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Last week a patient came in for acupuncture and, when she rolled over, I noticed a red bite behind her knee. There was a tiny black dot in the centre. When I asked about it, she said it felt achy and itchy. As someone who has been bitten many times by larval ticks, it looked all too familiar. We zoomed in with the camera on her phone and there it was, a larval tick.

“Oh my gosh!” she said. “Are you saying a creepy little tick could be burrowed into me and I wouldn't even be able to see it without some sort of magnifying glass???!!! That's my worst nightmare!!"

Larval ticks can be really small: less one 1mm in size. She’s the 9th patient I’ve seen with a larval tick in the past 18 months, and I've heard so many tick stories and been bitten multiple times myself, so I thought I’d write something about them here. 

 

Understanding Larval Ticks: Tiny, Hidden, and Often Missed

 

Larval ticks are the earliest stage of the tick lifecycle once its hatched out, and they’re almost invisible to the naked eye. They’re tiny, often no bigger than a speck of dirt (<1mm) and can attach in clusters. Most information about ticks in Australia focuses on adult ticks or nymph‑sized ticks, but people are often shocked when they learn about the larval stage. Even many doctors have never seen or heard of them. In my own case, when I was first bitten by larval ticks, it wasn’t until I spoke to a vet that I finally had confirmation that the tiny itchy, burning dots on me were larval ticks. I hadnt gotten any answers off the 3 different GPs I had been to, so I had to think outside the box. Lucky for me I found a vet with a microscope, who could confirm my suspicions. 

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Ticks progress through four stages: egg, larva, nymph, and adult. All three major Australian ticks ---- the paralysis tick (Ixodes holocyclus), the bush tick (Haemaphysalis longicornis), and the brown dog tick (Rhipicephalus sanguineus) — are three‑host ticks, meaning each life stage feeds once on a host, drops to the ground to moult, and then seeks a new host for the next stage. Adult female ticks lay several thousand eggs at ground level before dying. Yikes!

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The most problematic Australian tick, the paralysis tick, can be distinguished from other species by its darker front and back leg pairs, its greyish colour, and an oval‑shaped groove encircling its bottom, a feature used by entomologists for identification. But it’s often impossibly hard to see these markings on something so tiny as a larval stick (unless you have a microscope).

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A Chinese Medicine POV

 

In Chinese Medicine, sudden heat, irritation, aching, and heaviness after exposure align with patterns of toxic heat and external parasites. The Classical Chinese text the Huangdi Neijing describes parasites as “creatures that thrive in dampness and hide in the yin places of the body,” which is remarkably consistent with where ticks tend to attach --- in warm, soft, hidden areas.

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Historically, the bitter flavour was associated with clearing heat and drying dampness, and many classical formulas used bitter herbs to support the body after encounters with environmental pathogens. In modern practice, any herbal support related to tick exposure is always prescribed individually and used to help the body settle after appropriate first‑aid measures. The same applies to acupuncture, which can be used to support patients experiencing inflammation, heat, or generalised discomfort after environmental exposures. These approaches sit alongside, not instead of, recommended tick‑bite first aid, and must always be personalised and tailored to how the body is responding, as symptoms vary. 

 

Tick Saliva, Allergic Reactions and Why Timing Matters

 

Tick saliva is a venom containing hundreds of proteins with anaesthetic, anticoagulant, vasodilatory, anti‑inflammatory, and immunosuppressive properties, all designed to help the tick feed undetected. The tick’s saliva glands are actually located in the body of the tick, not the mouthparts, which is why it’s the body that contains the allergens and toxins. This is why it’s so important not to squeeze or squash a tick while it’s attached, even a tiny larval tick. Compressing the body can cause the tick to expel additional saliva and allergenic material into the skin, increasing the chance of a stronger reaction.

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It is important to find a latched on larval tick as soon as you can. As with larger ticks, the longer they remain attached, the greater the likelihood of tick‑related allergic responses, including the development of mammalian meat allergy (MMA or alpha‑gal syndrome). I recently learnt that Australia is the most affected country in the world for both mammalian meat allergy and tick‑related anaphylaxis, and this has been well‑documented by ASCIA and CSIRO. Mammalian meat allergy is a delayed allergic reaction to a carbohydrate called alpha‑gal, found in the meat and products of most mammals; in sensitised people, eating these foods can trigger hives, gastrointestinal symptoms, nausea, vomiting, or even anaphylaxis after eating a meal containing meat or meat by-products (including ingredients like gelatine). Recent studies have even uncovered a potential link between MMA and heart disease.

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There’s also ongoing discussion in Australia about Lyme‑like illness. NSW Health says that while locally acquired Lyme disease can’t be completely ruled out, there’s currently little evidence that the classic form of Lyme disease occurs here. At the same time, many Australian researchers, clinicians, and patient groups have reported people developing Lyme‑like symptoms after local tick bites, and some of these cases test positive in overseas laboratories and respond to Lyme‑directed treatment. Universities such as the University of Sydney and Murdoch University are actively studying tick‑borne pathogens, and because of this emerging research, some authorities now use the term “Lyme‑like illness” or “LD‑like illness” in Australia. It’s an area where the science is still evolving, and the conversation is ongoing. 

 

Identifying Larval Ticks

 

One of the biggest challenges with larval ticks, is simply identifying them. I’ve had patients told by doctors that they’d probably “brushed up against a cactus” or had a rash, only for us to zoom in with a phone camera and see the unmistakable round body and tiny back legs of larval ticks.

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Because they’re far too small to remove with tweezers, many people use pharmacy‑available permethrin cream (commonly used for scabies, called Lyclear) to help manage the initial irritation. Public tick‑bite resources including the Australian Department of Health and CDC Australia note that permethrin products are typically applied in a thin layer, left on the skin for a few minutes, then washed off before a second light application is applied for a few minutes more, before being thoroughly washed off again. These guidelines emphasise not rubbing the cream in but applying a small pea sized amount. It’s worth noting that the product label for Lyclear is written for scabies, not ticks, so the application is different. Permethrin is highly toxic to cats, so care is needed in households with pets. After using permethrin, it’s important to wash your hands thoroughly and gently clean the bite area with warm soapy water. 

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Once the larval tick has died, the bite usually feels less “bitey” or stingy, and the tiny body often sloughs off on its own. More noticeable skin reactions typically begin within 4–12 hours, can increase in size for 2–3 days, and may last up to two weeks. The itch can be intense. Some people also develop tick‑bite hypersensitivity, where the sting of the bite is felt immediately, often due to repeated exposure over time. This describes my own experience: my larval tick bite felt like acid was burning into my skin, sort of like a concentrated wasp bite but zingy and intense, and I could feel the little critter burrowing in. It's a sensation you don’t forget. 

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I developed significant swelling too, and felt quite ill, but after seeing three different GPs, none believed it was a larval tick or understood why I was reacting so strongly. This is why taking a clear, zoomed‑in photo of the tick with your phone can be incredibly helpful. Make a note in your diary too, with the time, the date of the bite, and changing symptoms. Take photos of any rash or swelling that develops. One GP I saw used a large magnifying glass to look at the bites and could only see “a series of black dots, maybe a row of splinters.” It wasn’t splinters though, it was my first major brush with larval ticks, and they had bitten me at night after I’d spent 15 relaxing minutes picking tomatoes and doing some light weeding before dinner. For future reference, splinters don’t start biting you at night, in multiple places, once you've come inside to make your dinner.

 

Where Larval Ticks Attach and How to Check Your Body

 

Ticks tend to attach in warm, soft, or hair‑bearing areas:

• the hairline

• behind the ears

• the back of the neck

• the armpits

• the groin

• behind the knees

• around the waistline

• inside the belly button

• near the nipples

• between the toes

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After spending time outdoors, especially camping, bushwalking or weeding, a full‑body check is always recommended. Pets should be checked too, as they are excellent at bringing ticks inside (check out that photo above for how tiny the larval ticks are on a pup!). My vet said humans often pass ticks onto pets, when the ticks come in on their shoes, so it's important to check indoor animals too, if the humans in the house have been outside, walking on the grass, especially after rain. Its good practice to leave your shoes in a laundry area, or away from pet bedding too. 

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Remember, ticks thrive in warm, humid environments so that can be bushland, long grass, leaf litter, and even suburban gardens, so it's important to always, always check yourself. After years of hiking both here and throughout Europe, I got all my major tick bites at home, in my garden, which came as a shock to me. Paralysis ticks are unfortunately present year‑round in the Blue Mountains and areas like Emu Plains and Penrith, but peak in spring and summer, especially after rain. The larval stage is most active in autumn, nymphs in winter, and adults in spring, though any stage can appear at any time. My dog got one on him in the middle of June. 

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Contrary to popular belief, ticks do not fall from trees. They cannot fly or jump. They usually climb no more than about 50 cm up vegetation and wait with outstretched forelegs in a behaviour called questing. This is why when you brush past some flowers or run out to get the morning mail in your sandals, you become the larval tick's mode of transport, and then they crawl up your leg and find a sweet spot, and then boom, they bite!

 

The CSIRO recommends that if you're heading into tick territory such as bushland, long grass or even your own garden, it’s helpful to cover up with long sleeves and pants tucked into socks. Light‑coloured clothing makes it easier to spot ticks before they attach. A friend of mine who works in bush regeneration also carries masking tape or duct tape to remove small ticks from clothing. You gently dab the sticky side of the tape against your clothes to lift off any tiny ticks, then fold the tape over so they’re contained before placing it in the bin. An adhesive lint roller can work in a similar way to remove ticks from clothing.

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When a friend and I were hiking years ago in Slovenia, some of the people we passed mentioned they had picked up quite a few ticks. We wore thick opaque tights under our clothes with socks over the top, and we had made a natural spray for our clothing using peppermint, thyme, neem and eucalyptus oil. I still do this when I'm hiking. The effectiveness of essential oils as a tick deterrent is still debated, but we happened to come home without any ticks on us.  

 

What To Do After Being Outdoors

 

When you have been outdoors, especially for a long period, it’s helpful to remove the clothes you were wearing and place them in the dryer on the hottest setting for 20+ minutes. Research has shown that intense heat from the dryer is far more effective than washing. Washing clothing in water over 60°C for at least 60 minutes may also work, but this method has only been tested on British tick species. Cold water definitely doesn't kill ticks, and neither does warm water or a short hot cycle. The hot dryer method is therefore the safest method — followed up by a hot wash, just to be on the safe side. 

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While you’re waiting for the dryer to finish, have a hot shower and check your body as you wash. Water won’t kill attached larval ticks, but it can help wash off any wanderers. After your shower, you can do a full head‑to‑toe tick check, looking carefully through every fold and crease of the body. Run your hands through your hair, feel behind your ears, and check between your toes. A mirror can help with hard‑to‑see areas, and zooming in with your phone on any itchy spots with a tiny dark centre can make things clearer. If you notice an itchy, tender area you can’t check yourself — especially on your back — you might ask a friend to look or visit a pharmacist or GP for assistance. Being aware of ticks, including tiny larval ticks, helps people recognise them earlier and seek support if needed.

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Final Thoughts

 

Everyone reacts differently to larval ticks. Some people barely notice them, while others experience heat, itching, burning, swelling, aching, bruising or a general sense of feeling unwell with flu‑like symptoms. Over the past two years I’ve seen a significant rise in larval tick cases in clinic, including patients who came in simply feeling “hot, achy, and off,” only for us to discover larval tick bites. One woman had forty‑two larval ticks on her torso. I’ve also had several patients develop mammalian meat allergy after tick exposure, and many have shared that their symptoms were initially misunderstood or dismissed. Sadly, this isn’t unusual as tick‑related conditions are still emerging areas of research in Australia, and awareness varies widely across the healthcare system.

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Larval ticks may be tiny, but their impact can be surprisingly big. Understanding what they are, where they hide, and how public health bodies describe their behaviour helps our Blue Mountains community stay informed and prepared.

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