Effective methods for tick removal: A systematic review.

AIM: Providing evidence-based first aid training to lay people is a cost-effective intervention. This systematic review aimed to collect the best available evidence on effective methods to remove a tick, performed by lay people.

METHODS: A systematic search was performed searching the Cochrane Library (via Wiley), MEDLINE (via the PubMed interface), and Embase (via the Embase.com interface) to identify studies with evidence on tick removal strategies. Study selection was performed by two independent reviewers and data extraction was achieved in a tabular format. GRADE was used to determine the quality of evidence.

RESULTS: Out of 2046 articles, six experimental animal studies were included. These studies compared different chemical treatments (gasoline, petroleum jelly, clear fingernail polish, or methylated spirit) or mechanical techniques (forceps or commercial devices) for tick removal. The available studies were all of very low quality and suggest that there is limited evidence in favor of pulling with commercial devices and in favor of pulling with forceps compared to rotation with forceps to remove ticks.

CONCLUSIONS: Limited evidence was found in favor of pulling with commercial tick removal devices or pulling with forceps. The evidence of the included studies is of very low quality and results of these studies are imprecise due to limited sample size, large variability of results, and/or lack of data. Since large high-quality studies are lacking, more rigorous studies are warranted to enable strong evidence-based recommendations.