What is the safest way to remove a tick?

While most tick bites are just annoying, they can lead to more serious health problems including allergic reactions (which range from large swelling around the bite to life-threatening anaphylaxis), infections (including the flu-like Rickettsia) and very rarely, tick paralysis.

So there are plenty of reasons to want to detach ticks as we soon as find them. But what is the best way and safest method to remove a tick?

Tick Removal Devices

There are many devices that can be purchased to remove a tick.  Tick Twister removes the tick with a twisting motion and without compressing it. It can remove nymphs and adults. View video for a demonstration.

The research on the use of these devices is on animals only.  It was noted that less force was required and less damage to the mouth parts. More studies are needed assessing the use of these tools in humans before any recommendation can be made.

Severe Larval Infestation

Infants and ticks

The use of some pesticides is contraindicated with infants. In severe infestation of microscopic larval ticks, a 30 minute bath with 1 cup of bicarbonate of soda can help to dislodge ticks.  Larval ticks may contain microorganisms for transmission.

Creams or Lotions

To remove ticks use a paralyzing topical cream or lotion such as:

i) Permethrin 5%, cream or lotion (usually for scabies )  (Lyclear 30g or Quellada Scabies Treatment 100ml)and is suitable for use for children. Apply from the chin down and wash off with warm, soapy water 8–14 hours later. Rinse thoroughly.  Can also apply to the scalp, neck, face and ears in children

For a single attached tick, dab Lyclear to the tick and leave alone for 1/2 hr. If the tick is still attached after 1/2 hr apply more Lyclear.  After another 1/2 hr the tick should be dead and safe to remove with tweezers if it hasn’t already fallen off.

Note: The likelihood of transmitting micro-organisms into the skin with these methods has not been studied and is unknown.

ii) Benzyl benzoate 25%, lotion (Ascabiol 200ml or Benzemul 200ml) is an alternative to permethrin though it is usually more irritant and use is unsuitable in children.  Apply from the chin down and wash off with warm, soapy water 24 hours later. Traditionally applied after a hot bath, but this is unnecessary (Hadani et al, 1977, Gouck, 1966).

Removing multiple nymph infestation of the head can be addressed with, anti-lice shampoo containing 1% permethrin e.g., Quellada Head Lice Treatment, 100ml, or dab permethrin 5% cream or lotion as in i) above.

Tick Removal Using Pesticides

i) pyrethroids -these include permethrin (Biomist®), resmethrin (Scourge®) and sumithrin (Anvil®).

ii) picaridin:  ( Off®)

For a single attached tick, apply permethrin spray (to a small exposed patch of skin created by a hole in a band aid) and leave alone for 1/2 hr. If the tick is still there after 1/2 hr apply more spray. After another 1/2 hr the tick should be safe to remove with tweezers if it hasn’t already fallen off.  Note. The likelihood of transmitting micro-organisms into the skin with this method has not been studied and is unknown.

Clothes – Insecticide Application

Pyrethroids or picardin sprays can be applied directly to clothes and shoes. Deet can also be used but may deteriorate plastics and other surfaces.

Ether containing aerosol sprays

Aerostart and Wart-Off Freeze (see the Australasian Society of Clinical Immunology and Allergy)

Ether containing aerosol sprays kill the tick by rapid freezing. It appears that further injection of allergen containing saliva is minimized but human studies need to be conducted to clarify.

Aerostart Spray

This is an anti-knock and anti-corrosive starting fluid for engines (which contains benzene) and is not registered for use in humans but there is anecdotal evidence in those with serious tick allergies (possibly applied to tick on a small patch of skin created by a hole in a band aid to minimize skin contact).

Wart-Off Freeze and Elastoplast Cold Spray

These products have been used in a limited manner and anecdotally reported to be effective.   As more experience is documented advice will be updated.  Both products are registered for use in humans.