Tick Bite and Super-High Magnification Dermoscopy

Case Presentation

Super-high magnification dermoscopy (SHMD) is the most recent advance in the field of dermoscopy and allows us to observe the skin up to ×400 magnification. We report a case of tick bite studied with SHMD. A 50-year-old woman reported the onset of a new mole on her breast (Figure 1A). Dermoscopy at 20x magnification (Medicam 1000, Fotofinder System, Bad Birnbach, Germany) revealed a tick attached to the skin (Figure 1B). After removing the tick, we used SHMD to study the tick type and its body components. We observed its dorsal partial scutum, demonstrating that the tick was a female belonging to Ixodidae family, and the intact rostrum, thus proving the correct removal of tick (Figure 1, C and D at 200x and 400x magnification).

Figure 1.

(A) Clinical and (B) dermoscopic view of a female tick belonging to Ixodidae family attached to patient’s breast. (C) SHMD showed clearly the components of the ventral side of tick’s body (200 x magnification): rostrum (R); genital pore (G); anus (A); two spiracle (S, air-breathing openings), and 4 pairs of limbs (L). (D) A close-up of the intact rostrum (400 x magnification).

Teaching Point

In the field of skin parasitoses, SHMD plays not only a role in diagnosis but also in evaluation of treatment efficacy [1]. Incomplete and unprofessional removal of ticks may increase risk of developing Lyme disease. The correct technique of tick removal includes the use of tweezers or hemostat, with which the physician should grasp the head of the tick and pull directly away from the skin, avoiding twisting or jerking movements [2]. SHMD is useful to evaluate elements that are not already clearly visible with traditional dermoscopy, such as signs of local superinfection or foreign body granuloma caused by incorrect removal of the tick. Moreover, the combination of traditional dermoscopy and SHMD is useful to study the tick’s body components, which, in this case, belonged to Ixodidae family. In fact, the female ticks of this family show a hard shield that partially covers their dorsal surface. The Ixodidae are known as vectors for several infectious diseases and their recognition is essential for their prevention and treatment.