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How To Remove a Tick

By

Matthew J. Streitz

, MD, San Antonio Uniformed Services Health Education Consortium

Last full review/revision Sep 2020| Content last modified Sep 2020
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Ticks should be removed from the skin to prevent tick-borne disease (eg, Rocky Mountain spotted fever Rocky Mountain Spotted Fever (RMSF) Rocky Mountain spotted fever (RMSF) is caused by Rickettsia rickettsii and transmitted by ixodid ticks. Symptoms are high fever, severe headache, and rash. (See also Overview of Rickettsial... read more Rocky Mountain Spotted Fever (RMSF) , Lyme disease Lyme Disease Lyme disease is a tick-transmitted infection caused by the spirochete Borrelia species. Early symptoms include an erythema migrans rash, which may be followed weeks to months later by neurologic... read more Lyme Disease , tularemia Tularemia Tularemia is a febrile disease caused by the gram-negative bacterium Francisella tularensis; it may resemble typhoid fever. Symptoms are a primary local ulcerative lesion, regional lymphadenopathy... read more Tularemia , tick paralysis Tick Paralysis Tick paralysis is a rare, ascending, flaccid paralysis that occurs when toxin-secreting Ixodidae ticks bite and remain attached for several days. In North America, some species of Dermacentor... read more , babesiosis Babesiosis Babesiosis is infection with Babesia species of protozoa. Infections can be asymptomatic or cause a malaria-like illness with fever and hemolytic anemia. Disease is most severe in asplenic patients... read more Babesiosis , anaplasmosis Ehrlichiosis and Anaplasmosis Ehrlichiosis and anaplasmosis are caused by rickettsial-like bacteria. Ehrlichiosis is caused mainly by Ehrlichia chaffeensis; anaplasmosis is caused by Anaplasma phagocytophilum. Both are transmitted... read more Ehrlichiosis and Anaplasmosis , ehrlichiosis Ehrlichiosis and Anaplasmosis Ehrlichiosis and anaplasmosis are caused by rickettsial-like bacteria. Ehrlichiosis is caused mainly by Ehrlichia chaffeensis; anaplasmosis is caused by Anaplasma phagocytophilum. Both are transmitted... read more Ehrlichiosis and Anaplasmosis , tick-borne encephalitis Tick-borne encephalitis Arbovirus (arthropod-borne virus) applies to any virus that is transmitted to humans and/or other vertebrates by certain species of blood-feeding arthropods, chiefly insects (flies and mosquitoes)... read more ).­

Indications

  • Presence of a tick attached to the skin

Contraindications

  • None

Complications

  • Inadequate or partial removal of the tick may cause infection or chronic granuloma formation.

Equipment

  • Cleansing solution such as chlorhexidine

  • Straight- or curved-tip forceps

  • Tweezers

  • #11 scalpel

  • Nonsterile gloves

Additional Considerations

  • 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.

Positioning

  • 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.

Aftercare

The main concern is transmission of various tick-borne illnesses. The bite itself is superficial and rarely problematic.

Prophylactic antibiotics

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.

More Information

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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