Tick Bite | Now WhatThere is not a week that goes by in late spring and early summer that I do not have a patient see me for advice about a tick bite.  If you find a tick on your skin, then you should try to remove it as quickly as possible.

How to Remove Ticks

Use fine-tipped tweezers, or a variety of other specific tick removal devices that are commercially available and grab the tick as close to the skin’s surface as possible.  You should be grasping the mouthparts and head of the tick, and not be squeezing its body.  Gently pull upward and maintain steady tension.  Be patient and wait for the tick to detach.  Do not twist or pull hard, since you are likely to cause the mouthparts to detach and remain in the skin.  Should this occur, try to remove the mouthparts with the fine tipped tweezers and see your doctor.  Once you have removed the tick, wash the area and your hands with soap and water, or rubbing alcohol.  Place the tick in a sealed container and dispose of it.  Do not crush it with your fingers.

Symptoms and Treatments

Tick bites are of concern since ticks can transmit Lyme disease and other tickborne illnesses such as babesiosis, anaplasmosis, and Rocky Mount spotted fever.  With regard to Lyme disease, the tick must be in place for at least 36 hours for it to transmit Lyme disease to you.  Other diseases can be transmitted in shorter periods of time.  If you have a rash around the tick bite, especially a “bull’s-eye” rash, or if you develop rashes elsewhere on your body, then see your physician immediately.

Even if you do not have a rash on your body, you should see a physician if you develop fever, chills, headache, fatigue, muscle aches, joint aches, an irregular heartbeat, one-sided facial droop or other nerve related complaints.  Your physician will probably prescribe doxycycline for 2 weeks if you have rashes or other symptoms after a tick bite.  Amoxicillin or cefuroxime axetil can be prescribed to patients who are allergic to doxycycline, pregnant, or less than 8 years old.

It is less clear how to proceed when you have had a tick bite and have no rashes or symptoms. The classic bull’s-eye rash of Lyme disease occurs only in about 80% of patients with Lyme disease, and some people develop Lyme disease without ever being aware of a tick bite or having a rash.  However, most physicians will not treat you with antibiotics if you have no rashes or symptoms, and you are positively sure the tick was attached for less than 36 hours.  If the tick was attached for more than 36 hours and the tick bite occurred in an area where more than 20% of the ticks are infected with the organism that causes Lyme disease (Borrelia), then a single dose of doxycycline 200 mg may be helpful in preventing the development of Lyme disease, provided treatment is started within 72 hours of tick removal.

When in doubt, it is often helpful to check Lyme titers, but the timing of that lab testing is important.  Once you have been infected with Borrelia, the incubation period lasts from 3-20 days and it can take 4-6 weeks for your body to develop antibodies against the organism.  It is for this reason that tests for Lyme antibodies immediately after a tick bite should be negative, even if you are infected, unless you have had Lyme disease in the past.  Once you have had Lyme disease and been treated, the antibodies remain in your blood and you might continue to have positive blood tests for Lyme disease.  Therefore, checking for Lyme antibodies immediately after new tick bites and again 4-6 weeks later will allow your physician to make a diagnosis of Lyme disease if your Lyme antibody titers are rising, even if you were treated for Lyme disease in the past.

Take tick bites seriously, but do not panic.  Remove all ticks as quickly as possible and see your doctor for treatment advice.

Note: Wilson KD, Elston DM. What’s eating you? Ixodes tick and related diseases, part 1: Life cycle, local reactions, and Lyme disease. Cutis. 2018 May;101(5):328-330. For more detailed information on how to remove a tick, visit https://www.cdc.gov/lyme/removal/index.html.

Tick Bite? Now What?

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