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It’s Buggin’ Me! How to Safely Use an Insect Repellent

Medically reviewed on May 10, 2016 by L. Anderson, PharmD

Why Should I Use an Insect Repellent?

The use of insect repellents is a safe and effective way to prevent insect and tick-borne diseases. Mosquito bites can lead to West Nile virus, Zika virus, malaria, dengue fever, and encephalitis, while the small deer tick can cause Lyme disease.

The U.S. Centers for Disease Control (CDC) strongly recommends the use of insect repellents to prevent transmission of West Nile virus and other mosquito-borne diseases. Most cases of malaria diagnosed in the U.S. originate from other parts of the world.

How Do Insect Repellents Work?

Many insects like mosquitoes are attracted to the host because of their skin odors and carbon dioxide from their breath. Repellents contain an ingredient that makes the person unattractive for biting; however, repellents do not kill the insect. Repellents are effective only at short distances from the treated surface, so the user may still see mosquitoes flying nearby.

In the warmer months it is important to use an insect repellent; in tropical climates it may be needed year-round.

How Should I Apply an Insect Repellent?

Apply repellents only when you are planning to be outdoors and only to exposed skin - not under clothing. Wash the treated skin with soap and water when you return indoors, especially if applied repeatedly throughout the day. Do not apply insect repellents directly to open wounds, and avoid spraying directly onto the face; instead spray on your hand and rub onto your face.

Choose a repellent that provides protection for the amount of time that you will be outdoors. Only apply repellents outside to help avoid breathing in the spray.

If you do get a bite or sting, follow these suggestions.

How Else Can I Protect Myself From Insects?

You can apply insect repellents containing DEET or permethrin to your clothing; however, DEET may stain clothing. Sprays containing permethrin are available specifically for clothes, insect nets, sleeping bags, shoes, and boots; do not apply permethrin directly to your skin.

You can also limit the time spent outdoors, especially at the peak mosquito-feeding times of dawn and dusk. However, most Zika virus infections are transmitted via mosquito bites particularly from the day-time active Aedes species of mosquito.

Are Insect Repellents Safe?

The U.S. Centers for Disease Control and Prevention (CDC) recommend using products that have been shown to be effective in clinical trials and that contain active ingredients registered with the U.S. Environmental Protection Agency (EPA) for use as insect repellents on skin or clothing. These repellents include DEET and picaridin for skin, and permethrin for clothing.

An EPA registered insect repellent is not expected to cause serious side effects to humans or the environment when used according to the directions.

What is DEET?

DEET, or N, N-diethyl-m-toluamide, has the best documented repellent effectiveness. DEET is active against mosquitoes, ticks, chiggers, fleas, and some flies. DEET concentrations range from 5 to 100 percent, but concentrations greater than 30 percent have not been shown to be more effective.

A long-acting formula is available that contains 34 percent DEET (Ultrathon lotion) and affords 6 to 12 hours of protection. Other retail brands names that contain DEET include Off, Cutter, and Sawyer.

One study found that the Aedes genus of mosquito, known to transmit Zika, Yellow Fever, dengue, and chikungunya, are not turned off by the widely used insect repellent DEET, as they cannot smell the DEET.

Is DEET Safe for Children or Infants?

The CDC states that DEET is safe for children and infants older than 2 months, and the American Academy of Pediatrics notes that repellents should contain no more than 10% to 30% DEET (look for N,N-diethyl-m-toluamide on the spray bottle) when used in children. Higher concentrations will last longer. Avoid prolonged, excessive use or internal consumption; brain injury has occurred in these situations.

No serious illness has been linked to the use of DEET in children when used according to manufacturer’s recommendations. However, once inside, it is best to wash repellent off with soap and water.

How Should I Apply an Insect Repellent on a Child?

Parents should choose a repellent based on the amount of outdoor time, mosquito exposure, and risk of mosquito-transmitted disease in the area. Important points to remember:

  • apply repellent to your own hands, then rub onto the child
  • avoid the child's eyes, mouth, and use sparingly around ears
  • avoid open wounds
  • do not apply repellent under clothing
  • wash treated clothing
  • wash the treated skin when you have returned indoors
  • keep repellents out of reach of children

Can Pregnant or Breastfeeding Women Use Insect Repellents?

Yes. According to the Centers for Disease Control and Prevention (CDC) and EPA, there are no additional precautions for pregnant or breastfeeding women using DEET or picaridin; the standard precautions and directions for use should be followed. In pregnant or breastfeeding women, there are no reported adverse events following use of repellents containing DEET or picaridin.

As always, contact your healthcare provider for answers to questions about the use of any medication in pregnancy or breastfeeding.

What About Zika Virus?

Most people don't even know they've been infected by a mosquito if they get Zika virus. Common symptoms include fever, rash, joint pain, and conjunctivitis (red eyes). But for pregnant women, it's important to avoid a bite from this Aedes species of mosquito. Zika virus can also be spread by sexual contact, so condom use is important. Zika virus can be passed from a pregnant woman to her fetus, and infection during pregnancy can cause a serious birth defect of the brain called microcephaly.

Women who are pregnant should not travel to areas with Zika. If you must travel to one of these areas or if you live in an area with Zika, talk to your doctor or other healthcare provider and strictly follow steps to prevent mosquito bites and to prevent sexual transmission. CDC has updated guidelines for Zika virus and which travel areas to avoid on their website.

Is Picaridin Also an Effective Insect Repellent?

Picaridin, also known as KBR 3023, is available in 5 to 20 percent concentrations and is an effective repellent for flies, mosquitoes, chiggers, ticks. One study has shown the 19 percent concentration of picaridin as effective as the Ultrathon brand of DEET lotion. An advantage of picaridin over DEET is that it does not damage plastic or fabric.

Various brand names are available in spray and wipes for application to the skin. Brands that contain picaridin include Cutter and Advanced Natrapel.

Are There Any Natural Insect Repellents?

OLE, or Oil of Lemon Eucalyptus (p-menthane 3, 8-diol) is a plant-based repellent and is registered with the EPA. In studies evaluating malaria, OLE provides 6 hours of protection against mosquitoes. OLE should NOT be used in children under 3 years of age. When OLE was compared to DEET for effectiveness against mosquitoes found in the U.S., OLE provided similar protection to lower concentrations of DEET.

OLE products include Repel Lemon Eucalyptus and Cutter Lemon Eucalyptus. Some consumers complain of the OLE odor.

Is Avon's Skin So Soft a Bug Repellent?

IR3535, found in some Skin So Soft products, is available in various strengths and is sold in combination with a sunscreen. CDC does not recommend using the combination products because the sunscreen will need to be applied more often than the repellent. Some studies have questioned the effectiveness of the 7.5 percent concentration of IR3535.

IR3535 is available as a lotion and a spray. Products that contain IR3535 include Avon's Skin So Soft Bug Guard Plus and Bull Frog Mosquito Coast.

Can I Spray Repellent On My Clothes for Added Protection?

Permethrin is intended for application to clothing and gear, but NOT directly to the skin. Permethrin is a synthetic pyrethroid contact insecticide that can be used on clothing, mosquito nets, tents and sleeping bags for protection against mosquitoes and ticks. It remains active for several weeks, even through multiple launderings.

Permethrin is available as a spray for clothes, insect nets, sleeping bags, shoes, and boots. One brand is Sawyer Premium Permethrin Clothing Insect Repellent. Follow label directions for timelines for re-application.

What Are the Common Side Effects With Insect Repellents?

Serious side effects to insect repellents are extremely rare if the product is used as directed. Allergic skin reactions and eye irritation are the most common reactions.

If you suspect you are having a skin reaction, stop use of the product, wash the area with soap and water, and call 911 or contact the National Poison Control Center at 1-800-222-1222. If the repellent gets into your eyes, flush your eyes with water immediately and contact 911 or the Poison Control Center.

Can I Apply DEET and a Sunscreen at the Same Time?

Yes, but apply the sunscreen first, then the repellent and follow the instructions for each product. When applying a product that combines both a sunscreen and a repellent in the same bottle, it may be necessary to reapply a sunscreen separately because it will need to be reapplied more frequently than the repellent. Reapplying the combination product too often may lead to toxic effects due to the repellent.

Swimming or sweating may lessen the effective time of these products, and reapplication may be needed.

Finished: It’s Buggin’ Me! How to Safely Use an Insect Repellent

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