1. INSECT REPELLENTS Daniel J. Trozak M.D

2. WHAT REALLY WORKS!  DEET (Ultrathon® or Sawyer Controlled Release®) on exposed sites and permethrin (Permanone®) on clothing. 99.9% for 8-12 hrs Ultrathon® 3.5-4 hrs for Sawyer’s C R®  Picaridin products (Cutter Advanced®) on exposed skin and permethrin (Permanone®) on clothing 99.9% 1.5 hrs.  Lemon-eucalyptus oil product (Off Botanical®) on exposed skin and permethrin (Permanone®) on clothing 99.9% 1.5 hrs.  Soy bean product (Bite Blocker®) on exposed skin and permethrin (Permanone®) on clothing 99.9% 1.5 hrs.

3. EPA Guidelines for the Safe Use of Insect Repellents  Verify that the product has an EPA approved label  Read the label before each usage  Use only as directed and against the insects listed  Keep it out of children’s reach *Most repellents or their vehicles have significant toxicity, if ingested!  Apply only to body sites listed *many have significant mucous membrane irritancy and would be more readily absorbed when applied to or around mucous membrane sites!

4.  Avoid application to cuts, open wounds, areas of dermatitis  Do not apply around eyes, mouth or hands of children  Use adequate amounts but avoid frequent re- application  Wash off with soap and water after exposure  If you suspect toxicity, wash off with soap and water and contact poison control. Have the product label available.  For information 24/7 call the National Pesticide Network @ 1 (800) 858-7378

5. What Doesn’t Work! NEJM V. 347 pp. 13-18, 2002

6. References  Insect Repellents: An Overview. J Amer Acad Derm 36: pp 243-49, 1997  Insect Repellents. The Medical Letter 31: iss. 792 pp 45-47, 1989  The Regulatory Controversies That Surround DEET. Cosmetic Dermatology 9, #3 pp 56-58, 1996.  Insect Repellents. The Medical Letter 45: Iss. 1157 pp 41-42, 2003.  Vector Borne Diseases Reaffirm Need for Insect Repellent. Skin and Allergy News: p 33, September 2003.  Comparative Efficacy of Insect Repellents against Mosquito Bites. NEJM 347: pp 13-18, 2002.  Insect Repellents-Past, Present And Future! Pesticide Outlook: pp 154-158, August 2001.  Catnip Repels Mosquitoes More Effectively Than DEET. August 28, 2001, WWW.sciencedaily.com WWW.sciencedaily.com  Medical Pearl: Permethrin can prevent arthropod bites and stings. J Amer Acad Derm 51: p 289, 2004.  Picaridin; A New Insect Repellent. J Drugs Derm 3: 59-60, 2004.  CDC Insect Repellent Update April 28, 2005 http://www.cdc.gov/ncidod/dvbid/westnile/RepellentUpdates.htm http://www.cdc.gov/ncidod/dvbid/westnile/RepellentUpdates.htm  Picaridin-A New Insect Repellent. The Medical Letter 47: Iss. 1210, 2005.