Removing ticks without trauma

P> Removing ticks is often difficult, especially if the patient or parent breaks off the body from the head when trying to dislodge the tick. To avoid this problem, parents can purchase a small metal device especially designed for tick removal at most well-stocked camping outfitters. The device has a linear groove that tapers at the end, allowing it to be applied at the point where the tick's mouth attaches to the skin, then brought snugly up against the tick's head while keeping the device between the head and the patient's skin. The device is lifted slowly using constant tension, not sheared forward, which also dislodges the head. Advise parents not to position the device between the neck and the body of the tick because it will decapitate the tick and remove only the body. Also, the device doesn't work as well on dead ticks as it does on live ones.

When the tick's head breaks off and remains lodged in the skin, I have found that the best way to remove it is by punch biopsy. The punching equipment comes in several sizes and is inexpensive and disposable. In my experience, the 2- to 3-mm size works best. A punch biopsy can be performed quickly and works far better than scraping and digging. It is effective on the child's extremities, the back of the scalp, and the trunk—all places where ticks are likely to embed themselves.

Before removing the tick, apply a local anesthetic or EMLA cream to the patient's skin. The biopsy causes only a small amount of trauma to the skin, and the holes heal nicely, possibly leaving a tiny scar. The youngest patient on whom I have used this technique was just under 2 years old. His mother was relieved to see how quickly the procedure went.

Wanda Lo, MD
San Luis Obispo, Calif.