Don't let the Bedbugs Bite...

http://www.aafp.org/afp/2012/1001/p653.html

  The American Family Physician magazine recently had a concise summary of bedbug diagnosis and treatment. A few caveats that I thought were worth mentioning:
1 The article has a nice picture depicting the full range of sizes and appearances of bedbugs across the bug's lifespan (nymphs, etc). While none of us are entomologists, knowing the general appearance is helpful. If you cannot access the AFP article, check out the life cycle pictures on the below linked Wikipedia article.
http://en.wikipedia.org/wiki/Bed_bug

2. People worry about eradication of bedbugs that have latched onto travel items, like backpacks and luggage. Note in the ending table it suggests either 2 hrs of heat over 120F, or 5 days of freezing. While bedbugs are hardy in a normal room environment, they are very temperature sensitive. For travel item decontamination, one easy tip in the North Carolina summers is to leave luggage, travel items, etc. in your car trunk for one afternoon, as temperatures are well over 120F. Alternatively, placing items in the freezer should help also-but note the time difference of 5 days.

3. Perhaps I did not read enough or was misled when I read about bedbugs as they re-emerged in the early 2000s, but I was under the clinical impression that most of the bites were papule or wheal like. However, as the article mentions, the appearance of bedbug bites can run the "maculopapular" gamut. A typical red flag, per the article, is the "breakfast, lunch, dinner" linear pattern of bites, but clinically I have also seen that with scabies clumping along an elastic waistband, or chiggers hitting a sockline. 

4. Lastly, in true "academic" non real world fashion the article cites that no treatment has been shown effective, so give reassurance and tell the patient to wait a week or two. Good luck with that strategy. People who are told of a bedbug diagnosis would rather drink cyanide than do nothing. If you are leery of topical or po steroids, I have heard many dermatologists recommend topical, over the counter Sarna lotion for 20-30 minutes of relief from the itch.

What varied appearances have you seen of suspected bedbugs? Papules? Scabbed macules?
Any favorite medicines for the itch?
Any tips to calm the hysteria?