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How to remove a tick
  1. Stewart Teece, Clinical Research Fellow,
  2. Ian Crawford, Clinical Research Fellow

    Abstract

    A short cut review was carried out to establish whether there was any evidence to decide between the various described methods of tick removal. Altogether 40 papers were found using the reported search, of which two presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Stewart Teece,Clinical Research FellowSearch checked by Ian Crawford, Clinical Research Fellow

    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.

    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]?

    Search strategy

    Medline 1966–04/02 using the OVID interface. [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]

    Search outcome

    Altogether 40 papers found of which 38 were irrelevant or of insufficient quality for inclusion. The remaining two are shown in table 2.

    Table 2

    Comment(s)

    Given that ticks have a respiratory rate of 3–15 breaths per hour suffocation would seem unlikely to work as the above studies showed, however anecdotal evidence suggests lignocaine gel may be efficacious in aiding removal.

    CLINICAL BOTTOM LINE

    Current evidence suggests that a straight slow method is best for removal without leaving the mouthparts.

    Report by Stewart Teece,Clinical Research FellowSearch checked by Ian Crawford, Clinical Research Fellow

    References

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