The Bottom Line

Protection against disease transmission from insect bites is an important worldwide public health issue. DEET
has been the most widely used and most effective insect repellent for 60 years. Newer repellents such as
picaridin, IR3535, and plant-derived oils may be somewhat safer but are not more effective than DEET.

The Full Story

As warm weather arrives in the US, the number of insect bites and stings reported to poison control centers
increases dramatically. More than just an annoyance, insect bites can spread disease. The growing concern
about the mosquito-borne Zika virus emphasizes this danger.
An insect repellent (IR) is defined as a chemical that makes the air within about 1.5 inch above human skin
obnoxious enough to insects that they are less likely to land and bite. Current guidelines require IRs to provide
at least a 50% repellency rate to make a reliable claim that they repel mosquitoes. IRs are divided into two
chemical classes: synthetic chemicals such as DEET (N,N-diethyl-3-methylbenzamide), picaridin and IR3535;
and plant-derived oils such as oil of lemon eucalyptus and oil of citronella.
Picaridin is a relatively new IR. Compared with DEET, its advantages include lack of chemical odor, non-
greasy consistency, and non-damaging to clothing and plastics. Its vapor is noxious to mosquitoes, flies,
chiggers, and ticks. Picaridin 20% spray has been shown to be comparable to DEET 20% for protection
against Aedes, Anopheles, and Culex mosquito species. 
US Environmental Protection Agency (EPA) registration data indicate that picaridin at a concentration of 20%
is effective against mosquitoes and ticks for 8-14 hours. The 10% concentration is effective for 3.5-8 hours. It is
recommended by the Centers for Disease Control and Prevention (CDC) for use in malaria-endemic areas.
Some studies have shown a shorter protection time for picaridin compared to DEET. Picaridin is not known to
produce the same nervous system toxicity as DEET but has not been subjected to as much long-term testing.
Human and animal studies of picaridin have not demonstrated skin, internal organ, or reproductive toxicity.
Picaridin is not recommended for use in children under 2 years of age.
IR3535 (ethyl butylacetylaminopropionate) was first marketed in the US as a skin moisturizer but, when noted
to be as effective as DEET against biting midges or "no-see-ums", it was adopted for use as an IR. IR3535 has
also shown greater effectiveness against black fly and sand fly bites than DEET, with a longer duration of
protection. IR3535 20% offers protection against Aedes and Culex mosquitoes for 7-10 hours but only 3.8
hours of protection against Anopheles in some studies. Therefore, IR3535 is not recommended for use in
malaria-endemic areas. It is a serious eye irritant but otherwise has a good safety profile. It can melt some
plastics and damage some fabrics.
IR3535 is found in some combination sunscreen/IR products. This is a problem because most sunscreens
should be reapplied about every 2 hours. Following those instructions could overexpose the user to the IR.
Animal studies have not demonstrated developmental toxicity, but there are no specific recommendations for
use or avoidance of IR3535 in children or pregnant women.
Oil of lemon eucalyptus (OLE) is an extract of the leaves of the lemon eucalyptus tree, Corymbia citriodora.
The leaf extract is refined to increase the concentration of a naturally occurring substance, para-menthane-3,8-
diol, also known as PMD. Commonly available products have a concentration of 30% OLE and 20% PMD.
Some studies have suggested that concentrations of 20-26% PMD may be as effective as 15-20% DEET
against both mosquitoes and ticks. However, the EPA believes that PMD’s maximum protection time against
mosquitoes and ticks is shorter than DEET’s. When used at concentrations of 30%, PMD offers complete
protection for 4-6 hours against ticks and several Aedes, Anopheles, and Culex species of mosquitoes. It is
recommended by the CDC for use in malaria-endemic areas but it requires more frequent application than
DEET.
OLE with enhanced PMD concentration is considered the most effective botanical IR but it can cause allergic
skin reactions. Synthetic PMD can be found in some repellent products at a concentration of 10%. These
products provide only a few hours of protection. They have less risk of allergic skin reactions than natural
PMD. The US Food and Drug Administration has recommended that PMD not be used in children younger
than 3 years.
Pure oil of lemon eucalyptus, an essential oil not formulated for use as an IR, has not undergone testing for
safety and effectiveness and is not registered by the EPA as an IR.
Citronella is a natural plant oil obtained from several species of Cymbopogon lemongrasses. Citronellol and
geraniol are major components of oil of citronella. Citronella is available as a lotion, oil, solid wax, and as a
component of candles and flame pots. Citronella has a short duration of action. A 4.2% concentration provides
1 hour of mosquito and tick protection. Citronella in candle form used indoors or citronella incense diffusers
used outdoors do not reduce mosquito bites to a degree acceptable to the EPA.
Citronella is ineffective against Asian tiger mosquitoes (the Asian tiger mosquito is now found in more than 20
states). The pests have been found to be infected with LaCrosse encephalitis viruses and West Nile virus,
which can cause encephalitis (inflammation of the brain). Citronella is not effective against flies, fleas, or ticks.
Oil of citronella can be mildly irritating to the skin and eyes. It can also cause skin allergies for some people
with prolonged or frequent exposure.
Botanical blend IRs have not been adequately tested and don’t repel aggressive species such as the Asian
Tiger mosquito. Some that contain geranium oil and soybean oil mixtures might provide some insect repellency
but frequent reapplication is necessary. These can cause allergic skin reactions.
Bug zappers are not effective and might actually attract mosquitoes while killing insects that are beneficial.
Clip-on IRs or fans are an inhalation concern especially for those with allergies to ragweed or
chrysanthemums. They can contain insecticides such as metofluthrin and allethrin that are more toxic than IRs.
For other ways to help prevent mosquito and insect bites and stings, read the article on mosquitoes in The
Poison Post®.

What Do Insect Repellents Do?

Not only do insect repellents keep mosquitoes, ticks, gnats and other bugs away, insect repellents are a safe
and effective way to prevent insect-borne diseases. Over one million people worldwide die from mosquito-
borne diseases every year.

Mosquito bites can lead to

 West Nile virus

 Malaria
 Dengue fever
 Encephalitis

and ticks can cause

 Lyme disease

Insect repellents are useful to prevent bites, skin eruptions and rashes that may be caused by an insect's bite.
Mosquito bites can cause severe skin irritation through an allergic reaction to the mosquito's saliva. Authorities,
such as the Center for Disease Control and Prevention (CDC) recommend the use of insect repellents to prevent
mosquito-borne diseases.

In the 20th century, malaria was eradicated in the temperate area of the world with the use of DDT and other
organophosphate insecticides. However, roughly 40% of the world's population in tropical regions may be
exposed to malaria. Over one million deaths and up to 500 million cases of malaria are still reported annually in
the world, with one child dying every 40 seconds due to malaria.

How do insect repellents keep bugs away?

You'd never know it, but humans attract mosquitoes and other blood feeding insects by their breath and skin
odors. The insect is attracted to the carbon dioxide in a human's breath. Repellents are effective only at the skin
area and close to the treated surface, so mosquitoes may still be seen flying nearby. Repellents contain an
ingredient that makes the person unattractive for biting; however, repellents do not kill the insect. Repellents
with higher concentrations (percentages) of active ingredient usually provide longer-lasting protection.

What's the best way to apply bug repellent?

Judicious use of insect repellents is important. Apply them when you plan to be outside and only to exposed
areas of the skin; for example, if you have on long pants, do not apply bug repellent to skin areas covered by
clothes. Mosquitoes that cause West Nile Virus may be biting in the early morning (dusk) and at sunset (dawn),
so be sure to apply repellent at these times. As long as the user is not getting bitten, there is no reason to
apply more repellent.

Be sure to follow instructions on the specific package of insect repellent you have purchased. Wash the treated
skin area with soap and water when you have returned indoors, do not apply repellent to open wound areas,
and avoid spraying repellent directly onto your face. It is best to spray repellent into your hands, then rub
carefully around the face, eyes and the mouth.
  Choose a repellent that provides protection for the amount of time that you will be outdoors.

Sweating or swimming may decrease the amount of the time the bug repellent is effective; extra applications
may be needed.

When applying insect repellents to children, avoid applying to their hands, around their eyes, or to any skin
areas that are cut or irritated.

You can cover-up with clothing instead of using insect repellent, but you may still get bites. You can apply
DEET or permethrin to your clothing; however, DEET may stain clothing. Sprays containing permethrin are
available specifically for clothes, mosquito nets, sleeping bags, shoes, and hiking boots. Be sure not to apply
permethrin directly to your skin.

What is the safety record of insect repellents?

Active ingredient names such as DEET, picaridin, and permethrin have been shown to be effective in clinical
trials and are registered with the U.S. Environmental Protection Agency (EPA) for use as insect repellents on
skin or clothing.

 When EPA registers a repellent, they evaluate the product for effectiveness and potential side effects on
humans and the environment.

An EPA registered insect repellent is not expected to cause serious adverse effects to humans or the
environment when used as directed.

CDC states that DEET and Picaridin insect repellents have demonstrated a higher degree of effectiveness in
peer-reviewed, scientific literature. Products containing these active ingredients typically provide longer-lasting
protection than others:

 DEET (N,N-diethyl-m-toluamide) - Insect repellents containing DEET have been used for more than 40
years to repel mosquitoes, ticks, fleas, biting flies and chiggers. It is often considered the "gold
standard" of bug repellents.
 Picaridin (KBR 3023) - Picaridin is roughly as effective as DEET at appropriate concentrations, but may
be less irritating.
 Oil of Lemon Eucalyptus (p-menthane 3,8-diol (PMD) Oil of Lemon Eucalyptus, a plant-based repellent,
is also registered as a repellent with the EPA. In scientific publications, when oil of lemon eucalyptus was
tested in the U.S. against mosquitoes, it provided protection similar to repellents with low
concentrations of DEET.
 Permethrin is another long-lasting repellent that is intended for application to clothing and gear, but
NOT directly to skin.

If you are concerned about using insect repellents you may want to contact your healthcare provider for
additional advice. The National Pesticide Information Center (NPIC) can also provide information at 1-800-858-
7378. If internal consumption or other poisoning due to insect repellent has occurred call 911 or the National
Poison Control Center at 1-800-222-1222.

What are some of the more commonly seen side effects with insect repellents?

 Skin reactions or allergic rashes

 Eye irritation, especially if it gets into the eye

Serious side effects to insect repellents are uncommon if directions are followed. If you think you are having an
adverse reaction, discontinue use of the product, wash the affected area with soap and water, and call 911 or
contact a Poison Control Center (National Poison Control Center 1-800-222-1222).

 If the repellent gets into your eyes, immediately flush your eyes with water and contact your doctor or
Poison Control Center.
Be sure to take the insect repellent bottle with listed ingredients to any doctor you may visit.  

Can I use an insect repellent containing DEET and sunscreen at the same time?

Yes -- sunscreens and insect repellents with DEET can be applied at the same time, but there are some special
considerations.

 Apply the sunscreen first, followed by the insect repellent containing DEET and follow the directions for
each product.

Some repellents are available with a sunscreen in the mixture already. When applying a combination product
that contains both a sunscreen and a repellent in the same lotion, it may be necessary to re-apply a sunscreen
separately because sunscreens typically need to be reapplied more frequently than repellents. Reapplying the
combination sunscreen-repellent product too frequently may lead to toxic side effects due to the repellent.

Insect repellent ingredients

DEET (Off, Cutter, Ultrathon, Sawyer)

 Studies have shown DEET, or N, N-diethyl-m-toluamide, is very effective against insects such as
mosquitoes, ticks, chiggers, fleas, and some flies. DEET is available in concentrations ranging from 5 to
100 percent, but concentrations above 30 percent have not been shown to be more effective. Ultrathon
lotion is a long-acting formula that gives roughly 6 to 12 hours of protection and contains 34 percent
DEET. DEET is available in lotions, sprays, and wipes for skin application. DEET can damage synthetic
fibers, certain plastics, and watch crystals. Allergic reactions and serious side effects are rare.
 The CDC states that DEET is safe for children and infants older than 2 months, and the American
Academy of Pediatrics (AAP) suggests that DEET solutions no greater than 30 percent in concentration
be used in children. In children, avoid prolonged, excessive use or internal consumption;
encephalopathy has occurred in these situations. Rash, mild irritation, urticaria (itching), and skin
eruptions have been reported. Limited studies are available in pregnant women.

Picaridin (Cutter, Advanced Natrapel)

 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. The various brand names are available in spray and wipes for
application to the skin.

IR3535 (Avon Skin So Soft Bug Guard Plus, Bull Frog Mosquito Coast)

 IR3535 is available in concentrations from 7.5 to 20 percent, and is sold in combination with a
sunscreen. CDC does not recommend using the combination products because the sunscreen will
probably need to be applied more often than the repellent, excessive use of the repellent may lead to
toxicity. Some studies have questioned the effectiveness of the lower 7.5 percent concentration of the
IR3535 product. IR3535 is available as a lotion and a spray.

Oil of Lemon Eucalyptus (Repel Lemon Eucalyptus, Cutter Lemon Eucalyptus, Coleman Botanicals)

 Oil of Lemon Eucalyptus (OLE) (p-menthane 3, 8-diol) is a plant-based repellent. In studies evaluating
malaria, OLE provides 6 hours worth of protection against mosquito bites, but should NOT be used in
children less than 3 years of age. OLE is registered with the EPA, and is available as a spray. According
to the CDC, when OLE was compared to DEET for mosquitoes found in the U.S., OLE provided similar
protection to lower concentrations of DEET. OLE is often marketed as a “natural” insect repellent.

Permethrin (Sawyer Premium Permethrin Clothing Insect Repellent)

 Permethrin is intended for application to clothing and gear, but NOT directly to the skin. Permethrin is a
synthetic pyrethroid contact insecticide used on clothing, mosquito nets, tents and sleeping bags for
protection against mosquitoes and ticks.  It remains active for several weeks through multiple
launderings. Permethrin is available as a spray for clothes, insect nets, sleeping bags, shoes, and boots.