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How To Remove a Tick

ByMatthew J. Streitz, MD, San Antonio Uniformed Services Health Education Consortium
Diane M. Birnbaumer, MD, David Geffen School of Medicine at UCLA
Reviewed/Revised May 2025
View Patient Education

Ticks should be removed from the skin to prevent tick-borne disease (eg, Rocky Mountain spotted fever, Lyme disease, tularemia, tick paralysis, babesiosis, anaplasmosis, ehrlichiosis, tick-borne encephalitis).­

(See also Tick Bites.)

Indications for Removing a Tick

  • Presence of a tick attached to the skin

Contraindications to Removing a Tick

  • None

Complications of Removing a Tick

  • Inadequate or partial removal of the tick may cause infection or chronic granuloma formation.

Equipment for Removing a Tick

  • Cleansing solution (eg, chlorhexidine)Cleansing solution (eg, chlorhexidine)

  • Straight- or curved-tip forceps

  • Tweezers

  • #11 scalpel

  • Nonsterile gloves

Additional Considerations for Removing a Tick

  • Ticks should be removed as soon as possible to reduce the cutaneous immune response and the likelihood of disease transmission. A tick’s mouthparts become cemented within 5 to 30 minutes of contact with the host’s skin.

Positioning for Removing a Tick

  • Position to provide excellent exposure of tick

Step-by-Step Description of Removing a Tick

  • Grasp the tick's mouth parts as close to the skin as possible using a blunt forceps (1) with medium-sized, curved tips placed parallel to the skin.

  • Apply gentle, steady traction to remove the tick.

  • Do not squeeze, crush, twist, or jerk the tick’s body. Doing so may expel infective agents.

  • If mouth parts are left behind, remove as much of them as possible with tweezers or the point of a scalpel blade.

  • Cleanse the area with soap and water or a mild antibacterial wound cleanser such as chlorhexidine.Cleanse the area with soap and water or a mild antibacterial wound cleanser such as chlorhexidine.

Aftercare for Removing a Tick

The main concern is transmission a tick-borne illnesses. The bite itself is superficial and rarely problematic.

  • Patients should return if any local pain, swelling, or erythema develops or if they develop systemic symptoms (eg, fever, headache, joint pains, malaise) within 4 weeks of the bite; most tick-borne illnesses except for Lyme disease typically present earlier.

  • The tick may be saved for laboratory analysis to check for tick-borne disease in the geographic area where the patient acquired the tick.

Prophylactic antibiotics

Prophylactic doxycycline to prevent Prophylactic doxycycline to preventLyme disease (2) should be given only when all of the following criteria are met:

  • The attached tick can be reliably identified as an adult or nymphal Ixodes scapularis tick.

  • The tick is estimated to have been attached ≥ 36 hours (based on degree of engorgement of the tick with blood or time of exposure).

  • Prophylaxis can be started within 72 hours of tick removal.

  • Patients live in or have visited an area where ≥ 20% of these ticks are infected with Borrelia burgdorferi (generally only in parts of New England, parts of the mid-Atlantic states, and parts of Minnesota and Wisconsin).

  • Doxycycline only contraindicated in pregnant or lactating women, children < 8 years of age, and people who have had an allergic reaction to a tetracycline antibiotic.Doxycycline only contraindicated in pregnant or lactating women, children tetracycline antibiotic.

Doxycycline is given as a single oral dose of 200mg for adults and 4.4mg/kg (maximum of 200 mg) for children.Doxycycline is given as a single oral dose of 200mg for adults and 4.4mg/kg (maximum of 200 mg) for children.

Prophylactic antibiotic treatment of tick bites is otherwise not recommended.

Warnings and Common Errors When Removing a Tick

  • Other methods of forcing the tick to disengage (such as the use of petroleum jelly, fingernail polish, a hot match, or alcohol) are not recommended. These methods can cause the tick to regurgitate and therefore increase the likelihood of infection.

Tips and Tricks for Removing a Tick

  • The forceps should be pulled slowly and steadily, directly away from the skin without twisting. Curved-tip forceps are best because the outer curve can be laid against the skin while the handle remains far enough from the skin to grasp easily.

References

  1. 1. Huygelen V, Borra V, De Buck E, Vandekerckhove P. Effective methods for tick removal: A systematic review. J Evid Based Med. 2017;10(3):177–188. doi: 10.1111/jebm.12257

  2. 2. US Centers for Disease Control and Prevention (CDC). Tickborne Diseases of the United States. Accessed May 6, 2025.

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