Washington, D.C., 3 September 2025 (PAHO) – The Pan American Health Organization (PAHO) has released the world’s first evidence-based guidelines for the treatment of tungiasis, a parasitic disease that affects millions of people in vulnerable communities across Latin America, the Caribbean, and sub-Saharan Africa.
Tungiasis is a neglected tropical disease caused by the female sand flea Tunga penetrans, which burrows into the skin—most often in the feet—causing severe inflammation, pain, and itching. In serious cases, it can lead to chronic complications such as fissures, ulcers, cognitive impairment, and deformities that restrict mobility, undermining people’s ability to work, study, and carry out daily activities.
Children and older adults are particularly affected, facing not only physical pain but also disability and social stigma. The disease thrives in settings of extreme poverty, where dirt floors inside homes facilitate transmission. The presence of domestic animals inside households, which serve as reservoirs, and lack of access to appropriate footwear further increase the risk of infection.
Evidence-based guidelines for an effective response
Tungiasis is part of the group of neglected tropical diseases (NTDs), more than 20 conditions that disproportionately affect populations living in poverty, with limited access to safe water, basic sanitation, and health services.
Challenges for controlling tungiasis include the scarcity of systematic epidemiological data—since the disease often affects remote and rural populations—and its limited prioritization in public health agendas.
The new guidelines, developed by a multidisciplinary group of experts from PAHO and the World Health Organization (WHO), provide practical recommendations to improve management of the disease in affected areas. Key recommendations include:
- Use of low-viscosity dimethicone: Recommended in both mild and severe cases to kill embedded fleas and reduce the risk of complications. It is applied directly to the lesions, offering a safe and simple solution.
- Alternatives in low-resource settings: When dimethicone is unavailable, the use of coconut oil combined with neem oil (a natural oil with repellent properties) is recommended as a viable option for resource-limited communities.
- Discouraged practices: The guidelines advise against the manual extraction of fleas by untrained personnel, due to the high risk of secondary infections, particularly in severe cases. The use of hydrogen peroxide (a common disinfectant) and potassium permanganate (a chemical antiseptic) is also discouraged, as they are ineffective and can cause further harm.
“These guidelines represent a significant step forward in addressing a disease that disproportionately affects the most vulnerable populations. However, their implementation requires the commitment of authorities, health professionals, and communities to ensure that even the most neglected diseases receive the attention they deserve,” said Dr. Sylvain Aldighieri, Director of PAHO’s Department of Communicable Disease Prevention, Control, and Elimination.
Alongside the treatment guidelines, PAHO has also released new recommendations to strengthen surveillance, prevention, and control of tungiasis in the Americas. This tool is designed to support the identification of affected populations and foster collaboration between human, animal, and environmental health sectors under the “One Health” approach, with the aim of implementing more effective and sustainable interventions. The initiative seeks to strengthen the response capacity of local health teams and national authorities, taking into account the epidemiological and social characteristics of each territory.
An integrated approach to prevention and control
PAHO has documented country experiences in the Region, including Brazil and Colombia, in surveillance, prevention, care, and control of tungiasis. These experiences demonstrate how an integrated approach can help address the disease. Actions implemented include active case finding and community-based surveillance, access to safe and effective treatments, application of the “One Health” approach, and improvements in household environments. Together, these efforts show how combining clinical, community, and environmental measures can help reduce the impact of tungiasis.
To facilitate access to the recommended treatment, PAHO has included dimethicone in the list of medicines available through its Strategic Fund, a technical cooperation platform that supports countries of the Americas in procuring essential medicines and health supplies. This measure will help strengthen tungiasis control actions and improve access to therapeutic options for populations at highest risk.