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Insects like mosquitoes, ticks and others which bite the skin generally do not produce any reaction in the skin of the individual unless the individual has developed an allergy to the insect. Thus, most individuals who are bitten by mosquitoes experience only a mild temporary itching when bitten by mosquitoes. The itching usually disappears within a few minutes without leaving any marks. Some individuals however, develop a red spot at each of the sites bitten by
the mosquitoes. Such spots are usually located at the exposed parts of the body. They persist for a few days and are completely asymptomatic.

Some individuals however, develop an allergic hypersensitivity to the mosquito bites and tend to develop either urticarial wheals at the sites of the mosquito bites or red bumps (papules). The urticarial wheals are common in adults while the papular reactions are common in children and are called ‘papular urticaria’. This term
is however, inaccurate because it denotes only a transient phase during which the individual develops a papule as well as an urticarial wheal at the site of the mosquito bite.

Generally,allergy to mosquito bites starts during childhood within the first few years, leading to itchy red papules which are usually located on the face, hands, forearms, feet, legs, thighs and the lower part of the abdomen (areas not covered with clothes). The papules cause severe itching which leads to excoriations and frequently get secondarily infected. The papules generally subside within a few days but further bites and new papules keep on replacing the old ones. Each papule leaves behind a pigmented scar upon healing, and possible disfigurement of the skin.

The eruptions occur throughout the year although these are likely to be more common during the monsoon season when the mosquitoes are abundant, and keep recurring year after year. After a few years however, the child tends to develop an urticarial response to the mosquito bite while the papular response tends to disappear. During the period when the urticarial response has already developed, while the papular response has not disappeard, the child would develop an urticarial wheal around each papule at the sites of the mosquito bites.

As the child grows further and the papular resp~mse disappears, he/she develops only an urticarial response and no papules. Subsequently however, even the urticarial response tends to disappear and only a mild transitory itching is seen. It is therefore, important to know that allergy to a mosquito bite is a self-limiting disease and will disappear in all cases.

Treatment

Management of this condition should thus be directed towards protecting the child from mosquitoes, by taking the following steps:

• The child should wear full-sleeved shirts and pyjamas to cover as much of the skin as possible. Even a thin cloth is useful.
• Mosquitoes in the house, especially in the bedrooms must be destroyed through insecticide sprays, fumigation with mosquito repellant mats, regular use of
  mosquito repellants in the bedrooms or on the skin.
• Sleeping under high speed fans or in air-conditioned rooms is helpful.
• The lesions which are already present or appear in spite of the above precautions have to be treated with local applications of a topical corticosteroid ointment.
• Oral anti-histamines can be used to reduce the itching, or one can use even oral corticosteroids if the lesions are too profuse. Antibiotics may be necessary if there is
  superadded infection.

These precautions/treatment have to be carried out till the individual is no longer allergic to mosquito bites.

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