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.)
Indications for Removing a Tick
Presence of a tick attached to the skin
Contraindications to Removing a Tick
None
Complications of Removing a Tick
Inadequate or partial removal of the tick may cause infection or chronic granuloma formation.
Equipment for Removing a Tick
Straight- or curved-tip forceps
Tweezers
#11 scalpel
Nonsterile gloves
Additional Considerations for Removing a Tick
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 for Removing a Tick
Patient comfort with excellent exposure of tick
Step-by-Step Description of Removing a Tick
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.
Aftercare for Removing a Tick
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 antibiotics
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.
Prophylactic antibiotic treatment of tick bites is otherwise not recommended.
Warnings and Common Errors When Removing a Tick
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 for Removing a Tick
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 English-language resources 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
