Tungiasis Medication

Updated: Mar 07, 2023
  • Author: Darvin Scott Smith, MD, MSc, DTM&H, FIDSA; Chief Editor: John L Brusch, MD, FACP  more...

Medication Summary

See Table 1, below.

Table 1. Medication Summary (Open Table in a new window)

Medication Name





Dimethicone  [59, 60, 61]

Apply directly to the affected area once or twice daily.


If legion numbers are under 40 or legions are in clusters: Apply 3 drops of NYDA® (approximately 50 μL each) to the exposed posterior side of the flea. Repeat the procedure 3x over 10 minutes.


If fleas are in excessive hyper-keratotic skin and located on top of each other: NDYA® must be used to wet the skin intensely and repeatedly.

No known contraindications. Shown to be safe for extended use.

Available under the brand name NYDA®. But not available in all tungiasis endemic areas.


Topical Antibiotic Lotions  [64, 58, 61]

0.8% ivermectin, 0.2% metrifonate and 5% thiabendazole lotions, applied 2 consecutive days.

No contraindications reported.

All are readily available except for metrifonate, which is no longer commercially available.


Zanzarin  [63, 8]

Apply to all infected areas and areas at risk for tungiasis infection twice daily.

No known contraindications.

No longer commercially available, but made of ingredients that could be locally manufactured in areas where tungiasis is common.


Neem Seed Oil and Coconut Oil  [61, 69]

One drop (approximately 0.05 ml) of a mixture of 20% cold-pressed virgin neem seed oil and 80% virgin coconut oil applied to the embedded flea’s abdominal tip on days 1 and 3. 

Actives in cold-pressed neem oil are not toxic following oral, inhalation, or dermal exposure.

May be locally available where both neem trees and coconut palms grow.

The mixture requires proper storage as azadirachtin has a high sensitivity to ultraviolet light, pH, and temperature.