The straight, slow method may be best for removing ticks
Date First Published:
January 11, 2002
Last Updated:
November 13, 2002
Report by:
Stewart Teece, Clinical Research Fellow (Manchester Royal Infirmary)
Search checked by:
Ian Crawford, Manchester Royal Infirmary
Three-Part Question:
In [patients with ticks attached to their skin] is [any of the popular methods better than the others] for [removal of an intact tick]?
Clinical Scenario:
A 27-year-old hiker attends with what appears to be a tick in the skin of his right leg. You seek the advice of your colleagues on the best method of removal, the registrar advises you to pull it straight out, another registrar suggests to pull out anticlockwise, the consultant denounces them as fools and says to pull clockwise. Sister suggests suffocating the tick with vaseline and a staff nurse thinks that nail varnish is better for this, a passing porter suggests burning it off with a lighted fag and the patient himself claims that his mother always recommended 70% isopropyl alcohol (for the removal of ticks). Confused you wonder whether there is any evidence for any of the suggested methods.
Search Strategy:
Medline 1966-04/02 using the OVID interface.
Search Details:
[exp ticks OR ticks.mp OR arachni$.mp OR tick.mp OR acarines.mp OR ixodes.mp OR parasit$ OR bloodsucker.mp OR dermacentor.mp OR amblyomma.mp OR ceratopogidae.mp] AND [exp"bites and stings" OR bite$.mp] AND [exp foreign bodies OR removal.mp OR excis.mp]
Outcome:
40 papers found of which 38 were irrelevant or of insufficient quality for inclusion. The remaining 2 are shown below.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Evaluation of five popular methods of tick removal. Needham GR. 1985, USA | 29 American dog ticks and 22 lone star ticks attached to a female Dorset sheep. | Experimental | Ease of removal and retained mouthparts. Testing with petroleum jelly, nail polish, 70% isopropyl alcohol and hot match (passive removal) and clockwise pull or straight pull with quick or steady even pressure (mechanical) | Failure of removal with passive methods. Removal with mechanical method steady even pressure most likely to give intact removal | Statistical significance not assessed |
| Removal of attached nymphs and adults of Ixodes ricinus (Acari: Ixodidae). De Boer R, van den Bogaard AE. 1993, The Netherlands | Ixodes Ricinus attached to the skin of pigs and sheep. | Experimental | Ease of removal, retained mouthparts. Testing with gasoline, nail polish and methylated spirit or by straight pull or rotation around axis | Failure of removal by chemical methods within 30 minutes. Straight pull less likely to leave mouthparts than rotation (0.01<p<0.02) |
Author Commentary:
Given that ticks have a respiratory rate of 3-15 breaths per hour suffocation would appear unlikely to work as the above studies showed, however anecdotal evidence suggests lignocaine gel may be efficacious in aiding removal (3).
Bottom Line:
Current evidence suggests that a straight slow method is best for removal without leaving the mouthparts.
Level of Evidence:
Level 3: Small numbers of small studies or great heterogeneity or very different population
References:
- Needham GR.. Evaluation of five popular methods of tick removal.
- De Boer R, van den Bogaard AE.. Removal of attached nymphs and adults of Ixodes ricinus (Acari: Ixodidae).
- Karras DJ.. Tick Removal.