How is the face examined for a subcutaneous tick?

How is the face examined for a subcutaneous tick? - briefly

First, conduct a thorough visual inspection under bright light, employing magnification to scan all facial regions for swelling, a central punctum, or visible movement. Then gently palpate any suspicious spot to detect a firm nodule and, if necessary, use a fine‑point needle or dermatoscope to confirm an embedded tick.

How is the face examined for a subcutaneous tick? - in detail

Examination of the facial area for an embedded tick requires systematic visual inspection, tactile assessment, and, when necessary, adjunct imaging.

Begin with patient positioning. The individual should sit upright with the head slightly tilted forward to expose the cheeks, chin, periorbital region, and neck. Adequate lighting is essential; a handheld lamp or examination light provides shadow‑free illumination.

1. Visual survey

   • Scan the skin surface from the hairline to the jawline, noting any small, dark, or raised lesions.
   • Look for a punctate central point (the tick’s mouthparts) surrounded by erythema or a papular halo.
   • Pay particular attention to moist folds (nasolabial, submental) where ticks may be concealed.

2. Palpation technique

   • Use gloved fingertips to gently press around suspicious spots.
   • A firm, localized nodule that moves slightly with pressure suggests a subdermal arthropod.
   • Compare firmness with surrounding tissue; a tick often feels like a hard bead beneath the epidermis.

3. Magnification and dermoscopy

   • Employ a dermatoscope or a magnifying lens (10–30×) to reveal the tick’s body outline, legs, or engorgement.
   • Identify the characteristic “hour‑glass” shape of the capitulum and the posterior shield (scutum) if visible.

4. Imaging adjuncts (optional)

   • High‑frequency ultrasound (10–15 MHz) can delineate a hypoechoic core within the dermis, confirming depth.
   • For deep or ambiguous lesions, a short‑wave infrared camera may highlight vascular changes around the attachment site.

5. Documentation

   • Record location using anatomical landmarks (e.g., "right lateral cheek, 2 cm inferior to the zygomatic arch").
   • Photograph the area with a scale indicator for future reference and legal records.

If a tick is identified, maintain the overlying skin intact until removal. Avoid squeezing the lesion, which can force mouthparts deeper. Use fine‑point forceps to grasp the tick’s mouthparts as close to the skin as possible and extract in a steady, upward motion. After removal, clean the site with antiseptic, re‑examine for residual parts, and advise the patient on signs of infection or tick‑borne disease.

The described protocol ensures thorough assessment, accurate identification, and safe management of facial ticks embedded beneath the skin.