Sand Fleas in Human Hair

Dear Dr. Rockoff,
Hello there. I live in Miami, Florida with many mosquitoes and insects that bit humans. Here is my problem.  On January 23, 2005, I went to visit my brother in Key Largo, Florida for a picnic.  While in the "Keys" the sand fleas were biting me so badly that I had to leave the picnic and buy some "Off."  I know that they were not mosquitoes because living in Florida for over 40 years, I have been bitten by many mosquitoes, and I know what they look like.  Anyway, somehow these sand fleas have gotten in my hair.  I have gone to my Primary physician and three Dermatologists for help, and no one seems to either believe me or  have a remedy.  I have literally picked out the fleas, and put them in Ziploc baggies to show the doctors, but they don't have an answer.  My primary physician gave me a topical called Permethrin cream to put in my hair.  Although that helped tremendously, it did not get rid of the fleas; it just controlled them a bit.  When I went to a Dermatologist, she absolutely had no idea what I had.  She took a biopsy of one of the bites and it came back as folliculitis.   I went to another Dermatologist and she gave me a prescription called Stromectol.  She said it was used in Third World countries for problems like mine.  Since January, I have literally controlled the amount of bites I receive by using dog/flea prevention shampoo, but I have not been able to get rid of them.  I absolutely do not have lice or scabies.  Do you have any suggestions on what I can do?  I am at my wits-end to this and I don't know what to do.  From what I have researched about sand fleas is that they dig themselves into the skin and lay their eggs.  That is what makes them different from a regular flea.  Any help from you would be greatly appreciated.  Thank you, and have a wonderful day.

[Alan Rockoff, MD]

I have no clinical experience with sand flea bites, known as tungiasis.  According to textbooks, this is not endemic to the US, but may be seen in people returning from endemic areas in the Caribbean.  Even assuming you had sand flea bites to start with, the question is whether you still do, or whether you are itchy because you think you still have them and are scratching the area.

When I suggest such a possibility to people convinced they have bugs in or on their skin, they often become annoyed and claim I am not taking them seriously.  That may be your reaction too, but here is an easy way to prove me wrong: Take the contents of the Ziploc bag and have them analyzed by an entomologist.  Your dermatologist can arrange this through a path lab, or else you can ask your local health department for a suggestion.

If these are indeed sand fleas now, you will need to consult a parasitologist.  There ought to be one at a nearby academic medical center.

Best.

Dr. Rockoff