Ticks should be removed from the skin to prevent tick-borne disease (eg, Rocky Mountain spotted fever, Lyme disease, tularemia, tick paralysis, babesiosis, anaplasmosis, ehrlichiosis, tick-borne encephalitis).
(See also Tick Bites.)
- Presence of a tick attached to the skin
- Inadequate or partial removal of the tick may cause infection or chronic granuloma formation.
- Cleansing solution such as chlorhexidine
- Straight- or curved-tip forceps
- #11 scalpel
- Nonsterile gloves
- Ticks should be removed as soon as practical to reduce the cutaneous immune response and the likelihood of disease transmission. A tick’s mouthparts become cemented within 5 to 30 minutes of contact with the host’s skin.
- Patient comfort with excellent exposure of tick
Step-by-Step Description of Procedure
- Grasp the tick's mouth parts as close to the skin as possible using a blunt forceps with medium-sized, curved tips placed parallel to the skin.
- Apply gentle, steady traction to remove the tick.
- Do not squeeze, crush, twist, or jerk the tick’s body. Doing so may expel infective agents.
- If mouth parts are left behind, remove as much of them as possible with tweezers or the point of a scalpel blade.
- Clean the area with soap and water or a mild antibacterial wound cleanser such as chlorhexidine.
The main concern is transmission of various tick-borne illnesses. The bite itself is superficial and rarely problematic.
- Patients should return if any local pain, swelling, or erythema develops or if they develop systemic symptoms (eg, fever, headache, joint pains, malaise) within 4 weeks of the bite; most tick-borne illnesses except for Lyme disease typically manifest earlier.
- The tick may be saved for laboratory analysis to check for tick-borne disease in the geographic area where the patient acquired the tick.
Prophylactic doxycycline (a single dose 200 mg orally for adults or 4 mg/kg for children under 8 years old) can prevent Lyme disease but should be given only when all of the following criteria are met:
- The patient is from an area where the incidence of Lyme disease is high.
- A partially engorged deer tick in the nymphal stage is discovered on the body.
- The tick is suspected to have been attached for at least 36 hours.
Some experts recommend a longer course of doxycycline (100 mg 2 times a day for 10 to 20 days) to ensure eradication.
Prophylactic antibiotic treatment of tick bites is otherwise not recommended.
Warnings and Common Errors
- Nonmechanical, traditional, and folk methods of forcing the tick to disengage (such as the use of petroleum jelly, fingernail polish, a hot match, or alcohol) are not recommended. These methods can cause the tick to regurgitate and therefore increase the likelihood of infection.
Tips and Tricks
- The forceps should be pulled slowly and steadily, directly away from the skin without twisting. Curved-tip forceps are best because the outer curve can be laid against the skin while the handle remains far enough from the skin to grasp easily.
The following are some English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
- Huygelen V, Borra V, De Buck E, Vandekerckhove P: Effective methods for tick removal: A systematic review. J Evid Based Med 10(3):177–188, 2017. doi: 10.1111/jebm.12257
- Cameron DJ, Johnson LB, Maloney EL: Evidence assessments and guideline recommendations in Lyme disease: The clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther 12(9):1103–1135, 2014. doi: 10.1586/14787210.2014.940900
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