How should a subcutaneous tick in people on the face be treated? - briefly
The tick must be removed immediately with sterile fine‑pointed forceps or a hypodermic needle, pulling straight out without compressing the body, then the wound is cleansed with an antiseptic. If attachment exceeded 24 hours, the patient is immunocompromised, or local disease risk is high, start suitable prophylactic antibiotics and schedule follow‑up for infection monitoring.
How should a subcutaneous tick in people on the face be treated? - in detail
A subdermal tick embedded in facial tissue requires prompt, aseptic removal to prevent infection and systemic disease.
First, confirm that the organism is indeed a tick and assess depth with gentle palpation or, if needed, high‑frequency ultrasound. Local anesthesia (e.g., 1% lidocaine with epinephrine) should be infiltrated around the lesion to eliminate pain and reduce bleeding.
Removal proceeds with one of two methods, chosen according to the tick’s position:
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Sharp excision – If the tick lies deep or its mouthparts are not visible, make a small elliptical incision directly over the body. Use sterile scissors or a scalpel to cut around the tick, taking care to include the mouthparts. Extract the entire organism with forceps, then close the wound with interrupted sutures or tissue adhesive.
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Direct traction – When the mouthparts are exposed on the skin surface, grasp the tick’s head with fine, non‑toothed forceps as close to the skin as possible. Apply steady, upward pressure without twisting. If resistance occurs, switch to the excision technique to avoid rupturing the mouthparts.
After removal, irrigate the site with sterile saline, apply a topical antibiotic (e.g., bacitracin) and cover with a sterile dressing. Prescribe a short course of oral antibiotics (e.g., amoxicillin‑clavulanate) if the wound is contaminated or if the patient is immunocompromised. Verify tetanus immunization status; administer tetanus toxoid if the last dose was more than ten years ago.
Monitor for local signs of infection—redness, swelling, purulent discharge—and for systemic manifestations such as fever, rash, or neurologic symptoms. If any of these develop, initiate appropriate antimicrobial therapy (e.g., doxycycline for possible Borrelia infection) and refer to infectious‑disease or dermatology specialists.
Document the tick’s species, stage, and removal method in the medical record, as this information guides post‑exposure prophylaxis and epidemiologic reporting.
In cases where the tick is deeply embedded and cannot be accessed safely through a superficial incision, consider referral to a maxillofacial surgeon or otolaryngologist for operative removal under general anesthesia.
Adhering to these steps minimizes tissue damage, reduces the risk of pathogen transmission, and promotes rapid healing of facial lesions.