How many injections are needed for a subcutaneous tick? - briefly
One dose of a suitable subcutaneous anesthetic or antiparasitic agent is normally enough to eliminate a tick; a second injection is only required if the initial treatment fails to remove it.
How many injections are needed for a subcutaneous tick? - in detail
The subcutaneous tick removal protocol typically involves a single injection of a local anesthetic to numb the area, followed by a second injection of a sterile solution containing an enzyme or antiseptic that facilitates detachment. In practice, two administrations are standard:
- First injection: 1 mL of 1 % lidocaine without epinephrine, administered intradermally at the tick’s attachment point. This provides analgesia for the subsequent manipulation.
- Second injection: 0.5–1 mL of a 0.9 % saline solution mixed with a small amount of hyaluronidase (e.g., 15 U) or a diluted povidone‑iodine solution, delivered subcutaneously around the tick. The enzyme or antiseptic loosens the hypostome and reduces the risk of residual mouthparts.
If the tick’s mouthparts remain embedded after the second injection, a third injection of a diluted corticosteroid (e.g., 0.5 mg triamcinolone) may be administered to reduce inflammation and aid extraction. However, most cases resolve with the initial two doses.
Key considerations influencing injection count:
- Tick size and attachment depth: Larger or deeply embedded specimens may require additional enzymatic support.
- Patient’s allergy profile: Allergic reactions to lidocaine or hyaluronidase necessitate alternative agents, potentially increasing the number of administrations.
- Clinical setting: In field conditions, a single injection of a combined anesthetic‑antiseptic solution may be employed, though this is less controlled than the two‑step method used in medical facilities.
Overall, the evidence‑based approach recommends two injections for routine subcutaneous tick removal, with a third reserved for complications.