Sandfly Bites and Cutaneous Leishmaniasis The message in this article is - don't travel in the Philippines, especially Palawan, without insect repellant lotion and antibacterial ointment! Some of the beaches of the Philippines, especially Palawan, have sandflies. I have been bitten on the Palawan beaches of Sabang, Port Barton and El Nido. They mostly bite around sunrise and sunset you wont necessarily notice them. The next day the bites will become extremely itchy. If you are bitten, serious lesions can develop in only a few days. The affliction is called Cutaneous leishmaniasis. These are the the skin sores resulting from a tropical infection by parasitic protozoa of the genus Leishmania, which are spread by the (female) sandfly ( also spelt as sand fly ). The sores are sometimes called tropical ulcers. You will know you have a tropical ulcers developing if all normal treatment fails and the wounds become progressively bigger and finally, very painful. Infection dwells underneath the scabs and in my case was much more serious than it looked. The parasite destroys the skin cells, leaving a huge cavern underneath the scab. These wounds are not to be left for a better time to treat. They can leave permanent scars. The locals in Palawan call the advanced infections "pizzas". Prevention The most effective preventative is to apply insect repellant with a high concentration of DEET. In Palawan, "Off!" is widely sold and has the high concentration of DEET. You can also mix the repellant with sun tan lotion, coconut oil or any other oil. The locals use only coconut oil. On one occasion I was bitten on a beach near the "Big Lagoon" of El Nido in late 2003. I took my T-shirt off for about 15 minutes to get a bit of sun on my white skin and was bitten in 4 places on my upper body. There were no bites on the areas where I had applied sun-tan lotion. Immediate Treatment If a scab has already formed, do the following. Mix hydrogen peroxide with betadine 50/50. Using a ball of cotton wool, dab the wound with this mix. It will dissolve the scabs and reveal what's underneath. Once the wound is open and clean, apply a 2% antibacterial ointment (Mupirocin Bactroban is the local brand), using a cotton bud. Cover with a patch of open weave gauze and tape into place. Repeat this process twice a day or more until the wounds are no longer infected and starting to heal. Repeat treatment immediately after your shower. This can take one week to 10 days +, depending on severity. If no scab has formed yet, clean the area with alcohol or a betadine solution and apply some antibacterial ointment. Keep this up for a few days. All of the abovementioned items would be stocked by most Philippines' pharmacy stores. I still get bitten sometimes but, because I carry my antibacterial ointment, they never develop beyond a mosquito bite size. If you want to see what my sandfly bites looked like, then click below. Warning - the pictures are quite horrible. Pictures of My Sandfly Bites For more information about leishmaniasis The Tropical Disease Research (TDR) centre (supported by WHO, UNICEF and others) has good information about this disease. Click on their "animated life-cycle of leishmaniasis" and see how the parasite multiplies and destroys the body cells. http://www.who.int/tdrold/diseases/leish/lifecycle.htm (needs Flash player) Please note that I am not a medical professional and the above advise is based on what I have learnt from my experiences of sand fly bites. Nicnics In the Philippines, sandflies are usually called nicnics or nic nics. This name may also refer to sand fleas. If you are anywhere in the Philippines and you want to know if there are sandflies or sand fleas on the beach, you ask one of the locas "are there any nicnics on the beach?".