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Tâche Noire: A Classic Case Treated with Dual Freeze Cycles of Liquid Nitrogen Cryotherapy and Clasped Manoeuvre.

Zawar V, Karad G, Chuh A - J Cutan Aesthet Surg (2015 Jul-Sep)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Skin Diseases Centre, Nashik, Maharashtra, India.

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Dear Editor, A tâche noire is a cutaneous hallmark occurring after a hard tick bite... He had a history of handling dogs and cattle... However, he did not recollect any arthropod bite... The site became ulcerated [Figure 5]... Under 10× microscopy, we visualized its mouthparts and confirmed that it was a hard tick [Figure 6]... Tâche noire is the cutaneous hallmark after a hard tick bite in 13-68% of patients with Rickettsia conorii infection, the pathogen causing Mediterranean spotted fever (African and Indian tick typhus)... It is endemic throughout Africa, the Middle East, southern Europe, India, and southwestern Asia... It is important to remove the ticks as early as possible to reduce the chance of tick-borne infections... We speculate that administration of cryotherapy may cause acute cryospasm of mouthparts and body parts at the base of the clasped skin, which may help immediate release the clasp of the tick... To the best of our knowledge, our report is the third report on the utilization of cryotherapy in removing an attached tick and the first in the literature describing administration of double-freezing with a clasping maneuver... We emphasize that cryotherapy is an easy, inexpensive method for prompt, safe, and complete removal of a tick by liquid nitrogen cryotherapy... Cryotherapy might prevent the subsequent risk of transmission of infections... However, close clinical monitoring is still highly recommended... There are no conflicts of interest.

No MeSH data available.


Tick mounted on light microscope (10×)
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Figure 6: Tick mounted on light microscope (10×)

Mentions: After informed consent from the patient, we opted for cryotherapy. We applied 15 s of freezing directed from the lateral side of the tick, focusing on its mouthparts by tightly pinching the lesion [Figure 2]. The previously flat and horizontally engorged tick became vertical [Figure 3]. This was due to transient spasmodic movements of its trunk posteriorly with its clasp not released anteriorly. After 3 min of thawing, we executed a second cycle of 15 s of freezing to the top position of the mouthparts [Figure 4]. After another 3 min of thawing, the tick spontaneously released its clasps and was removed in toto. The site became ulcerated [Figure 5]. Under 10× microscopy, we visualized its mouthparts and confirmed that it was a hard tick [Figure 6]. We prescribed systemic azithromycin 500 mg twice daily for 3 days, systemic levocetirizine 5 mg daily for 7 days, and topical sodium fusidate ointment 2%. The site healed after 1 week [Figure 7].


Tâche Noire: A Classic Case Treated with Dual Freeze Cycles of Liquid Nitrogen Cryotherapy and Clasped Manoeuvre.

Zawar V, Karad G, Chuh A - J Cutan Aesthet Surg (2015 Jul-Sep)

Tick mounted on light microscope (10×)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4645155&req=5

Figure 6: Tick mounted on light microscope (10×)
Mentions: After informed consent from the patient, we opted for cryotherapy. We applied 15 s of freezing directed from the lateral side of the tick, focusing on its mouthparts by tightly pinching the lesion [Figure 2]. The previously flat and horizontally engorged tick became vertical [Figure 3]. This was due to transient spasmodic movements of its trunk posteriorly with its clasp not released anteriorly. After 3 min of thawing, we executed a second cycle of 15 s of freezing to the top position of the mouthparts [Figure 4]. After another 3 min of thawing, the tick spontaneously released its clasps and was removed in toto. The site became ulcerated [Figure 5]. Under 10× microscopy, we visualized its mouthparts and confirmed that it was a hard tick [Figure 6]. We prescribed systemic azithromycin 500 mg twice daily for 3 days, systemic levocetirizine 5 mg daily for 7 days, and topical sodium fusidate ointment 2%. The site healed after 1 week [Figure 7].

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Skin Diseases Centre, Nashik, Maharashtra, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Dear Editor, A tâche noire is a cutaneous hallmark occurring after a hard tick bite... He had a history of handling dogs and cattle... However, he did not recollect any arthropod bite... The site became ulcerated [Figure 5]... Under 10× microscopy, we visualized its mouthparts and confirmed that it was a hard tick [Figure 6]... Tâche noire is the cutaneous hallmark after a hard tick bite in 13-68% of patients with Rickettsia conorii infection, the pathogen causing Mediterranean spotted fever (African and Indian tick typhus)... It is endemic throughout Africa, the Middle East, southern Europe, India, and southwestern Asia... It is important to remove the ticks as early as possible to reduce the chance of tick-borne infections... We speculate that administration of cryotherapy may cause acute cryospasm of mouthparts and body parts at the base of the clasped skin, which may help immediate release the clasp of the tick... To the best of our knowledge, our report is the third report on the utilization of cryotherapy in removing an attached tick and the first in the literature describing administration of double-freezing with a clasping maneuver... We emphasize that cryotherapy is an easy, inexpensive method for prompt, safe, and complete removal of a tick by liquid nitrogen cryotherapy... Cryotherapy might prevent the subsequent risk of transmission of infections... However, close clinical monitoring is still highly recommended... There are no conflicts of interest.

No MeSH data available.