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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. Itchy and infected bites are handled by video; a sore that does not heal, or fever after a trip, needs tests in person.
- Sandflies: tiny, hairy flies, 1.5 to 3.5 mm long, that bite at dusk and during the night, mainly in Mediterranean countries.
- When: adult sandflies are active in Europe from April to November, depending on how far south you are.
- Leishmaniasis: a parasite passed on by some sandflies. The skin form causes a sore weeks or months after the bite, often painless.
- Emergency: call 112 for a severe headache with a stiff neck, confusion or a seizure, or red, hot, spreading skin with a high temperature.
Sandfly bites are rarely urgent. Do not book a video appointment if you have a severe headache with a stiff neck or a dislike of bright light, confusion or a seizure, or red, hot, spreading skin with a high temperature and feeling very unwell. Call 112 or go to an emergency department.
Can an online doctor treat sandfly bites?
Yes. Sandfly bites itch like other insect bites, and a doctor can assess them by video, ease the itching and treat any infection. The doctor also checks for the rare infections sandflies can carry in southern Europe, and tells you when tests are needed: a sore that will not heal, or a fever weeks or months after a trip, needs an in-person assessment.
How an online consultation helps with sandfly bites
- The bites assessed: Sandfly, mosquito or another bite: where you were and when you were bitten help tell them apart.
- Itch relief that suits you: An antihistamine or a steroid cream, chosen after the doctor checks your other medicines.
- Infection treated: Scratched bites that become red, hot or crusted are checked, and treated with antibiotics when needed.
- Watching for leishmaniasis: Which kind of sore, weeks or months later, needs a doctor to see it.
What the doctor checks in an online sandfly bite consultation
The doctor looks at the bites and asks about your trip. The doctor asks about:
- Warning signs: a severe headache, a stiff neck, confusion, a high temperature, or spreading redness.
- The bites: where they are, how many, and when they appeared.
- Your trip: the country and region, evenings and nights outdoors, and the dates.
- A changing sore: a spot that has grown, crusted or opened weeks after the trip.
- How you feel: fever, tiredness or weight loss in the weeks or months after travel.
- Your health: a weakened immune system, pregnancy, and the medicines you take.
Before the call, note the dates and places of your trip, and photograph any sore that is changing every few days.
What are sandflies, and where do they bite?
Phlebotomine sandflies are tiny, hairy flies, 1.5 to 3.5 mm long, with large black eyes and long legs. Only the females bite, to feed on blood. They fly weakly, in short hops, and usually stay within a few hundred metres of where they breed.
- When they bite: mostly at dusk and during the night. They can also bite by day in dark rooms or shaded plants, especially when disturbed. Adults are active from April to November in Europe, and the warmest regions have up to three generations between May and September.
- Where: mainly in Mediterranean countries. They are gradually spreading north and to higher altitudes: one species already reaches northern France, Belgium and Germany, and models expect another to reach western Germany and western Switzerland by 2040.
- Where they breed: females lay 30 to 70 eggs at a time in cracks and holes in the ground or in walls, in animal burrows and among tree roots, never in water, and adults rest by day in cool, dark corners of homes and animal shelters.
- Wind: even a light wind reduces biting, because they fly so weakly.
- Size: they are much smaller than mosquitoes, so they can get through gaps that keep mosquitoes out.
What do sandfly bites look like?
Like most insect bites, sandfly bites are small, swollen, itchy lumps, which may look red. Because sandflies feed at dusk and at night, bites are usually on skin that was uncovered then, such as the ankles, legs, arms, neck and face.
Can sandfly bites make you ill?
Most sandfly bites cause only itching. In southern Europe, some sandflies carry infections:
Swipe sideways to compare →
| Infection | What it causes | When it appears | What to do |
|---|---|---|---|
| Cutaneous leishmaniasis (skin) | One or more sores, often painless, that change in size and look over time, and can leave scars | Within a few weeks or months of the bite | See a doctor about any sore that does not heal after a trip |
| Visceral leishmaniasis | Fever, feeling generally unwell, anaemia, and an enlarged spleen and liver | Within months of the bite, sometimes years | See a doctor promptly: it is serious without treatment |
| Sandfly fever | A short, usually mild fever, sometimes called three-day fever | Days after the bite | Rest, fluids and fever relief; see a doctor if severe |
| Toscana virus | Usually mild, but sometimes infection of the brain and its linings | Days after the bite | Call 112 for a severe headache with a stiff neck or confusion |
Dogs are the main domestic carrier of the leishmania parasite in Europe. Worldwide, an estimated 700,000 to 1 million people get leishmaniasis each year, most of them the skin form, and about 95% of skin cases occur in the Americas, the Mediterranean basin, the Middle East and central Asia. More than 90 species of sandfly can carry the parasite.
The infections follow the seasons: sandfly fever starts in April and peaks by September, Toscana virus infections of the nervous system happen in summer, and new cases of leishmaniasis in people and dogs often appear in autumn and winter, after the biting season.
Sandflies or sand fleas?
The names are easy to mix up, but they are different insects with different problems. Sandflies are flies that bite and fly off. The sand flea, or chigoe flea, is a flea of tropical countries whose female burrows into the skin, mostly of the feet, and stays there. Sandflies do not lay eggs in the skin: they lay them in cracks in the ground and in walls.
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| What differs | Sandflies | Sand fleas (tungiasis) |
|---|---|---|
| Where | Mediterranean Europe, spreading north | Tropical and subtropical areas of the Caribbean, South America and sub-Saharan Africa |
| What happens | A female bites, feeds and flies away | A female burrows into the skin and grows there as her eggs develop, over 4 to 6 weeks |
| Where on the body | Skin uncovered at dusk and at night | The feet in about 99% of cases: toes, soles, the sides of the feet and the heels |
| What you notice | Small, itchy, red lumps | A painful, very itchy spot with a dark centre, making walking and sleeping difficult |
| What to do | Itch relief; see a doctor about a sore that does not heal after a trip | Removal by a nurse with sterile instruments, a dressing and a tetanus check; infection needs treatment |
Sand fleas live in dry, shaded soil and on unsealed earth floors. If you have been in an area where they occur and have a painful lump on your foot, do not dig it out yourself: infection is common, and removal with unclean tools can lead to abscesses and tetanus.
Which sandfly bite treatment might the doctor recommend?
Most sandfly bites need only itch relief. This is the framework the doctors use:
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| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Itchy bites after evenings outdoors | Cold compresses, an antihistamine, hydrocortisone cream | Yes | Not usually needed |
| Many intensely itchy bites | A stronger steroid cream, and an antihistamine at night | Yes | Not usually needed |
| Scratched bites that are red, hot or crusted | Antibiotic cream or tablets | Yes | If redness spreads fast, or with a high temperature |
| A sore that grows or will not heal weeks after a trip | Tests for leishmaniasis | Yes, to assess | For skin tests and specialist treatment |
| Fever, tiredness or weight loss months after a trip | Blood tests | Yes, to assess | For tests and treatment |
| A severe headache, stiff neck or confusion | Emergency assessment | No | Call 112 now |
Worried about bites or a sore after a trip? A doctor can tell you in one consultation what needs checking.
See available times →Treatment options for sandfly bites
What you can do yourself
- Wash the bites with soap and water.
- Hold a cold compress, or an ice pack wrapped in a cloth, on itchy or swollen bites.
- Try not to scratch, which can let in infection.
- Ask a pharmacist about an antihistamine or a mild hydrocortisone cream for the itching.
Prescription treatment
A prescription is never issued without a consultation. For very itchy or inflamed bites, the doctor may prescribe a stronger steroid cream for a short time, and infected bites may need an antibiotic cream or tablets. Leishmaniasis is diagnosed and treated by specialists in person. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Ordinary mosquito nets with wide mesh do not keep sandflies out. Treating a sore that will not heal with creams for weeks, instead of having it checked, can delay the diagnosis of leishmaniasis.
How to avoid sandfly bites
There is no vaccine against the infections sandflies carry, so avoiding bites is what protects you:
- Use an insect repellent on exposed skin, and under the ends of sleeves and trousers. Repellents with DEET are generally the most effective.
- Cover up from dusk, with long sleeves, long trousers and socks.
- Sleep in a room with screens on the windows or with air conditioning, or under a fine-mesh bed net, ideally treated with insecticide, tucked under the mattress.
- Use a fan: even a light breeze reduces biting.
- Ask your vet about repellent collars or spot-on treatments for dogs you travel with.
Special situations
A weakened immune system
Leishmaniasis can be more serious. Tell the doctor about your trip if you have a fever or feel unwell afterwards.
Pregnancy
Tell the doctor if you are pregnant, because it changes which creams and medicines are suitable.
Living in or visiting the Mediterranean
Bites are most likely from late spring to autumn, at dusk and at night. Other holiday health problems are covered on the travel illnesses page.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When sandfly bites are treated online, and when you need in-person care
Treated online: itchy and inflamed bites, infected bites without spreading redness or a high temperature, and advice on preventing bites and on which symptoms to watch for after a trip.
In-person care: a sore that does not heal after a trip, a fever or weight loss in the months afterwards, and any severe headache, stiff neck or confusion.
When to get in-person care
Call 112 or go to an emergency department now for:
- a severe headache with a stiff neck or a dislike of bright light
- confusion, drowsiness or a seizure
- red, hot, spreading skin with a high temperature and feeling very unwell
Get medical advice the same day for:
- a high temperature after a trip to southern Europe
- a bite that is red, hot, swollen and increasingly painful, or leaking pus
- a high temperature with tiredness and weight loss in the months after a trip
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about the bites: show them on camera in good light, and say where and when you travelled, and how any sore has changed.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s a sandfly bite? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Mosquito bites can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about sandfly bites
What do sandfly bites look like?
Small, swollen, itchy lumps, which may look red, like other insect bites. They are usually on skin that was uncovered at dusk or at night, such as the ankles, legs, arms, neck and face.
What causes sandfly bites, and why do they itch?
Sandfly bites happen when a female phlebotomine sandfly, 1.5 to 3.5 mm long, cuts the skin with saw-like mouthparts to feed on blood, usually at dusk or at night; it injects saliva that stops clotting, and the immune reaction to that saliva is what causes the itchy, red, often blistered bump a few hours later. Sandflies fly weakly and stay close to where they breed, in damp, dark places such as animal shelters, rubble and basements.
Where are sandflies found in Europe?
Sandflies are found mainly in Mediterranean countries: Spain, Portugal, southern France, Italy, Greece, Malta, Cyprus, Croatia and the Balkans, and the islands. They are gradually spreading north and to higher altitudes with warmer summers, and some species now reach Germany, Belgium and Switzerland, so sandfly bites are possible on a summer trip well beyond the coast.
When do sandflies bite?
Sandflies bite mostly at dusk and during the night, in still, warm air, and also by day in dark rooms or shaded plants when disturbed; only the females bite, to feed on blood. In Europe, adult sandflies are active from April to November, longest in the far south, with the most sandfly bites in July and August.
Can sandfly bites make you ill?
Rarely. Most bites cause only itching. In southern Europe, some sandflies carry leishmaniasis, sandfly fever or Toscana virus, so a sore that does not heal or a fever after a trip needs a doctor.
Are they sandfly bites or something else?
Sandfly bites are small, red, intensely itchy bumps, often in clusters on the face, neck, arms and ankles after an evening outdoors in the Mediterranean, and some blister. Mosquito bites are larger and puffier; bed bug bites run in lines on skin uncovered in bed; flea bites cluster on the ankles indoors with pets; and a sandfly bite that turns into a painless sore that enlarges and does not heal over weeks may be cutaneous leishmaniasis and needs a doctor.
What does a leishmaniasis sore look like?
One or more sores, often painless, that appear within a few weeks or months of the bite and change in size and appearance over time. Some heal on their own over months or years, but they can leave scars.
How do I treat sandfly bites at home?
Clean sandfly bites with soap and water, hold something cool against them to take the heat out, and keep your nails short so scratching does not break the skin, because sandfly bites are itchier and longer-lasting than mosquito bites. A non-drowsy antihistamine by day and a sedating one at night help the itch, calamine or a mild hydrocortisone cream calms the lumps, and a bite that becomes hot, weeps or grows into an ulcer over weeks needs a doctor, since sandflies can carry leishmaniasis.
How can I avoid sandfly bites?
To avoid sandfly bites, use a DEET-based repellent, cover up from dusk, sleep in a room with window screens or air conditioning or under a fine-mesh bed net, and use a fan, because a light breeze reduces biting.
Are sandflies and sand fleas the same?
No. Sandflies are tiny flies that bite at dusk and at night, mainly around the Mediterranean, and then fly away. Sand fleas live in tropical countries, and the female burrows into the skin of the feet, where she has to be removed by a nurse.
Do sandflies lay eggs in your skin?
No. Sandflies lay their eggs in cracks in the ground and walls, in animal burrows and among tree roots. It is the tropical sand flea that burrows into the skin and produces eggs there.
How long do sandfly bites last?
Like most insect bites, they usually settle within a few days. A spot that grows, crusts or turns into a sore weeks after a trip is different, and needs a doctor to check for leishmaniasis.
Do mosquito nets stop sandflies?
Only fine-mesh nets do. Sandflies are much smaller than mosquitoes and can get through larger holes, so use a small-mesh net, ideally treated with insecticide.
Can an online doctor treat sandfly bites?
Yes, usually. A doctor can assess the bites on camera, treat itching and infection, and tell you which symptoms after a trip need tests in person.
- Phlebotomine sand flies: factsheet for experts, ECDC, European Centre for Disease Prevention and Control, updated 15 June 2020.
- Leishmaniasis: fact sheet, WHO, World Health Organization, 2023.
- About leishmaniasis, CDC, US Centers for Disease Control and Prevention, 2024.
- Preventing leishmaniasis, CDC, US Centers for Disease Control and Prevention, 2024.
- Tungiasis: fact sheet, WHO, World Health Organization, 28 April 2023.
- Insect bites and stings, NHS, National Health Service (UK), reviewed 1 June 2023.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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