Treatment of tungiasis with a two-component dimeticone: a comparison between moistening the whole foot and directly targeting the embedded sand fleas

Abstract

BackgroundTungiasis (sand flea disease) is caused by the penetration of female sand fleas (Tunga penetrans, Siphonaptera) into the skin. It belongs to the neglected tropical diseases and is prevalent in South America, the Caribbean and sub-Saharan Africa. Tungiasis predominantly affects marginalized populations and resource-poor communities in both urban and rural areas. In the endemic areas, patients do not have access to an effective and safe treatment. A proof-of-principle study in rural Kenya has shown that the application of a two-component dimeticone (NYDA®) which is a mixture of two low viscosity silicone oils caused almost 80% of the embedded sand fleas to lose their viability within 7 days.MethodsIn this study we compared the efficacy of two distinct modes of application of NYDA®; one targeted application to the area where the parasite protrudes through the skin and one comprehensive application to the whole foot.ResultsIndependent of the two modes of application, the dimeticone caused more than 95% of embedded sand fleas to lose all signs of viability within 7 days. The targeted application killed embedded sand fleas more rapidly compared to when the whole foot was covered. The proportion of viable lesions at day two were 7.0 versus 23.4% (p < 0.01) and at day five 3.9 versus 12.5% (p < 0.02).ConclusionsOur findings suggest that the dimeticone could provide a safe and effective treatment for tungiasis in areas with difficult access to health care.Trial registrationISRCTN ISRCTN74306878

Prevalence, intensity and risk factors of tungiasis in Kilifi County, Kenya II: Results from a school-based observational study

“…Targeting school-aged children in school for diagnosis and treatment of tungiasis, using recently evaluated safe and effective treatment options, namely dimeticone or neem oil [2, 28, 29], might be the most cost-effective way to reduce the disease burden given that the affected resource-poor communities do not have access to optimal medical care and limited ability to pay for expensive medications. However, the treatment must be provided every time a new infection in a child is detected by the teachers to prevent the life cycle being introduced into classrooms with a cracked or natural sand/mud floor, and to break the cycle at home.…”

Control of Tungiasis in Absence of a Roadmap: Grassroots and Global Approaches

“…Two randomised controlled trials have shown that embedded sand fleas can be effectively killed by the application of a synthetic oil containing two different dimethicones [ 44 , 45 ]. The efficacy varied between 78% and 95%.…”

Very severe tungiasis in Amerindians in the Amazon lowland of Colombia: A case series

“…Its mode of action is purely physical. The topical application of this product has been proved highly effective in randomized control trials in Kenya and Uganda in patients with up to 30 embedded sand fleas [29, 48]. Here we show that the formula is also effective in patients with several hundred of embedded sand fleas located in clusters and in several layers on top of each other in hyperkeratotic or partially necrotizing skin.…”

“…Here we show that the formula is also effective in patients with several hundred of embedded sand fleas located in clusters and in several layers on top of each other in hyperkeratotic or partially necrotizing skin. While in simple tungiasis an application of a few drops of the dimeticone—targeted to the abdominal cone which protrudes through the skin–are sufficient [48], in very severe tungiasis the skin needs to be intensively wetted and treatment should be repeated after 24 hours.…”