The white stuff that comes out of jiggers is a result of the swelling caused by the flea. When the female sand flea burrows into the skin, it feeds on the hosts blood and lays eggs. As the flea expands, the outer layer of the skin is stretched thin, resulting in the appearance of a white halo around the black dot at the center of the lesion. The black dot is the rear end of the flea. The swelling ends in the condition of physogastry. The lesion can grow to the size of a pea and is often accompanied by intense itching, inflammation, and acute pain. Severe pathology following an infestation is caused by bacteria entering the skin when the jigger penetrates, which can lead to abscess formation, tissue necrosis, and gangrene. Tungiasis is commonly known as pulga de areia, or foot-bug. Mechanical extraction of burrowed sand fleas is common in endemic areas, and the procedure is usually done by the patients themselves or a caregiver under non-sterile conditions using instruments such as sticks, hairpins, thorns, safety pins, sewing needles, or scissors.