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What is the best ointment or cream for insect bites?
Drug reviews: use, side effects, effectiveness

Best OINTMENT or CREAM for insect bites

For many customers, ointment or cream for insect bites is the first line of rescue in stings management. In this post, I will review the best ointment or cream for insect bites available over the counter and from pharmacies. I will also discuss alternative options for insect bites, mainly the use of antihistamines. As with many of my previous posts, I will base my recommendations on the evidence (if possible) and draw a conclusion.  

Table of Contents

  • Symptoms of sting bites
  • What causes bite itchiness and redness?
  • Sting bites: Do I need to see a GP?
  • The best ointment or cream for insect bites
  • Ointments for insect bites
  • Creams for insect bites
  • Alternative options for insect bites
  • Conclusion

Symptoms of sting bites

Common symptoms of bite stings are localised and usually and include:

  • Redness
  • Pain 
  • Itchiness 
  • Swelling
  • Skin warm to touch

Serious reaction to insect stings, for example, bees is possible. Anaphylaxis due to insect sting needs urgent medical help.

Insect bite symptoms: redness, itchiness and pain.
Insect bite symptoms: redness, itchiness, irritation and pain.

What causes bite itchiness and redness?

Release of histamine in the tissues surrounding bite is one of the primary cause of the redness, itchiness. Histamine is a compound which commonly causes allergic reactions, including allergic rhinitis (hayfever). Insect venoms (wasps) contain several allergens, which cause unpleasant symptoms, and in some cases, may cause an anaphylactic reaction (Moffitt, 2003).

Sting bites: Do I need to see a GP?

Most stings are self-resolving, which means they go on their own. From time-to-time insect bites may get infected. Some insects, for example, ticks, may cause prolonged infections. Infected ticks may cause Lyme disease, which requires antibiotic treatment.

According to NHS, the following individuals should contact their GP regarding their bites:

  • Suspected infection caused by a sting. Symptoms of infection may include swelling, redness, pain or pus at the site of the bite.
  • Other infection symptoms are present, for example, feeling unwell, high temperature (fever), cold-like symptoms, and swollen glands.
  • The area affected by bite is large. The site of a sting covers 10 cm or more.
  • Symptoms of bite do not go away after a few days.

For more information on the prevention and removal of stings, visit nhs.uk.

The best ointment or cream for insect bites, part 1: creams  

Products available for insect bites in supermarkets or pharmacies come almost entirely in the form of creams. Ointments for insect bites are mainly available online, for example on Amazon.co.uk

1. Hydrocortisone cream for insect bites

Hydrocortisone cream is probably one of the best options in the management of itchy skin caused by insect bites. Hydrocortisone cream is classified as a mild steroid cream. Steroid creams are useful in the management of different skin conditions characterised by redness, skin dryness and itchiness.

Most pharmacies sell hydrocortisone cream as ‘own’ label product or branded products, foe example HC45 Hydrocortisone cream. All over the counter hydrocortisone creams are of the same strength (1% of hydrocortisone).

Hydrocortisone cream such as HC45 hydrocortisone can be used to manage insect bite reactions; however, it should not be used to treat infected bites, which may be difficult to tell, especially when a reaction to the bite is very recent.

Eumovate (clobetasone butyrate 0.05%) is classified as a moderate steroid and is the strongest steroid cream available over the counter; however, its use is restricted to the management of eczema and dermatitis.

Where can you buy hydrocortisone cream?

Hydrocortisone cream is classified as pharmacy-only medicine (P), which means it can only be sold in pharmacies, including online chemists and sellers on Amazon.co.uk

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Hydrocortisone cream: restriction on use

Hydrocortisone cream which is sold in pharmacies have few restrictions, which reflect the licensing of this medicine:

  • Age restrictions: Adults and children above ten years of age.
  • Duration of the treatment: 7 days maximum.
  • Not to be used on the eyes, face, the anogenital area, broken or infected skin including infected bites.
Can hydrocortisone cream help with symptoms of insect bites?

Steroid creams such as hydrocortisone decrease many chemicals (mediators), which cause inflammation, redness and itchiness caused by insect bites. For example, topical steroid creams decrease prostaglandin production (anti-inflammatory effect) and stop the activity and reduce the number of mast cells (Ahluwalia, 1998). Mast cells release histamine, which produces some of the symptoms experienced after insect stings like irritation and itchiness.

2. Anthisan cream for insect bites

Anthisan Cream contains a medicine called mepyramine maleate. Mepyramine maleate is classified as an antihistamine with antipruritic and local analgesic actions, although there is not much (any) evidence to support the benefit of this antihistamine in the management of insect bites.  

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3. Lanacane medicated cream for insect bites

Lanacane crema is another medicated formulation, which can be used for insect stings. Lanacane cream contains 3% benzocaine, a local anaesthetic which is effective pain and anti-itch medication.

Lanacane can be purchased in supermarkets and pharmacies, however not all retail outlets may stock this item. You can buy Lanacane online, which may be the easiest option. 

Lanacaine and other skin numbing creams cause a local loss of pain sensation. The mechanism action of local anaesthetic creams is well defined, and their effectiveness well documented.

Who can use Lanacane cream?

Lanacane is licensed for adults and children from 12 years of age.

Patients on certain medicines may not be able to use Lanacane cream. Read product information leaflet or speak to the pharmacist before use.

Can you use Lanacane cream with other creams?

Lanacane cream can be applied up to three times a day. It is possible to use Lanacane cream with other creams such as hydrocortisone cream. Please leave a gap between the application of both creams.

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4. Eurax cream

Eurax cream contains an active ingredient called crotamiton. Eurax cream is a general sale item, which means it can be purchased in any retail outlet, like supermarkets and pharmacies. Eurax is a popular cream to stop itchiness caused by many different conditions, including:

  • Dermatitis and Eczema
  • Rashes caused by allergies 
  • Hives, nettle rash
  • Chickenpox
  • Insect bites and stings
  • Heat rashes
  • Sunburn
  • Personal itching

Eurax cream is also licensed for the treatment of scabies and itchy skin infestation in the skin.

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Is Eurax cream good for insect bites? 

Eurax cream is a popular choice on Amazon.co.uk with many great reviews on its effectiveness. There is not much (scientific) information on the efficacy of Eurax cream as an anti-itch product. 

Crotamiton can affect histamine-induced skin itchiness (Sekine et al., 2012). Histamine, a is one compound which is realised after insect bite occurred. Histamine contributes to skin itchiness, redness and skin rash. Crotamiton was also found to (weakly) affect serotonin release, another compound which has its role in the transfer of the information (about itchiness) to the brain (Saltsman, 2014).

Eurax cream can be used alongside other creams, for example, hydrocortisone.

Who can use Eurax cream? 

Eurax cream can be used by adults and children over three years of age. Eurax can be applied two to three times a day. 

5. Eurax HC for insect bites 

Eurax HC crema brings the best of two active ingredients previously reviewed. Eurax HC contains hydrocortisone 1% and crotamiton. 

Eurax HC is a pharmacy-only medication with similar sale restrictions to previously reviewed hydrocortisone cream. 

Other creams for skin itchiness 

17 creams to stop itching lists more options in the management of itchy skin. Some products, such as calamine cream, may be used in the symptomatic management of skin itch caused by insect stings. 

The best ointment or cream for insect bites, part 2: ointments 

As I mentioned in the introductory part of this post, there are not many ointments available over the counter, which can be used explicitly for insect bites. A topical form of hydrocortisone ointment exists, however in the UK, ointment forms of steroids are prescription-only medicines.

There are plenty of ointments, which can be purchased from Amazon.co.uk. Here are some of the most popular products.

6. Lucas Papaw Ointment

Lucas Papaw Ointment is one of the most popular ointments sold not only to manage bug bites but also for various skin conditions with a long history of use.

The main ingredient found in the ointment is papain, which is also known as papaya. Papaya is classified as a protease (an enzyme), a chemical which breakdowns proteins.

Is papaya effective against insect bites?

Some evidence supports papaya’s anti-inflammatory actions when applied to the skin (Stremnitzer et al., 2015). Limited evidence exists to support the use of papaya in the symptomatic management of insect bites. In animal studies, papaya did not show a positive effect against bee venom as opposed to hydrocortisone, which decreases the size of lesions produced by the injection of bee venom (Agostinucci et al., 1981).

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7. Zam Buk Brand Ointment

Rose And Co Zam Buk Brand Ointment is a traditional herbal antiseptic ointment, which is sold for various skin conditions including insect bites. Zam Buk Brand Ointment is a mixture of three ‘antiseptic’ ointments eucalyptus, pine and thyme oil.

There is little (scientific) evidence to support the use of above items in relieving the main symptoms of insect bites, despite an overwhelming amount of positive reviews on Amazon.co.uk.

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Alternative options for insect bites

Antihistamines for insect bites

Antihistamines tablets or liquid antihistamines for children are among the first options in the symptomatic management of insect bites. Regardless of the type of insect bite, histamine release at the injury site makes a logical approach to try an antihistamine as one of the first aids.

Oral antihistamines used before or after mosquito bites effectively reduce the main symptoms they cause (Foëx & Lee, 2006).

Non-drowsy antihistamines, such as loratadine or cetirizine may be preferred by some. Drowsy antihistamines, which are usually used as main ingredients in over the counter sleeping tablets, may help control the symptoms at night.

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After Bite

After Bite is one of the most recognised products for insect bites. After Bite comes as easy to use pen applicator. The main active ingredient found in After Bite pen is ammonia.

There is no specific evidence to support the effectiveness of After Bite, however many positive reviews (in thousands) can be read online, including Amazon.co.uk

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Insect Sting & Bite anti-itch relief plasters

I included Moskinto Plaster – Mosquito or Insect Sting & Bite anti-itch relief in this post purely because of many positive reviews.

Moskinto Plasters are non-medicated. Not much information is provided by the manufacturers of Moskinto Plasters on this product’s mechanism or effectiveness. Moskinto Plasters control the itchiness and swelling caused by insect bites ‘purely mechanically’ – whatever it means.

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Cold therapy

Application of cold compress or ice pack can effectively relieve inflammation and pain caused by insect bites.

Conclusion

What is the best ointment or cream for insect bites?  

I review many products which can be used for symptomatic management of insect stings. Most medicated products come in the form of creams.

Perhaps the best approach to help with insect bites is combination use of products including cream(s), antihistamine and if needed pain relief with simple analgesics like ibuprofen or paracetamol.

Since the main symptoms are associated with histamine release at the bite site, use of non-drowsy hayfever tablets would be most appropriate. Ibuprofen works as a painkiller and anti-inflammatory drug, which offers a dual benefit to the treatment.

Without good evidence, it is difficult (or rather inappropriate) to call a single product ‘the best’.

Hydrocortisone cream has the most evidence in terms of efficacy and could be called the best cream for insect bites.

Skin itchiness and redness can last up to ten days. In most cases, insect bites will go on their own and will not become infected. Avoidance of scratching is crucial to minimise the risk of infection. Individuals whose symptoms worsen (significant swelling/redness) or fell unwell after the bite should seek medical help (NICE, 2020).

What is the best ointment or cream for insect bites that you used? Please leave comments below.

References:

Agostinucci William, Alex A. Cardoni, Philip Rosenberg (1981). Effect of papain on bee venom toxicity. Available at: https://doi.org/10.1016/0041-0101(81)90081-7 Accessed on 16/02/2021

Ahluwalia A. Topical glucocorticoids and the skin–mechanisms of action: an update. Mediators Inflamm. 1998;7(3):183-193. doi:10.1080/09629359891126 Available at: https://dx.doi.org/10.1080%2F09629359891126 Accessed on 14/02/2021

Foëx BA, Lee C. (2006).Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. Oral antihistamines for insect bites. Emerg Med J. 2006;23(9):721-722. doi:10.1136/emj.2006.040154 https://dx.doi.org/10.1136%2Femj.2006.040154 Accessed on 16/02/2021

Moffitt JE. Allergic reactions to insect stings and bites. South Med J. 2003 Nov;96(11):1073-9. doi: 10.1097/01.SMJ.0000097885.28467.21. PMID: 14632354. Available at: https://doi.org/10.1097/01.smj.0000097885.28467.21 Accessed on 15/02/2021

NICE (2020). Insect bites and stings: antimicrobial prescribing. Available at: https://www.nice.org.uk/guidance/ng182/chapter/Recommendations#assessment-and-advice Accessed on 16/02/2021

Saltsman Kirstie (2014). Serotonin Drives Vicious Cycle of Itching and Scratching. Available at: https://www.niams.nih.gov/newsroom/research-briefs/serotonin-drives-vicious-cycle-itching-and-scratching Accessed on 04/12/2020

Sekine R, Satoh T, Takaoka A, Saeki K, Yokozeki H. Anti pruritic effects of topical crotamiton, capsaicin, and a corticosteroid on pruritogen-induced scratching behaviour. Exp Dermatol. 2012 Mar;21(3):201-4. doi: 10.1111/j.1600-0625.2011.01433.x. PMID: 22379965. Available at: https://doi.org/10.1111/j.1600-0625.2011.01433.x Accessed on 04/12/2020

Stremnitzer C, Manzano-Szalai K, Willensdorfer A, Starkl P, Pieper M, König P, Mildner M, Tschachler E, Reichart U, Jensen-Jarolim E. Papain Degrades Tight Junction Proteins of Human Keratinocytes In Vitro and Sensitises C57BL/6 Mice via the Skin Independent of its Enzymatic Activity or TLR4 Activation. J Invest Dermatol. 2015 Jul;135(7):1790-1800. doi: 10.1038/jid.2015.58. Epub 2015 Feb 23. PMID: 25705851; PMCID: PMC4471117. Available at: https://doi.org/10.1038/jid.2015.58 Accessed on 16/02/2021

 

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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