Tick bites, especially from deer ticks, are of special concern in the northeastern United States, because deer ticks are known carriers of Lyme disease. This malady starts with a rash on the skin that appears, on average, ten days after the tick bite. If unnoticed and untreated, the illness can progress into a wide range of other symptoms, such as fever and joint pain.
In endemic regions, a recent increase in awareness of the disease has in some cases spilled over into hysteria, resulting in countless unnecessary prescriptions and blood tests, not to mention anxiety. There are a few salient points to remember about Lyme disease. First, only deer ticks transmit the disease. Second, even if a deer tick is infected with Lyme disease, the probability of getting the illness after a bite is low, unless the tick has remained on the skin for more than a day. Third, the disease is treatable with a simple antibiotic, especially when diagnosed early.
If you find a tick on Jimmy’s skin, just remove it, either with tweezers or by scraping it off with a blade or a credit card. You don’t need a doctor to take it off. No matter how precise you are, it’s almost impossible not to leave a little bit of the tick in the skin. These suckers don’t let go easily. That’s okay, though, because the part of the tick that’s left in the skin doesn’t increase the chance of transferring Lyme disease; for that, the tick has to be alive and actively sucking blood. Don’t dig deeper to remove that last bit; it will eventually disintegrate, just like a splinter, and digging around could cause an infection.
Once you’ve removed the tick, throw it out; there’s no need to analyze it. The lab could tell you whether or not it’s a deer tick, but your course will be the same in either case. If the tick has been attached for over 36 hours, an antibiotic prophylaxis can decrease potential transition rates. All patients should monitor for symptoms.
After the tick is out, observe the site of the bite for any changes. In the early days you may see an inflammatory reaction that resolves quickly, like any insect bite. If the spot becomes infected, you’ll see spreading redness and pain; this local infection can be treated with an over-the-counter antibiotic cream. If the characteristic Lyme disease rash were to develop, it would only appear one to three weeks later. It is circular and red, and the center gradually clears, forming what looks like a bull’s-eye with a red and scaly edge. Lyme rashes vary in intensity and appearance, so any redness that appears after a few days in a spot where you removed a tick is suspect and requires medical attention. With treatment, Lyme disease is easily cured, and the rash wanes within a week. Most cases that progress to a more severe or chronic infection do so because people either didn’t notice the rash or dismissed it.
Blood test for Lyme is optimal at least 6 weeks after the tick bite, if determined clinical necessary by a physician. If tested too early, the results may be inaccurate. There is no risk in waiting. Yearly blood tests to detect Lyme infection despite the absence of any symptoms are especially unhelpful.
The key is prevention in heavily infested areas with careful daily inspections, insect repellents and full clothing coverage
*Article updated June 2021, in accordance with most recent AAP guidelines.