You've been stung

By Dr. Grace C. O'Neil, M.D., F.A.C.E.P, Tripler Army Medical CenterAugust 11, 2017

You've been stung
(Photo Credit: U.S. Army) VIEW ORIGINAL

HONOLULU - (August 10, 2017) Hawaii is an island paradise in almost every way. However, behind all of this beauty are some pretty nasty little creatures like centipedes, millipedes, scorpions, an array of flying insects and the dreaded fire ant.

Tripler Army Medical Center, also known as TAMC, sees patients regularly for insect stings, especially centipede stings. Centipedes have one set of legs per segment of their body, and they have between 15-177 legs total. They hide in dark, damp places and they inject venom to immobilize their prey through pincers that extend from their head.

Centipedes are night creatures, so most stings occur at night. They make two small puncture marks and the stings can cause redness and swelling, and are painful. An ice cube wrapped in a cloth and placed on a centipede bite usually relieves the pain. Over the counter anti-histamines can help reduce swelling and you should apply an over the counter hydrocortisone cream if your symptoms still do not improve. Symptoms rarely persist for more than 48 hours. Make sure your tetanus shot is updated.

Millipedes have two sets of legs for every segment of their body, and can have anywhere between 80-400 legs. They have shorter legs than a centipede. Although they do not bite, they may secrete a toxin that can be irritating, especially if rubbed into the eye by accident! Therefore, wash their secretions from the skin with soap and water.

Scorpions have eight legs and a pair of pincers (like a crab). There is one scorpion in Hawaii, the "lesser brown scorpion". The stinger injects venom and is located at the end of a narrow tail that curves around and over the back of the scorpion's body. The sting causes pain, redness, itching and swelling like a bee sting. People can also have nausea, vomiting, diarrhea and pain from the sting. If anyone has difficulty breathing, fainting, swelling of the tongue or other severe symptoms, call 911 immediately.

Other insects that sting include bees, wasps, yellow jackets, hornets and the imported fire ants. When the sting is caused by a honey bee, the stinger can remain in the skin because it is barbed. It is important to remove the stinger as soon as possible because the stinger will continue to release venom for 45-60 seconds following the sting. After the stinger is removed, wash the area and use a cold compress to relieve the pain. Symptoms are usually mild and include some localized swelling, itching and redness at the site of the sting. Over the counter anti-histamines can help with itching. Try to avoid rubbing or scratching the sting site, as germs from the surface of the skin could be introduced into the wound and cause an infection.

Some people can develop a severe total body reaction that includes nausea, vomiting, abdominal pain, low blood pressure, a total body rash, and difficulty breathing from swelling of their tongue and airway. Severe symptoms usually start within 30 minutes of being stung and these patients need to go to the hospital immediately.

If you are entering an area with bee or wasp activity, avoid wearing perfume or using scented soap as they may react to odors in their environment. Avoid wearing brightly colored clothing with patterns and try to remain calm if a bee or wasp lands on you. In swimming pools, avoid bees or wasps trapped on the surface of the water and wear long pants and a long-sleeve shirt if you are going into an area with a bee or wasp nest.

Fire ants can hitchhike on potted plants, mulch, firewood, and soil to your property. The "Little Fire Ant" sting burns like fire. Some people develop red welts that burn and itch for days. Cold packs, over the counter, pain-relievers and anti-histamines can help relieve symptoms. Rarely, a large number of stings can trigger a life-threatening allergic reaction. Call 911 if someone develops chest pain, difficulty breathing, hoarseness or swelling of the tongue or throat.