Tick Removal Technique

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. ^[12]

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. ^{[13, 14]}

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

View Media Gallery

In a comparison of three 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. ^[15] 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.

Akin Belli et al retrospectively evaluated 160 patients after dividing them into four groups according to the tick-detachment technique used—card detachment, lassoing, freezing, and tweezers. ^[16] They found the following efficacy rates: 33 (82.5%) of 40 for tweezers, 19 (47.5%) of 40 for lassoing, 3 (7.5%) of 40 for card detachment, and 0 (0%) of 40 for freezing. The efficacy rate of the technique using tweezers was significantly higher than that of the other three techniques (P< .05).

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. ^[17] 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.

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. ^[2]

Alopecia areata affecting the arms.

View Media Gallery