How does a subcutaneous tick manifest? - briefly
A subcutaneous tick presents as a small, firm, painless nodule beneath the skin, often showing a central punctum where the tick’s mouthparts are embedded. The lesion may swell, become erythematous, and occasionally cause itching or localized inflammation.
How does a subcutaneous tick manifest? - in detail
A subcutaneous tick embeds its mouthparts beneath the skin, leaving only a small puncture or no visible exterior sign. The initial lesion often appears as a firm, slightly raised nodule, sometimes mistaken for a cyst or lipoma. Over days to weeks, the nodule may enlarge as the tick feeds, producing a localized swelling that is tender to palpation.
Typical clinical features include:
- A smooth, dome‑shaped bump, usually 0.5–2 cm in diameter.
- Minimal erythema surrounding the lesion; the skin may appear normal or slightly pink.
- Absence of a visible tick body; only the attachment point or a tiny slit may be seen.
- Occasional itching or mild discomfort, especially when the tick moves or expands the feeding cavity.
- Possible secondary inflammation if the host’s immune response reacts to tick saliva, leading to localized heat and swelling.
Systemic manifestations are uncommon but can arise if the tick transmits pathogens. In such cases, patients may develop fever, headache, malaise, or a rash distant from the bite site. Laboratory testing may reveal elevated inflammatory markers or specific serologic evidence of infection.
Diagnostic steps:
- Physical examination focusing on the nodule’s consistency, depth, and any central punctum.
- Ultrasound imaging to visualize a hypoechoic structure beneath the epidermis, confirming the presence of a foreign body.
- Dermoscopy may reveal a tiny entry point or residual mouthparts.
- If infection is suspected, serology or PCR for tick‑borne diseases (e.g., Borrelia, Anaplasma) should be performed.
Management consists of careful extraction. The recommended technique involves:
- Local anesthetic infiltration around the lesion.
- Small incision with a scalpel or fine‑point forceps to grasp the tick’s mouthparts.
- Gentle traction to remove the organism in one piece, avoiding rupture.
- Post‑removal cleaning with antiseptic, followed by observation for signs of infection.
If complete removal is not feasible, surgical excision of the nodule may be indicated. Antibiotic prophylaxis is considered when pathogen transmission is probable or when the wound shows signs of bacterial infection.
Follow‑up includes monitoring the site for healing, checking for delayed allergic reactions, and reassessing for systemic symptoms that could indicate disease transmission.