Itchy bumps on skin like mosquito bites: What are they?

Several skin conditions can cause itchy lumps that resemble bug bites. These include allergic reactions, infections, and chronic conditions.

Most people experience this symptom at some point. Itchy bumps can appear as a result of allergies, infections, insects, and, sometimes, nonidentified factors.

However, there is one general principle that the American College of Allergy, Asthma & Immunology recommend people to follow when their skin itches: Do not scratch it.

Additional general self-care practices for itchy skin include:

• bathing frequently in lukewarm water
• using gentle, hypoallergenic soap
• limiting exposure to the sun
• applying cold compresses
• avoiding tight clothing in areas where itchy bumps appear

Understanding the different conditions that can cause itchy bumps on the skin can help people get appropriate treatment. Depending on the cause, treatment can range from avoiding certain foods to taking prescription medications.

Keep reading to learn more about some common causes of itchy bumps that look like mosquito bites and how to treat them.

The medical term for hives is urticaria, and it describes a condition that produces raised itchy areas on the skin. If a person notices bumps on the skin that resemble mosquito bites but has not had any exposure to mosquitos, the cause is probably acute urticaria. The term “acute” means that the condition does not last longer than 6 weeks.

Hives are very common, affecting about 20% of people at some point in their lives. Certain kinds of foods, such as peanuts, tree nuts, and seafood, cause hives in many people due to an allergic reaction. Latex, pollen, insects, various plants, and some medications, such as sulfa drugs or even aspirin, may also cause hives.

Hives cause characteristic red, purple, or skin colored itchy bumps that appear and disappear quickly anywhere on the body. These bumps typically turn white or disappear when a person presses them.

Treatment

The treatment for hives depends on the severity and cause of the rash, but it includes avoiding known triggers. People who are extremely allergic to a trigger — for example, peanuts or certain insects — may need to carry an epinephrine auto-injector, such as an Epipen. This device can stop a potentially life threatening reaction if a person has accidental contact with a known allergen.

Anti-itching lotions and over-the-counter (OTC) antihistamines can provide relief for mild symptoms, while more intense outbreaks may require stronger prescription versions of these drugs or corticosteroids.

Learn more about hives here.

According to the Centers for Disease Control and Prevention (CDC), bed bug bites can resemble bites from other bugs, although they can take as long as 2 weeks to materialize.

People who notice itchy bumps on the skin that resemble mosquito bites should check for:

• other signs of bed bugs
• bed bugs themselves on a mattress or sheet
• dead bed bugs
• blood spots on a mattress or sheet
• the characteristic musty smell associated with bed bugs

If the bites appear in a straight line, they are likely to be due to bed bugs. However, bed bug bugs can also appear in more random formations.

Treatment

Unless someone has a severe allergic reaction, experts recommend simple self-care practices to treat any bites. These include not scratching, applying OTC antiseptic ointments, and taking antihistamines.

Learn more about bed bugs here.

Contact dermatitis is essentially an allergic reaction that develops when a person’s skin comes into contact with something to which they are allergic, such as latex or certain metals or household products.

It can take 1–2 days for the reaction to develop and 2–3 weeks for symptoms to disappear. Contact dermatitis may hurt as much as it itches, and it may present with inflammation and blisters.

Treatment

Self-care with cold compresses, calamine lotion, and soothing baths can help provide relief.

Prescription medication, such as antihistamines and cortisone, may be necessary if the reaction is severe.

Working with healthcare professionals can help people identify their triggers, which can be complicated.

According to the American Academy of Allergy, Asthma & Immunology, there are more than 3,700 substances known to cause contact allergies. Avoiding triggers is a key part of managing contact dermatitis, along with thoroughly washing the affected area with soap and water after exposure happens.

Learn more about contact dermatitis here.

The human itch mite is responsible for scabies. This mite digs its way through the top layer of the skin and lays eggs. Its tunnels can sometimes be visible on the surface of the skin, where they appear as raised, crooked, skin colored lines. However, the most common symptom of scabies is itchy bumps on the skin. These are like mosquito bites, only smaller.

Sites of the body that this very itchy condition commonly affects include the wrists, the elbows, between the fingers, and behind the knees.

Treatment

Only a prescription lotion will treat scabies effectively, and individuals need to follow the application directions exactly. Anyone who has had extensive skin-to-skin contact with someone with scabies should also seek treatment.

It is very important that people with scabies thoroughly wash and dry all of their clothes, towels, sheets, bedding, and other household items. Other remedies for scabies may also help.

Learn more about scabies here.

Also known as atopic dermatitis, this common condition causes itchy, red, irritated skin that can sometimes develop bumps. In the long term, it can make the skin thicker, scaly, and flaky, as well as causing it to change color.

Scratching makes eczema worse and increases the risk of infection. Eczema occurs due to a combination of genetic and environmental factors, which prompt the immune system to overreact to certain triggers, such as laundry soap or sweating. It typically affects the face, elbows, knees, scalp, and backs of the hands.

Treatment

According to the National Eczema Association, treating eczema calls for a mix of self-care, OTC drugs, and prescription medications. People with eczema can identify and learn to manage or avoid triggers for their outbreaks.

Changing bathing practices and using moisturizer can also help. Prescription lotions, systemic medications, UVB light, and biologics can address more severe symptoms.

Learn more about the different types of eczema here.

Skin problems, such as itchy bumps on the skin similar to mosquito bites, can range from mild to severe.

Some issues, including bed bug bites, can be fleeting, while others, such as allergic reactions to certain foods, are signs of a permanent condition. However, most skin problems generally respond well to treatment.

If the symptoms do not improve with self-care practices, people should see a medical professional to determine what is causing the outbreak and how to treat it.

How to Prevent & Treat (Infographic)

You try your best to prevent them, but bug bites happen. Between the stings, swelling and itching, it can be hard to know which type of bug is to blame and how to treat symptoms. Amanda Robinson, ARNP, UnityPoint Health, identifies common bug bites and how to prevent them.

Types of Bug Bites

Identifying bug bites isn’t always easy, and depending on the type of bite, symptoms can vary. Robinson says, regardless of what bug bit you, the bites typically have similar characteristics, including pain, itching, swelling and redness. Some common bug bites include bed bugs, mosquitos, ticks and chiggers. Here are a few tips to help you figure out what bit you:

• Bed bug bites. Look for clusters of bug bite marks together on the face, neck, arms, hands or any other body parts, especially after sleeping. They resemble mosquito bites and are often itchy and appear slightly swollen and red. Some people have no reaction to bed bugs and won’t notice bite marks. Bed bug bites don’t always show up immediately and can take up to two weeks to develop in some people. Bed bugs don’t spread disease.
• Mosquito bites. Appears as a slightly swollen and red area that may itch and be irritating. The symptoms usually develop quickly after being bitten and get progressively worse over 8-12 hours. Mosquito bites don’t usually appear in clusters. It may take up to 10 days for a bite to completely heal. While mosquito bites may happen any time of the day, this pest is most active during warmer months in the early morning and in the evenings — when it’s cooler. Mosquitos spread disease including Zika virus, West Nile virus, malaria, Chikungunya virus and dengue.
• Tick bites. You may notice a tick bite, because you can still see the tick attached. If it dropped off, you might see a red spot or rash near the bite, which could itch and burn. However, many tick bites don’t have symptoms. If you notice more severe, flu-like symptoms call your doctor. Ticks carry Lyme disease.
• Chigger bites. These bites usually show up in clusters. They like warm, moist areas of the body — like on the ankles where socks fit tightly, around the waste and near the groin. You might notice red skin with bumps, blisters or a hive-like rash not long after being in grassy or wooded areas. Chiggers aren’t dangerous and don’t spread disease.

“Rarely, bee stings can cause an allergic reaction in people, which can lead to a condition called anaphylactic shock,” Robinson says. “Symptoms of anaphylactic shock include hives, wheezing, shortness of breath and abdominal pain. Without appropriate care, death could result. Individuals who are allergic to bee stings should always carry an Epi-Pen with them.”

Bug Bites While Sleeping

Getting bug bites at night, especially when you’re asleep is no fun. There are three likely sources for bug bites at night — spiders, mosquitos or bed bugs. Spiders and mosquitos usually find their way into your home — and into your bedroom — during the warmer months.

“Honestly, many mosquito and spider bites look similar. With a new spider bite, you may see two distinct dots from the spider’s fang. Spider bites also tend to swell in more of a circular shape and mosquito welts look more uneven. For symptoms, spider bites often come with more pain, but both can be itchy,” Robinson says.

If you experience bug bites in clusters at night, make sure to check your bed for bed bugs. Pull back the sheets to look for any of the reddish, brown bugs, particularly focusing on reviewing the seams and the head of the bed.

How to Prevent Bug Bites

“As the saying goes, an ounce of prevention is worth a pound of cure. While some bug bites can’t really be prevented, there are proven ways to guard off others,” Robinson says.

Using insect repellent can be an effective prevention method, but only for certain bugs.

• Non-preventable. Unfortunately, repellents aren’t effective against stinging insects, such as bees, wasps or hornets. They also don’t keep spiders away. You really can’t prevent stings or bites from these pests, other than staying away from areas of known infestation.
• Preventable. Repellents are extremely useful in keeping mosquitoes, biting flies, gnats, fleas, chiggers and ticks away.

Mosquito repellents containing picaridin and DEET are the most recommended forms of prevention. Wristbands, stickers or other wearables containing repellent are not as effective, regardless of the repellent type used. 

“If you’re specifically trying to fend off ticks, products with DEET are best. You may also consider permethrin-treated clothing and gear. For pests like gnats and mosquitos, using either DEET, picaridin or PMD (para-Menthane-3,8-diol) products work well. If you’re trying to go all-natural, lemon eucalyptus oil is a great option. It’s safe for use on children over the age of 3,” Robinson says.

Robinson offers these tips when using bug spray:

• Lightly cover skin. Use just enough to lightly cover, but not saturate, your skin. If you’re using with sunscreen, apply the sunscreen before the bug spray. Frequent reapplication of repellent isn’t necessary.
• Don’t apply under clothing. Apply insect repellent to exposed skin, clothing or both, but not under clothing.
• Wash your hands. Clean your hands after applying repellent, and don’t apply it to the hands of small children, as they will end up rubbing their eyes.
• Not for everyone. Some products, especially those with higher DEET contents aren’t for very young children. Read the label to make sure you’re using products safely.

How to Treat Bug Bites

From ice to oatmeal and even honey — there are plenty of home remedies you can try to help relieve itching bug bites. 

“Start by using cold compresses for stings or bites. An over-the-counter cortisone cream is great for itching. If these options don’t provide enough relief, consider a trip to urgent care for a prescription cream or ointment. If you believe your bug bite is infected, definitely come see us,” Robinson says. 

DIROFILARIOSIS-PARASITIC DISEASE

Published: 17.06.2015

The mosquito season has begun. And if you
have not yet felt the obsessive attention of little bloodsuckers in their own
apartment, then, once in nature, you will definitely encounter them. To such
the meeting does not hurt to prepare, especially if there are atypical reactions to
mosquito bites. In addition to the usual allergy to an insect bite (itching, swelling,
redness), symptoms of general malaise, pain at the bite site,
unpleasant and alarming “movements” under the skin. It might not be
other than dirofilariasis .

Dirofilariasis is more common in areas with a warm and humid climate:
southern Europe, the countries of the Balkan Peninsula, Turkey, Africa, India. In Russia, dirofilariasis was registered in the southern
regions: in the Krasnodar and Stavropol Territories, the republics of the Northern
Caucasus, Astrakhan, Volgograd, Rostov, Lipetsk, Voronezh
regions, as well as Primorsky and Khabarovsk territories. In recent years
the parasite spread in
more northern regions of Russia. In Belarus annually
3–7 cases of dirofilariasis are detected. The most common disease occurs in
Gomel region.

Dirofilariasis —
a rare type of helminthiasis, in which the parasite is introduced under the skin and migrates along
body. For this disease
characterized by slow development and a long chronic course, accompanied by
complications in the heart, liver and kidneys.

Pathogen – immature nematode
Dirofilaria repens (roundworm). The parasite has a filamentous body
light yellow in color, tapering towards both ends, their larvae, called dirofilariae,
have a length of 0.22-0.30 mm. The length of an adult female
17–20 cm, width – 0.3–0.7 cm. Males are slightly smaller – 7 cm and 0.45 cm, respectively.

Microfilariae vector are
mosquitoes of various types incl. and mosquitoes that live year-round in warm and
basements of apartment buildings. They fly into the ventilation
systems in apartments and feed on humans and pets. Thus,
if there is a sick dog or cat in a city apartment, the transmission of infestation
can be carried from them to the person.

Main sources
infestations for humans are dogs. The disease also occurs in
foxes, ferrets, cats. Infection of dogs and other carnivores occurs in
in the process of feeding on them mosquitoes infested with dirofilaria larvae. IN
within 3 months, the larvae develop in the subcutaneous fat and connective
animal tissues, shed twice and penetrate into the bloodstream. By circulatory
system, the larvae migrate to the heart and pulmonary artery, where after 3-4 months
reach sexual maturity and become capable of producing larvae. Female
Dirofilaria gives birth to up to 30,000 larvae every day. microfilariae,
circulating in the blood of infested animals are non-invasive and do not
pose an immediate danger to other animals or humans.

For further
development, these parasites must be ingested by mosquitoes. The period of development of the larva in a mosquito to the invasive stage is about 17 days.

A person is infected by the bite of a mosquito that carries
contain dirofilaria larvae. Infestation
people, as a rule, occurs during agricultural work or recreation on
nature, where there are affected animals and mosquito colonies. More often
this happens during the period of insect activity (May-September). Increasing quantity
identified invasions in humans in recent years due to the growth of vagrant
animals, their mass migration between settlements, the process
urbanization, climate warming. All of these factors contribute to the transmission
parasite from wild animals to domestic and human.

Usually in the human body parasitizes one
helminth.

In rare cases, 2-3 helminths parasitize humans,
which, apparently, is associated with repeated cases of infection. In humans
the female helminth grows into an adult, but the “children” – dirofilaria –
does not give birth, therefore this disease is from a person
not transmitted to humans. Once in the body, the parasite reaches
largest in six months and is located under the skin (mucosa
shell), where a capsule of connective tissue is formed around it. IN
further the female gradually dies and collapses. The parasite is very
active: moves in the body at a speed of 10–30 cm per day. Clinical
symptoms

From
from the moment of infection until the manifestation of the main typical clinical symptom (movement of the pathogen, or
seals with it) passes from 1 month
up to several years.

Dirofilariasis manifests itself by migration through the body
parasite.

Later
a few days at the site of a mosquito bite, a small dense formation appears,
which may be accompanied by itching. Then it gradually increases
reaching a diameter of up to four centimeters. There is slight redness and
swelling of the skin over it, increased itching and pain. With the development of inflammation, the nodule
softens, suppurates, an abscess may form, on top of which
a hole appears from which the end of the worm protrudes.

When the parasite moves to its old place of residence, no
no traces remain, and a seal appears in the new area. There are symptoms of general intoxication: weakness, malaise,
headache, nausea, fever. An important symptom is migratory on palpation.
the knot is very mobile. Such a nodule persists for 2-3 months and periodically
disappears. All these sensations are present until the helminth around
a capsule will form.

Cases of localization of dirofilarial nodules in the area
head, neck, abdomen, popliteal region, thigh and other places.

Almost half of the cases of dirofilariasis involve
in the pathological process of the organs of vision.
Eye damage may be the only manifestation of the disease.
Helminths are localized and migrate in the subcutaneous tissue of the eyelid or under
conjunctiva. A knot (granuloma) is formed around the helminth, edema develops.
With the localization of the helminth in the subcutaneous tissue of the eyelids, a limited
tumor-like swelling, as a rule, with mild inflammatory
phenomena. The presence of the parasite under the conjunctiva causes phenomena
conjunctivitis. The disease can lead to severe hyperemia of the conjunctiva,
significant tearing. With the development of a granuloma in the orbit, pain is noted,
edema, erythema, exophthalmos, diplopia. Human can
completely lose sight.

Usually patients do not attach importance to the strange “pimple”.
After 1-3 months, when they begin to feel movement in that area or if
infiltrate appears on the face, they seek medical help.

Diagnostics. Specific
there is no diagnosis of dirofilaria detection. One of the diagnostic symptoms: the presence
feeling that a living thing is moving or crawling inside a dense formation
creature.

The final diagnosis is established only after the removal of the helminth, followed by parasitological
morphological research.

Treatment. Treatment of heartworm disease in humans
surgical and consists in removing the helminth.

Prevention

1. Personal measures
   prevention – protection against mosquito bites .
2. Combat
   mosquitoes in residential buildings, underground houses and other places.
3. Identification and
   treatment of invasive dogs, cats.

What and who can bite at night at home in bed. Types of insects.

One fine morning you wake up with a strong itch and see that red bite marks have appeared on your body. It can be blood-sucking insects or parasites. Before you start fighting them, you need to know what can bite in bed. By observing the appearance of bites, their position on the body and the approximate time of their appearance, it is easy to determine the culprits.

Mosquito bites

Mosquito bites are not noticeable, and we often notice this when the bite begins to itch. Once the mosquito has tracked down the prey, it sticks with its proboscis to thin, well-circulating patches of skin. Mosquito bite symptoms:

• redness;
• itching;
• swelling;
• blisters.

Itching and redness appear a few minutes after the bite. If a blister forms at the puncture site, the skin around it swells and becomes red.

Why do mosquitoes bite

If someone bites you at night, especially in summer, it is most likely a mosquito. They are especially active at dusk. Darkness does not prevent them from tracking down their prey. Finding it helps carbon dioxide, which is released by a person when exhaling. Mosquitoes feel it at a distance of up to 50 meters.

Mosquitoes react to heat and body odor. Therefore, the warmer the room, the more they bite. Mosquitoes choose their prey by the characteristic smell, the more bacteria on the surface of the skin are involved in the formation of the smell, the higher the likelihood of a bite.

Mosquito bites – harmless or dangerous

A mosquito bites because it needs blood protein to produce eggs. When it bites, the immune system recognizes its saliva as a threat and releases histamine. Itching is an allergic reaction to a bite. It is usually harmless, but annoying and disturbing. If the bite is not combed, then the itching gradually decreases and after a few days there will be no trace of redness. If the bubble is combed, the wound may become inflamed.

How to get rid of mosquitoes

Mosquitoes are the companions of summer, and it is impossible to completely get rid of them, but you can reduce the likelihood of bites. To do this, put mosquito nets on windows and doors. You can leave the air conditioner on as mosquitoes avoid cool air. Ultrasonic traps, fumigators, spirals help to fight them well.

If you prefer traditional methods, place geranium flowers and peppermint on the window. You can treat the frames with tincture of wheatgrass, wormwood. Essential oils of clove, anise or tea tree repel mosquitoes.

Bedbugs

Mosquitoes are the most harmless of those that can bite at home. They can be tolerated, and in the cold period they usually disappear. Another thing is if you are attacked by bedbugs.

Bed bugs reproduce very quickly and can withstand temperatures from 4 to 40 degrees. They not only live in bed, but also remain in carpets, sofas, lamps or picture frames. They hide during the day, and at night they look for their owners to take blood. Bed bugs are not picky about their diet. These parasites usually feed on human blood, but in an emergency they can spread to animals.

What a bed bug looks like

When a bed bug is small, it is difficult to see it. When its size reaches 6 millimeters, it is already visible to the naked eye. After a bloody feast, they become fatter, even a little longer. This is what a bed bug looks like:

• body length from 4 to 6 millimeters;
• reddish brown;
• six hairy legs;
• flat body shape.

Bed bug eggs are creamy white in color and are only a millimeter in size and therefore difficult to recognize. Bed bugs can live without food for up to 6 months.

Bed bug bites

If you wake up in the morning with noticeable bites, you may have been bitten by bed bugs. You can determine what it is they are by looking at the location of the spots.

The bug rarely enters the blood vessel the first time. These little bloodsuckers avoid long walks on the body, their bites always have an ordinary design (street of bugs). When attacked, exposed areas of the body are especially affected: legs, arms, neck and face.

The effect of a bite depends on the sensitivity of the person. In some, it causes severe swelling, in others, swelling and itching, and in 20% of people there is no reaction at all. A bed bug bite is usually painless. However, if you experience pain, then see a doctor as soon as possible and treat for bed bugs.

How to find them

Bed bugs hide during the day, but if you carefully examine the bed, you can find their traces.

1. It bites a person in a blood vessel, causing blood to leak. Therefore, small blood stains appear on the sheet, bedspread and nightwear.
2. Another sign of infection is small black excrement that remains on the skin, footpaths. Fecal particles are approximately 0.5-1.0 mm in size. There are especially a lot of them near the daytime shelter of the parasite.
3. In their development they go through five larval stages, each phase beginning with a molt. The remains of the molt remain near the nests.
4. One of the typical signs of infection is a repulsive sweet smell. It is especially felt with a strong infection.

Bed bugs prefer to live in living, enclosed rooms close to places to sleep and rest. Traces of their existence can be found on mattresses, bed frames or behind wallpaper. Bed bugs love warmth and darkness. They hide in crevices, crevices, furniture joints, preferring materials such as wood, paper and textiles.

Note from the expert of GorSES:
Of course, you can fight bed bugs on your own, but most likely you will lose precious time and lose the battle. Therefore, it is better to turn to professionals. They know where little invaders might be hiding and have effective, safe disinfectants.

Fleas in bed

In addition to bedbugs, mosquitoes, there are other parasites: for example, fleas. Flea vinegar is similar to mosquito. From a mosquito puncture, it differs in smaller size and quantity. Flea bites are usually concentrated in one place. They itch a lot, swell, blush. In addition, scratches can become inflamed, and pathogens can enter the wound.

What are the

There are over 2500 species of fleas that specialize in different host animals. Usually they rarely change owners, but in the absence of food they can choose another victim. Several species are dangerous for humans in our latitudes.

1. The human flea (pulex allerans) has been virtually eradicated but can occasionally be found. She mainly lives in beds, carpets, upholstered furniture and comes out of the nest to drink blood.
2. The cat flea (ctenocephalides felis) lives on and around cats. It is transmitted to dogs and people, as it is much less attached to the owner.
3. The dog flea (ctenocephalides canis) behaves very much like the cat flea, but is more attached to the owner. In exceptional cases, it can run over to a person, but usually cannot survive there.
4. Other types of fleas that can bite humans are hedgehog, pigeon, rat or chicken fleas.

All species go through four stages of development. Well fed with blood, adult females lay up to 50 eggs per day. Flea eggs do not have an adhesive effect and can fall out of fur, clothing at any time. This is one of the reasons why fighting them is laborious, annoying.

After 3-10 days the eggs hatch into larvae. They primarily feed on blood in adult droppings, as well as dead skin, hair, and other organic debris. The larvae are not yet able to suck blood. After a few days at the larval stage, they pupate, and after 7-14 days adult parasites appear. A flea lives, after hatching, on average 4-12 weeks.

What it looks like

The body of the flea is brown. It has six strong long jump legs and a sucking, burning trunk for eating. Thanks to the flattened sides, they can move through hair, fur, and other surfaces. Depending on the species, an adult flea has a size of 1.5 to 4 mm. By the way, fleas cannot fly, but they can jump very far. Their specially built legs allow them to jump distances up to one meter.

How to deal with

Effective flea control is not a one-time action, but a combination of different measures over a long period. It is necessary to start the fight by determining the cause of the infection. Do pets have fleas, or did they accidentally jump into the house. The reason may be an old sofa from a flea market, a mattress from the attic.

If animals have bloodsuckers, then in addition to treatment, it is necessary to disinfect the couch, preferably the apartment. If fleas are found in the bed, then it is necessary to wash the linen in hot water, vacuum the mattresses thoroughly. All of these measures can help with a minor infection. With a large area of ​​​​infection, and a significant number of parasites, it is better to call a special organization.

Louse

It is easy to understand that you are being bitten by a louse. Firstly, severe itching occurs exclusively on the hairy parts of the body (head, beard, eyebrows, pubis). Secondly, they bite throughout the day, and not just at night, like other blood-sucking insects. There are three types of lice that feed on human blood:

• head lice;
• pubic;
• underwear.

Lice live in the host’s hair or clothes. The female animal lays eggs that can develop without male fertilization. Human lice eggs are covered with a hard shell of chitin and attached to the host’s hair or textile fibers of clothing. They are insoluble in water, so they are difficult to wash out.

The most dangerous are linen lice, they can cause fever, headache. To combat them, it is necessary to thoroughly wash the linen at a temperature of 60 ° C. Mattresses, pillows, blankets should be placed in a plastic bag for a month. In winter, you can take out things in the cold for a day.

The sooner you identify who bites in bed, the easier it will be to get rid of parasites. Call 8 (800) 775-22-97.

Review:
We rented an apartment on the first floor, everything seemed to be clean and tidy. A few days later, all the legs were covered with a small rash, and the child had his hands.