of days.
First aid:  Clean the site with soap and water and apply an antibiotic ointment.  Apply a cool compress.  Take aspirin or acetaminophen for pain.  If symptoms are severe, see a doctor.
Seek medical attention if:  You've been bitten by either of two types of poisonous spiders--the brown recluse or the black widow--or by a spider that cannot be identified.  Treatment for a black widow bite may require an antivenom medication; doctors may treat a brown recluse bite with corticosteroids and antibiotics.

Poisonous Plants
(poison ivy, oak and sumac)

What to look for:   The first symptom of an allergic reaction to urushiol, the oily resin found in all parts of these plants, is severe itching.  A few hours or days later, redness, burning, swelling and blistering occur, often eruption in streaks or patches where the plant touched the skin.
First aid:  Fast action after contact with the resin, which becomes bound to the skin within 15 minutes, is often enough to avoid or minimize the reaction.  Remove clothes, wash the area thoroughly with soap and water, clean under fingernails to avoid spreading the resin.  Apply Zanfel, which inactivates the resin.  Hydrocortisone creams and antihistamines can ease symptoms.
Seek medical attention if:  Symptoms are severe; the rash covers large areas of the face or causes swelling of the eyelids; it becomes more widespread or involves sensitive areas, such as the genitalia; symptoms don't improve after five to seven days.

Bee Stings

What to look for:   A bump, redness, swelling, pain or itching.
First aid:  Of all the flying insects that sting, only the honey bee leaves its stinger and the attached venom sac well anchored in the skin.  Remove both as soon as possible to decrease the amount of venom injected.  Instead of using tweezers, which may cause more venom to be released and the reaction to worsen, gently scrape the skin with a straight-edged object, such a a credit card or a table knife.  Wash the area soap and water to prevent infection.  Treat pain with aspirin or acetaminophen and a cool compress or ice pack.  A past of baking soda and water may relieve itching, as will an OTC hydrocortisone ointment.
Seek medical attention if:  You have a systemic reaction, which may include shortness of breath; swelling of the eyes, lips, tongue or throat; hives; fatigue; nausea; vomiting; or muscle aches.  The earlier the onset, the more severe the reaction.  Problems with breathing can signal the onset of anaphylactic shock, an extreme allergic reaction that can cause air passages to close and even result in coma or death.  Sensitive people should be prescribed auto-injectable epinephrine (Epi-Pen) and carry it with them at all times during bee season.  Also seek emergency car if you're stung in the mouth or nose, as swelling may block airways (even in a nonallergic person), or if multiple bites occur around the eyes or genitals.

Snake Bites

What to look for:   A snake bite almost always occurs on an arm or a leg.  Poisonous pit viper snakes--rattlesnakes, water moccasins and copperheads--leave fang marks.  The bite from the poisonous coral snake lacks these puncture wounds (they have small mouths and short teeth) and may be harder to detect.
First aid:  Bites from non-venomous snakes such as the garter, ribbon and milk snake should be treated like any animal bite.  Wash with soap and water, then apply antibiotic ointment and bandage.  Watch for signs of infection or allergic reaction, which even non-poisonous snake bites can cause.
Seek medical attention if:  You're bitten by a poisonous snake or a snake that cannot be identified.  Immobilize the bitten limb and keep it lower than the heart; have the victim stay as still as possible.  Remove constrictive clothing, since swelling may progress rapidly.  Do not cut or squeeze the bit or try to suck out the venom.  If medical attention cannot be obtained within 30 minutes, call the regional poison center for advice on how to treat the victim.  Do not apply a tourniquet or ice.

Tick Bites

What to look for:   A dark bump the size of a pinhead or larger.
First aid:  If a tick is attached to you, grasp it close to its head or mouth with tweezers.  Pull the tick out slowly and steadily without twisting.  Don't squeeze the tick or use petroleum jelly or a lit match to kill it--these measures will cause it to burrow into the skin more deeply.  Clean the area thoroughly with soap and water.  If some parts of the tick cannot be removed, get medical help.  Watch for the next week or two for telltale signs of Lyme disease (see below).  It can take up to 48 hours for an infected tick to pass the bacteria to you, longer for certain symptoms to show up.
Seek medical attention if:  You have a Lyme-like rash (resembling a bull's eye, the central area clear with a red dot in the middle and a circle of red surrounding it), or you're suffering from flulike symptoms, including fatigue, fever, joint pain, inflammation, after having been in a tick-infested area.  However, Lyme disease is not always associated with a rash, and even when one occurs, it may not be the classic one.  An ELISA test for Lyme disease may be done two to three weeks after the bite ( an earlier test can produce a false negative result).  If it's positive, antibiotics--which are quite effective if the disease is caught early on-- will be prescribed.

Minor Wounds

What to look for:   Abrasions, superficial scrapes that may or may not bleed, or puncture wounds, which penetrate the skin and cause bleeding.
First aid:  Cleanse minor injuries with tepid water and gentle soap or antiseptic wash (not hydrogen peroxide, which destroys the cells that help repair skin), taking care to remove sand, dirt or any small objects.  Apply an antibiotic ointment and bandage the area with a nonstick dressing.  After a week, switch to plain petroleum jelly, and continue using it underneath a bandage until new skin grows over the wound.  Allowing a fresh cut to "breathe" and a scab to form by not using a bandage will actually delay dealing time by as much as 50 percent.
Seek medical attention if:  The wound is deep, you can't control the bleeding and/or the cut is gaping or on the face, in which case you might need stitches.

*Family Circle, July 13, 2004

Contributors to this story include:
Jeanine B. Downie, M.D., a dermatologist in Montclair, New Jersey:
David Leffell, M.D., professor of dermatology and surgery at Yale School of Medicine and author of Total Skin (Hyperion):  Helene Rosenzweig, M.D., assistant clinical professor of dermatology at UCLA School of Medicine:
Greg Stockton, director for Emergency Physicians Medical Group Northwest in Everett, Washington:
Bruce Bonanno, M.D., American College of Emergency Physicians.