A prospective cross-over field trial shows protection of lemon eucalyptus extract against tick bites

Ixodes ricinus can transmit several microorganisms, out of which Borrelia burgdorferi and tick-borne encephalitis (TBE) virus are the most important pathogens in humans. A lemon eucalyptus extract (Citriodiol) has been shown to be a natural repellent against mosquitoes, stable flies, and midges. We have investigated whether the use of the extract would reduce the number of attached I. ricinus ticks in humans. A volunteer sample of 111 individuals was recruited among healthy, outdoor active adults living in two highly I. ricinus-infested areas. They were randomly divided into two groups: one group applied the Citriodiol spray daily for 2 wk to the lower extremities, whereas the other group was instructed not to use any type of repellent on any part of the body. After 2 wk, the scheme was reversed. All volunteers filled in a daily diary, giving information about outdoor activities and the number of observed, attached, or not yet attached ticks, including the anatomical location of the ticks found. Forty-two attached ticks were reported during the weeks when the Citriodiol spray was used, and 112 were reported when it was not. The median number of reported attached ticks per person decreased from 1.5 (range, 0-9) to 0.5 (range, 0-2; P < 0.05) during the weeks when the repellent was used. The number of reported attached ticks noted below the waist was 13/42 (31%) during the period when the spray was used and 73/112 (65%) when no spray was used (P < 0.001). No evident redistribution of attached ticks from protected areas to unprotected areas was seen. Citriodiol may become a useful means in reducing the number of tick bites and thereby tick-borne infections, although additional studies are warranted.