A 29-year-old healthy Indian woman presented with a 6-week history of a tender, draining papule under the distal margin of her left great toenail. She reported recent travel to rural Kenya near Tanzania and wore open-toed sandals through the sandy terrain. On the distal margin of the left great toe she had a discrete, well-defined, 4mm, yellowish-white, moist, eroded papule with serous drainage. An excisional biopsy was obtained and the base cauterized. Histopathology revealed a nonspecific dermal infiltrate surrounding a thick eosinophilic protein layer with cavities containing impregnated flea parts. The patient was diagnosed with tungiasis and the site healed without complications.
Tungiasis is a cutaneous ectoparasitic infestation by the fertilized female sand flea Tunga penetrans. Tungiasis is prevalent in tropical Africa and in Central and South America and lives in sandy soil. The female sand flea burrows into the dermis of the host resulting in a painful necrotic abscess. Complications include ulceration, secondary infection, tetanus, and gangrene. Treatment consists of sterile removal of the lesion, including cautery of the residual cavity. If untreated, tungiasis is frequently self-limited. For multiple lesions, thiabendazole is recommended. Prevention includes appropriate protective footwear. Dermatologists should be aware of this disease entity with the increase in international travel.