By Gary M. White, MD
Tungiasis is the invasion of the skin by the sand flea Tunga penetrans--also known as the chigoe.
- People who walk barefoot or in sandals along the humid sand contaminated by the feces of pigs and cows are at risk.
- Endemic areas include Central and South America, the Caribbean, and India. Other areas of potential occurrence are Africa and Asia.
- The fertilized female parasite burrows into the skin and draws nourishment from the blood of the superficial dermis.
Single or multiple erythematous, painful papule(s) on the toe or feet are characteristic of Tungiasis. Dermoscopy shows in the central part of the lesion a brown ring with a central pore. This corresponds to the pigmented chitin surrounding the posterior opening of the exoskeleton.
Complications are relatively uncommon but include bacterial superinfection (more common in countries with less hygienic conditions) which can lead to cellulitis, gangrene and loss of toes etc. Other complications include nail dystrophy and/or loss and even tetanus.
Curettage after infiltration of local anesthetic is effective. Oral thiobendazole 25 mg/kg/day for heavily infected patients has been used.
Dermatology Online Journal 14(12)
Note: There are many (graphic) videos of the removal of the sand flea on youtube.
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