This 25-year-old man developed a dark papule with a small central crust on the side of the foot 7 days after returning from a visit to the beach. Within 2 weeks an itchy nodule with a central crust expanded and discharged numerous eggs from the center. Tungiasis is caused by the burrowing wingless flea Tunga penetrans which is endemic to certain areas of the world inclidjng Central and South America, the Caribbean Islands, Africa, Pakistan, and India. The impregnated female burrows into the upper dermis resulting in a lesion resembling an abscess. If secondary infection does not occur, the lesion usually resolves without treatment following discharge of the eggs and the death of the female. Complications can include secondary infection and rarely tetanus and gangrene.
