Guidelines for the treatment of tungiasis

Overview

Tungiasis, a neglected tropical disease caused by the sand flea Tunga penetrans, continues to affect millions of people in vulnerable communities across South America, the Caribbean, and sub-Saharan Africa. This condition causes severe pain, inflammation, disability, and social stigma, particularly among children, and can lead to long-term cognitive impairment. Despite its widespread impact, tungiasis remains largely neglected in global public health agendas.  This comprehensive technical guide, grounded in the latest scientific research, offers seven evidence-based recommendations for the effective management of tungiasis. The recommendations address the most effective treatments, such as the use of low-viscosity dimethicone, particularly for severe and mild tungiasis. They also discourage some practices like the use of hydrogen peroxide and potassium permanganate and non-professional mechanical extraction in severe cases, as this common practice carries a high risk of secondary infections and physical trauma. Alternative treatments such as coconut oil combined with neem oil are encouraged, especially in resource-limited settings. The use of topical ivermectin is also recommended when other treatments are not available. Furthermore, the importance of educational and community-based approaches that empower communities to reduce transmission and improve access to proper treatments is emphasized. This guide aims to provide clinicians, public health professionals, policymakers, and community leaders with practical tools to treat tungiasis, reduce its burden on affected populations, and help prevent its spread. By following these recommendations, communities can move toward a more sustainable and effective response to this neglected disease.