What is Skeeter Syndrome?

Skeeter syndrome is a large local reaction after a mosquito bite that can mimic an infection.

What’s your first thought if your child has a large swollen area that is hot, red, and either painful or itchy?

A child with Skeeter syndrome - a bite that quickly got red, hot, and swollen.
A child with Skeeter syndrome – a bite that quickly got red, hot, and swollen. Photo by Vincent Iannelli, MD

You’re probably thinking that this bite is infected, right? It was gone without treatment over about 48 hours.

What is Skeeter Syndrome?

While that is certainly a possibility, if the reaction occurs right after a bite or sting, it is much more likely to be an inflammatory reaction – Skeeter syndrome.

The American Academy of Allergy Asthma and Immunology defines Skeeter syndrome as an inflammatory reaction to mosquito bites.
The term Skeeter syndrome was first used in a report by Simons and Peng in 1999.

Although the American Academy of Allergy Asthma and Immunology says that Skeeter syndrome is relatively rare, spend a few minutes with a pediatrician and they will likely tell you that we see it all of the time…

“The large local reactions to mosquito bites that we have designated as skeeter syndrome occur within hours of the bites and are characterized by the cardinal signs of inflammation: swelling (tumor), heat (calor), redness (rubor), and itching/pain (dolor). By inspection and palpation, it is impossible to differentiate between inflammation caused by infection and inflammation caused by an allergic response.”

Skeeter syndrome Case Studies

These reactions can be especially impressive, and scary, for parents if they occur on a child’s eyelid or penis – as loose tissue in these areas can lead to a lot of swelling.

So how can you tell if a child has Skeeter syndrome or cellulitis, an infection that requires antibiotics?

“The reactions were initially misdiagnosed as cellulitis and investigated and treated as such, although by history they developed within hours of a mosquito bite, a time frame in which it would have been highly unlikely for an infection to develop.”

Skeeter syndrome Case Studies

Although cellulitis can mimic or look just like Skeeter syndrome, it is the timing of the reaction, very soon after the bite, that will help you and your pediatrician make an accurate diagnosis. That’s important, because the treatments for Skeeter syndrome and cellulitis are very different.

In general, kids with Skeeter syndrome only require symptomatic care, perhaps an antihistamine and topical steroid cream, while cellulitis is treated with antibiotics.

Are there any other differences between Skeeter syndrome and cellulitis?

While cellulitis will likely continue to worsen, especially if it isn’t treated with antibiotics, you can expect the redness and swelling triggered by Skeeter syndrome to start to get better after two to three days. Keep in mind that many bites and stings do worsen over the first day or two though…

What Causes Skeeter Syndrome?

The large local reaction that occurs with Skeeter syndrome is triggered by antigens in the saliva of the mosquitoes.

While these typically just cause mild local reactions in most of us, others can have severe, delayed reactions, exaggerated local reactions, or very rarely, anaphylactic reactions.

“The children with skeeter syndrome remain healthy, except for recurrent large local inflammatory reactions to mosquito bites.”

Skeeter syndrome Case Studies

So what should you do for your child with Skeeter syndrome?

For one thing, use insect repellents so that they don’t get mosquito bites. And work to control the mosquitoes around your home.

You might also give them an age appropriate dose of a second-generation H1-antihistamine such as cetirizine to prevent or treat the reaction if they do get some bites.

Are mosquitoes the only insects that cause Skeeter syndrome?

By definition, yes.

But we often see these same type of large, local reactions (LLRs) after fire ant bites, bee stings, and other bites and stings.

“There is no clear definition of LLRs. They are generally described as any induration larger than 10cm in diameter around the insect sting. The swelling can occur immediately or 6 to 12 hours after the sting and can gradually increase over 24 to 48 hours. The swelling usually subsides after 3 to 10 days. LLRs represent a late-phase immunoglobulin E (IgE)–associated inflammation.”

Pansare et al on Summer Buzz: All You Need to Know about Insect Sting Allergies

Sweat bees, very small bees, for example, are notorious for “stinging” people around their eyes and causing what looks like periorbital cellulitis, as they like to drink the salt on our sweaty skin.

Is your child’s bite or sting infected?

Just remember, even if the area is hot, red, and swollen, if it got like that within hours of a bite, then it probably isn’t infected.

“The type of clinical reaction determines the risk of allergic reactions to future stings.”

Pansare et al on Summer Buzz: All You Need to Know about Insect Sting Allergies

And also be reassured that children who only have large local reactions are very unlikely to go on to have more severe, anaphylatic type reactions in the future.

More on Insect Bites and Stings

Learn How to Spot and Treat Poison Ivy

You can probably spot poison ivy if you were looking out for it, right?

Leaves of three, let it be…

You know the problem though, right? Most of the time, you aren’t actually looking out for it.

Spotting Poison Ivy

It would be nice if we got a warning anytime we were going to be around poison ivy.

Poison Ivy Warning Sign
Our local YMCA used to have a sign warning kids to stay out of the surrounding woods.

Or if someone was nearby to point it out to us.

Poison ivy won't always be this easy to spot.
Poison ivy won’t always be this easy to spot.

That’s not usually going to happen, so you need to learn how to spot poison ivy if you want to avoid it.

What’s the first step in learning how to spot poison ivy? Understanding where poison ivy is likely to be growing.

Any “wild” area, especially along tree lines and fences, just off paths and trails, and around ponds and lakes, are likely places you will find poison ivy.

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Whether it is a tree line, fence, or edge of a path, you will likely find poison ivy growing nearby.

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Yup, there it is on one of the posts.

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Looks like a great place to go fishing… and get exposed to poison ivy if you aren’t careful.

If you really want to avoid getting a poison ivy rash when you are outside in an area that might have poison ivy plants, it is likely a good idea to wear long pants, a shirt with long sleeves, gloves, and boots. There are also products, like IvyX, that you can apply to your skin that are supposed to protect you from poison ivy oils.

Identifying Poison Ivy

While it is a good rule of thumb that you might run into poison ivy in a wild area, in some parts of the country, you might even encounter poison ivy in your own backyard. That’s why learning how to identify poison ivy plants is so important, especially if you or your kids have severe reactions to these plants.

This poison ivy plant is growing out of the edge of a lawn.
This poison ivy plant is growing out of the edge of a lawn. Photo by CDC/ Dr. Edwin P. Ewing, Jr..

What’s the key to identifying poison ivy? That’s right – think of the old adage – leaves of three, let it be.

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Birds eat the poison ivy berries and poop out the seeds, which is why you find these plants growing along tree lines… or in your garden.

Poison ivy plants use aerial roots to grab on to trees and fences.
Poison ivy plants use aerial roots to grab on to trees and fences.

There is a little more to it than that though. After all, other plants have three leaves. If you really want to be a pro at identifying poison ivy, you also need to know that with poison ivy:

These dead poison ivy plants on this tree could still trigger a reaction.
The dead poison ivy plants clinging to this tree could still trigger a reaction.

  • the middle leaflet has a longer stalk (petiole) than the other two
  • leaflets are fatter near their base, but are all about the same size, are green in the summer, and can be red in the fall
  • you can sometimes find poison ivy plants with clusters of green or white berries
  • their stems don’t have thorns, but do have aerial roots, which help them cling to trees and fences

Most importantly, understand that even a dead poison ivy plant or a plant without leaves can trigger a reaction.

Thinking about burning poison ivy? Don’t! Inhaling the smoke from a burning poison ivy plant can be deadly.

What about poison oak and poison sumac?

They look very similar (well, except poison sumac, which has 7-13 compound leaflets, instead of just 3), but unlike poison ivy, which grows as a vine, these other plants that can cause the same type of reaction grow as a low shrub (poison oak) or a tall shrub/small tree (poison sumac).

Avoiding Poison Ivy Rashes

If your kids are active and adventurous, it is likely going to be a little harder to avoid poison ivy than for kids who rarely go outside.

And even if they get good at spotting poison ivy, the next time they spot it, might be when they are climbing down a tree that is covered in it.

What can you do if your child is exposed to poison ivy?

  1. You can quickly cleanse the exposed areas with rubbing alcohol. How quickly? You have about 10 to 15 minutes to prevent a poison ivy reaction after an exposure.
  2. Next, rinse the exposed areas with cool water. Don’t use soap, since soap can move the urushiol around your body and actually make the reaction worse. It is the urushiol oil from the poison ivy that actually triggers your poison ivy rash.
  3. Don’t forget to scrub under your nails with a brush.
  4. Now, take a shower with soap and warm water.
  5. Lastly, put on disposable gloves and wipe everything you had with you, including shoes and tools, etc., with rubbing alcohol and water. And wash the clothes you were wearing. It is possible that urushiol that remains on these things could trigger another reaction if you touch them later.

Instead of rubbing alcohol, several over-the-counter  products are available, like Zanfel, IvyX Cleanser Towelettes, and Tecnu Extreme Poison Ivy Scrub or Cleanser.

You could even use a degreasing soap (dishwashing soap, like Dawn). One group of dermatologists has suggested that you could prevent a poison ivy rash after getting exposed by using a damp washcloth and liquid dishwashing soap, washing for three minutes with “repetitive, high-pressure, single-direction wipes under hot, running water.” Repeat this full body wash two more times within one to two hours of your exposure.

If these methods don’t work and your child gets a poison ivy rash, look for treatments to control the itching and inflammation, which will likely mean visiting your pediatrician for a prescription for an oral steroid (tapered over two to three weeks to prevent a rebound rash) and a steroid cream. In addition, other anti-itch treatments and home remedies can be helpful, including an oral antihistamine, calamine lotion, oatmeal baths, cold, wet compresses made with Domeboro powder packets (modified Burow’s Solution), etc.

Keep in mind that without treatment, poison ivy rashes typically linger for about three weeks. Fortunately poison ivy isn’t contagious, so you wouldn’t have to keep your child our of school for that long, but except for very mild cases, see your pediatrician for treatment if they have poison ivy.

What to Know About Poison Ivy

Learn to avoid poison ivy, so that you can avoid getting a poison ivy rash.

More on Poison Ivy