BUG WEEK: Day 1- How to remove a tick

Today I had a great lecture about the basic bugs that cause dermatological lesions. In spite of making me feel itchy all over, I actually learned a lot. In fact, it inspired me to dedicate a week to the creepy crawlies of dermatology.

But today, I have a very specific topic... HOW TO REMOVE A TICK. There was some discussion of this at lecture today, where the experienced opinion is that heat should be applied to the tick in the form of a heated paper clip in order to cause its release of the skin. However, my friends and I were discussing this apparently controversial topic, and it was brought to my attention that heating the ticks stresses it and causes it to regurgitate material into the skin before letting go. The method my freind recommended was to grab the tick as close to the skin as possible and just pull it out. She just completed a back country trip in Minnesota, which involved many a tick, so she had considerable experience in this area. My concern with just pulling the tick out is that there will likely be foreign material left in the skin. Which is worse, some mouth parts or regurgitated tick saliva in your skin?

I decided to do a lit search on pubmed...

Removal of ticks: a review of the literature
Health Protection Agency Centre for Infections, London, UK

Oteo JA, Martínez de Artola V, Gómez-Cadiñanos R, Casas JM, Blanco JR, Rosel Evaluation of methods of tick removal in human ixodidiasis. L.Rev Clin Esp. 1996 Sep;196(9):584-7.

The current opinion is that the tick should be grasped as close to the skin as possible, preferably with curved forceps and pulled straight out with constant force. This minimizes the chance for foreign material to remain in the skin and because the tick is removed immediately, it will not have the chance to regurgitate any material. If the barbed mouth piece is left behind, the chances for secondary infection and allergic response are increased. Multiple studies have been done on tick removal with measured outcomes including rates of complications (transmitted diseases and secondary infections) as well as retained mouth parts.

1. suffocating the tick- because ticks have a low respiratory rate, it usually takes a while to suffocate them, giving the tick more time to transmit disease
2. chemical irritants- in the studies, the ticks did not consistently detach
3. heat- in the studies, the ticks did not consistently detach
4. unscrewing the tick- higher likelihood of retained mouth parts
5. commercially available devices with grooves, like this one were better for immature ticks, but left behind mouth parts of mature ticks
6. forcep or finger removal of tick from point of attachment- RECOMMENDED METHOD

The WHO and the CDC recommend the forcep removal method. Here is an image and text from the CDC web page.

Remove a tick from your skin as soon as you notice it. Use fine-tipped tweezers to firmly
grasp the tick very close to your skin. With a steady motion, pull the tick’s body away from your skin. Then clean your skin with soap and warm water. Throw the dead tick away with your household trash.

Avoid crushing the tick’s body. Do not be alarmed if the tick’s mouthparts remain in the skin. Once the mouthparts are removed from the rest of the tick, it can no longer transmit the Lyme disease bacteria. If you accidentally crush the tick, clean your skin with soap and warm water or alcohol.

Don’t use petroleum jelly, a hot match, nail polish, or other products to remove a tick.