People who live in or visit tropical or subtropical areas that have sand fleas are most at risk for tungiasis. This painful, itchy skin lesion occurs when a sand flea burrows into your skin to lay eggs. Tungiasis is common in impoverished areas. It can cause life-threatening infections. Treatments involve killing or removing the sand flea.
Tungiasis is a painful, itchy skin condition that occurs when female sand fleas burrow into your skin to feed as they lay their eggs. You develop white circles with black dots in the centers. These lesions most commonly affect your feet but they can develop anywhere on your body.
The first report of tungiasis dates back to the 1500s. The crew of Christopher Columbus developed tungiasis after shipwrecking on the Caribbean island of Haiti.
Tunga penetrans (T. penetrans) and Tunga trimamillata (T. trimamillata) are the scientific names of the sand fleas that cause tungiasis.
Other names for sand fleas include:
The types of fleas that cause tungiasis don’t live in the United States. As their name suggests, sand fleas prefer sandy areas like beaches. They also like the warm, dry soil in livestock stables and farms. And sand fleas are able to hitch rides on animal fur.
At one time, you would only find these particular sand fleas in the West Indies and Caribbean islands. But they’re now found in these tropical and subtropical regions:
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More than 20 million people worldwide are at risk of tungiasis. Impoverished people who go barefoot and live in rural areas, remote villages and shanty towns in large cities are more likely to get tungiasis. The condition is more problematic among children assigned male at birth (AMAB) between the ages of 5 and 14 and the elderly. It’s estimated that 8 in 10 disadvantaged children living in areas that have sand fleas develop tungiasis.
You can get tungiasis from direct contact with sand fleas that live on the ground or by touching the fur of an animal that has sand fleas. Sand fleas most commonly attach to the fur of pigs, cows, dogs, cats and rats. These sand fleas are too small to see.
Only female sand fleas impregnated with eggs cause tungiasis. Male sand fleas also bite and feed on your blood. But because they don’t have eggs to nurture, they don’t burrow into your skin and cause tungiasis.
The female sand fleas bite and claw the outermost layer of your skin (the epidermis), creating an opening. They burrow into the middle skin layer (the dermis) where they feed on blood from your blood vessels. Your blood provides the nutrients the female needs to produce its eggs. The sand flea gets oxygen through the bite opening in your skin. The black dot you might see in the center of the white circle on your skin is the hind end of the burrowed sand flea. This is where the eggs come out.
The sand flea can live inside your skin, growing bigger with its eggs and your blood, for up to six weeks. During this time, it may eject up to 100 eggs, which fall out of the opening in your skin and onto the ground. After laying its eggs, the sand flea dies and falls off as your skin sheds.
In about four days, the sand flea eggs hatch into larvae and begin to feed on organic material in the sand or soil. The larvae turn into pupae, which mature into adult sand fleas in about four weeks. These adults then seek people out to feed on their blood.
Sand fleas can’t jump far. That’s why they most commonly burrow into the soles of your feet, in between your toes, or into your heels and outside of your foot. You probably won’t notice when the female sand flea first enters your skin. Once it burrows into your skin, you may see a white circle that looks like a ring or halo with a black dot in the center. Over time, the black dot grows as the sand flea gorges on blood and gets bigger with eggs.
The lesion may be:
People with tungiasis are at risk for serious bacterial infections from the burrowed insect and from scratching at the skin. These infections can permanently disfigure the foot and affect a person’s ability to walk.
Other possible complications include:
Healthcare providers who provide care in regions where tungiasis is prevalent can diagnose the condition by examining the skin. Most people who live in these regions are familiar with tungiasis and know when they have it.
Your healthcare provider can use sterilized forceps or a needle to remove a burrowed sand flea. Because the flea swells up with blood, a wide cut (excision) may be necessary to get all of the flea out.
Other methods for removing the sand flea include:
No, only a healthcare provider using sterilized tools or other proven methods should attempt to remove a burrowed sand flea.
In areas where healthcare services aren’t widely accessible or affordable, people often try to remove the sand flea using unsterile methods. Sometimes, adults use the same instrument to treat multiple infected family or community members.
These unsafe methods increase the risk of:
If you’re traveling to an area where tungiasis is prevalent, you can lower your risk of infection by wearing closed-toe shoes, socks that cover your ankles and long pants. It’s best to not go barefoot. You can also use a plant-based insecticide called Zanzarin® on your feet twice a day to lower your risk of tungiasis. Your healthcare provider can help you find this treatment. Some countries also spray a different type of insecticide on the ground to kill sand fleas.
Many people with tungiasis improve without treatment. However, the painful, itchy symptoms can be uncomfortable until the sand flea dies. In impoverished areas that lack quality healthcare services, tungiasis can lead to infections that may threaten limbs and lives.
Call your healthcare provider if you have been to an area with sand fleas and you notice:
You may want to ask your healthcare provider:
Sand fleas are the only fleas that burrow into your skin to feed on blood. Other types of fleas land on the surface of your skin to temporarily feed on your blood. You may have multiple flea bites, or small red bumps on your skin. While flea bites can itch and be unsightly, they’re more of a nuisance than a health threat like tungiasis.
A note from Cleveland Clinic
If you’re visiting an area that has sand fleas, it’s wise to take precautions to lower your risk of developing tungiasis. You should wear closed-toe shoes and socks that cover your ankles. You can also spray a specific type of insecticide on your feet. Ask your healthcare provider before you travel about how to find this insect repellent. Many people with tungiasis seek treatment to remove the sand flea or kill it. It’s important to get proper medical help to remove the sand flea to lower your risk of infections and other complications.
Last reviewed by a Cleveland Clinic medical professional on 09/10/2022.
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