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Tick Removal Technique

  • Author: Steven Brett Sloan, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Feb 11, 2016
 

Removal of Attached Tick

It is important to use fine-tipped forceps and wear gloves because handling ticks with bare fingers may result in infection through breaks in the skin. This precaution is directed particularly to individuals who remove ticks from domestic animals with unprotected fingers. Children, elderly persons, and immunocompromised persons may be at greater risk of infection and should be especially careful to avoid removing ticks with unprotected fingers.[9]

Grasp the tick as close to the skin surface as possible (eg, grasp the mouth parts), and pull upward with steady, even traction (see the image below). Do not twist or jerk the tick, because this may cause the mouth parts to break off and remain in the skin. However, do not be unduly alarmed if the mouth parts remain in the skin; they are not infectious. Do not squeeze, crush, or puncture the body of the tick, because its fluids (ie, saliva, hemolymph, and gut contents) may contain infectious organisms.[10, 11]

Grasp the tick as close to the skin surface as pos Grasp the tick as close to the skin surface as possible and pull upward with steady, even traction.

In a comparison of 3 commercial tick removal tools with medium-tipped nontissue forceps, Stewart et al found that nymphal ticks were removed consistently and more successfully with commercial tools than with forceps but that adult ticks were more difficult to remove.[12] They concluded that the commercial tick removal tools tested were functional for removal of nymphs and adults and should be considered viable alternatives to medium-tipped forceps.

Do not apply a hot match to the tick or try to smother it with petroleum jelly, gasoline, nail polish, or other noxious substances. Doing so only prolongs exposure time and may cause the tick to eject infectious organisms into the body.[13] The use of lidocaine (subcutaneously or topically) may actually irritate the tick, leading it to regurgitate its stomach contents.

Once the tick is removed, wash the bite area with soap and water or with an antiseptic to destroy any contaminating microorganisms. The person who removed the tick should wash his or her hands as well.

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Complications

Tick bites can become infected secondarily by organisms such as Staphylococcus aureus and group A Streptococcus. Such infection may be manifested by the following:

  • Impetigo
  • Ecthyma
  • Cellulitis
  • Erysipelas
  • Shallow, painful, purulent ulcers

Retained tick material may lead to secondary infection. Host scratching may also lead to increased tissue damage with subsequent lichenification or infection.

Lesions may persist chronically to become papules, nodules, or plaques. These represent the formation of a tick-bite granuloma, which is typically a 0.5- to 2-cm nodule that develops days to months after a bite and may persist for months or years, gradually decreasing in size.

The etiology of tick-bite granulomas is not entirely clear. In some cases, retention of tick mouth parts or cuticular fragments may lead to granuloma formation. In other cases, granulomas form in the absence of any evidence of retained mouth parts, which suggests that salivary secretions alone may be responsible. Granulomas may also represent a neurodermatitic response caused by scratching.

In rare cases, alopecia caused by tick bites has been recorded. Alopecia can begin within a week of tick removal and typically occurs in a 3- to 4-cm circle around a tick bite on the scalp; it has the clinical appearance of alopecia areata (see the image below). A moth-eaten alopecia of the scalp caused by bites of Dermacentor variabilis (the American dog tick) has also been described. No particular tick species appears more likely to cause alopecia. Hair regrowth typically occurs within 1-3 months, though permanent alopecia has been observed.[1]

Alopecia areata affecting the arms. Alopecia areata affecting the arms.
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Contributor Information and Disclosures
Author

Steven Brett Sloan, MD Associate Professor, Department of Dermatology, University of Connecticut School of Medicine; Residency Site Director, Connecticut Veterans Affairs Healthcare System; Assistant Clinical Professor, Yale University School of Medicine

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Journal of the American Academy of Dermatology;Up to Date;Medical Review Institute of America.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Acknowledgements

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. McGinley-Smith DE, Tsao SS. Dermatoses from ticks. J Am Acad Dermatol. 2003 Sep. 49(3):363-92; quiz 393-6. [Medline].

  2. Demicheli V, Debalini MG, Rivetti A. Vaccines for preventing tick-borne encephalitis. Cochrane Database Syst Rev. 2009 Jan 21. CD000977. [Medline].

  3. Kunze U. Conference report of the 10th meeting of the international scientific working group on tick-borne encephalitis (ISW-TBE): combating tick-borne encephalitis: vaccination rates on the rise. Vaccine. 2008 Dec 9. 26(52):6738-40. [Medline].

  4. Banzhoff A, Broker M, Zent O. Protection against tick-borne encephalitis (TBE) for people living in and travelling to TBE-endemic areas. Travel Med Infect Dis. 2008 Nov. 6(6):331-41. [Medline].

  5. De Boer R, van den Bogaard AE. Removal of attached nymphs and adults of Ixodes ricinus (Acari: Ixodidae). J Med Entomol. 1993 Jul. 30(4):748-52. [Medline].

  6. Wormser GP, Nadelman RB, Dattwyler RJ, et al. Practice guidelines for the treatment of Lyme disease. The Infectious Diseases Society of America. Clin Infect Dis. 2000 Jul. 31 Suppl 1:1-14. [Medline].

  7. Volkman D. Prophylaxis after tick bites. Lancet Infect Dis. 2007 Jun. 7(6):370-1. [Medline].

  8. Dennis DT, Meltzer MI. Antibiotic prophylaxis after tick bites. Lancet. 1997 Oct 25. 350(9086):1191-2. [Medline].

  9. Oteo JA, Martinez de Artola V, Gomez-Cadinanos R, et al. [Evaluation of methods of tick removal in human ixodidiasis]. Rev Clin Esp. 1996 Sep. 196(9):584-7. [Medline].

  10. des Vignes F, Piesman J, Heffernan R, et al. Effect of tick removal on transmission of Borrelia burgdorferi and Ehrlichia phagocytophila by Ixodes scapularis nymphs. J Infect Dis. 2001 Mar 1. 183(5):773-8. [Medline].

  11. Gammons M, Salam G. Tick removal. Am Fam Physician. 2002 Aug 15. 66(4):643-5. [Medline].

  12. Stewart RL, Burgdorfer W, Needham GR. Evaluation of three commercial tick removal tools. Wilderness Environ Med. 1998 Fall. 9(3):137-42. [Medline].

  13. Needham GR. Evaluation of five popular methods for tick removal. Pediatrics. 1985 Jun. 75(6):997-1002. [Medline].

 
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Ixodes scapularis mimicking a nevus at first glance.
Ixodes scapularis close-up.
Ixodes scapularis, tick vector for babesiosis. Courtesy of the Centers for Disease Control and Prevention.
Typical appearance of erythema migrans, the bull's-eye rash of Lyme disease.
Alopecia areata affecting the arms.
Grasp the tick as close to the skin surface as possible and pull upward with steady, even traction.
Bulls-eye rash
 
 
 
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