Bed bug bites vs hives – How can we tell the difference?

Waking up with bites all over your body can be worrying, especially if they cause additional itching and other concerning symptoms. Then, you start wondering if they are bed bugs or something else. Bed bugs and hives are common problems, and either one of them can be blamed for a skin rash. But they have different causes and solutions. So, it is very important to make sure which one is causing the skin problems before you start doing something about it.

In this article, we’re making it easier for you and reviewing the information clearly and very briefly. After reading, you will have a complete understanding on what bed bug bites look like, how are they different from hives, and how to get rid of bed bugs fast.

Spotting and recognizing bed bug bites

Recognizing bed bug bites is not as difficult as it may seem, and even the average person can make an educated guess and have a strong understanding before going to the doctor. Everyone has a different experience with bed bugs; but typically their bites usually look reddish and swollen and extremely itchy but bites do not spread when scratched. They are not usually big lesions unless you have an allergic reaction to them and a large skin rash area.

One of the key features to recognize bed bug bites is that you will have most lesions located around the same area. Different from other pests, bed bugs crawl and do not jump or fly. Thus, you will see nearby bites instead of red spots located in distant parts of your body.

Another important feature is that bed bugs inject an analgesic substance when they bite. They are stealthy and may be completely unnoticeable were it not for the red spots in your body. You are definitely unlikely to wake up because you can feel them biting you, unless you are sleeping very lightly.

These are typically what Hives look like on skin.

Finally, their bites only happens at night. They only leave their hiding places at night, when everyone is sleeping. Otherwise, it is very unlikely you will find one of them around your bed or elsewhere, and it is even more difficult to catch them in the middle of their dinner.

What are the main differences: Bed bugs vs hives

The difference between bed bug bites and hives is enormous. However, you can have an overlapped allergic reaction to bed bugs, too.

But in general, this is how it looks like:

  • Lesion size: Bed bug bites are smaller than hives. Actually, bed bugs are usually rounded lesions, very small. Even if two lesions converge and look bigger, they are still much smaller than hives which are rather large, usually larger than one quarter size in comparison.
  • Lesion color: As for the color of a bed bug bite, they look reddish with a lighter surrounding skin. Hives look pinkish instead of red, but the color varies after the individual’s skin color.
  • Location in the skin: Bed bugs bite at night and prefer areas of the body that are not covered by clothes. They won’t make the effort of going inside your clothes. And, they are located in clusters of three, usually referred to as breakfast, lunch, and dinner. On the contrary, hives do not have a pattern. They can appear anywhere in the body, including areas covered by layers of clothes.
  • Reproduction of the symptoms: If you have a bed bug issue at home, you won’t be the only one with bites. Having several people with the same marks points out at bed bugs as the cause of your rash, not hives. Because hives are not contagious and it is less likely to have two people with the same symptoms at the same time.
  • Medical history: Bed bugs appear regardless of your medical records or personal history of disease. On the contrary, hives usually appear in allergic people, or anyone who had recent contact with an allergen. You may even track down the cause of hives in certain foods you eat or products you use to clean your house.
  • Home environment: Another important difference you need to make is your home environment. Do you have old furniture near your bed? Are there cracks, rusty spots, or hiding areas in your furniture or walls? You may even have a folding in your wallpaper you might have not notice. All of these are hiding spots for bed bugs. You may even find them or their eggshells on your mattress or furniture.

To make it easier for you, we’re leaving a small table with the most important differences:

 Bed BugsHives
Lesion sizeSmall, rounded lesions. Usually the size of a pencil’s eraser tipSmaller or larger lesions, usually the size of one quarter
Lesion colorBright redPinkish or pale, depending on skin type
Lesion locationExposed areas, in clustersAnywhere on the body, not particular pattern
Who has symptoms?You and other people in the householdOnly you
Medical historyNo medical historyAllergies, asthma, and other forms of atopy
Home environmentDark crevices, cracks, old furnitureNew detergents, perfumes, or substances brought to your house

So how do we get rid of them?

Getting rid of bed bugs can be quite challenging if you don’t know how they reproduce and where. To start with, you need to get rid of the clutter at home, or at least have everything thoroughly cleaned up. Stay alert on everything that may be used as a hiding place, and that includes cracks on your walls, old furniture, rusty spots, and any opening on your mattress.

There are many extermination methods once you find where are they hiding. You can use more aggressive methods that include pesticides and toxic substances. But if you have pets or small children at home or do not know the safety measures, we recommend using diatomaceous earth, which is absolutely safe to use and dries them up to death. But then, sometimes a bed bug infection is very severe, and in these cases, you may need professional help instead.


Reinhardt, K., & Siva-Jothy, M. T. (2007). Biology of the bed bugs (Cimicidae). Annu. Rev. Entomol.52, 351-374.

Doggett, S. L., Dwyer, D. E., Peñas, P. F., & Russell, R. C. (2012). Bed bugs: clinical relevance and control options. Clinical Microbiology Reviews25(1), 164-192.

Goddard, J., & deshazo, R. (2009). Bed bugs (Cimex lectularius) and clinical consequences of their bites. Jama301(13), 1358-1366.

Wollenberg, A., & Feichtner, K. (2013). Atopic dermatitis and skin allergies–update and outlook. Allergy68(12), 1509-1519.

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