Bullseye! – How to Recognize Tick Bites and Prevent Becoming a Tick Target

Ticks are arachnids that serve as a food source for many birds, reptiles and amphibians. However, ticks themselves feed off of mammalian blood, which they do by latching onto the skin and literally sucking blood until they become completely engorged (like balloons!), until they fall off or until they are physically removed. They can sit on the skin for hours or even days!

The tick bite itself isn’t a big deal. The problem is that tick bites can be a vector for transmitting other infections, most commonly: Lyme disease and Rocky Mountain Spotted fever. These infections are caused by specific spirochetes that each infect a specific tick species; the tick then deposits the infectious agent into the human when it bites and attaches to the human. These ticks often live on other animal hosts (deer, dogs, mice, rats...) and transfer from the animal to the human host when they are nearby.

Ticks that transmit Lyme disease are more commonly found in the northeast US (New York, Connecticut, New England), western Wisconsin and California. In North America, the ticks that transmit Lyme disease are members of the Ixodes genus (usually Ixodes scapularis, the blacklegged tick, aka the deer tick). Mice and deer are the major animal reservoirs. Transmission occurs mostly commonly in the spring and summer, and the likelihood of infection is most correlated with increased time in spent in wooded or rural areas (like camping, hiking, cottaging).

Great – I live in one of those areas - How Will I Know if I was Bitten?

Find the Tick! - Tick bites do not leave a mark on the skin, nor are they associated with a bump or rash on the same day that the bite occurs. If you have spent time in wooded areas, check all of your skin for attached ticks, including your scalp, feet, waistband and flexural areas (soft, warm spots in your elbow, knee, neck and groin creases). If ticks are removed from the skin within the first 24 hours of attachment, there is minimal risk of them transmitting infection, and you do not need to worry about further treatment.

Diagnosis of acute Lyme disease (rash) is generally made based on clinical exam. The classic bullseye rash, aka erythema migrans (you can have a single one or multiple ‘targets’) is characteristic of a Borrelia burgdorferi and Borrelia mayonii infection, the spirochete that can be transmitted via a bite from the Ixodes deer tick. But it does not develop for at least 1-2 weeks AFTER you are bitten! You do not usually feel sick with this rash, but you may develop fevers and headaches. However, sometimes the rash may be solid red, blistered or look like a spider bite and not necessarily a bullseye, or there may be no rash at all, despite infection, making it easy to miss the diagnosis if you don’t suspect it.  Most people (75%) do not recall getting bitten by a tick in the first place!

Left untreated, the rash will resolve on its own within a couple of weeks. This doesn’t mean that the infection is gone, too. People with untreated Lyme disease can later develop neurological symptoms, including headaches, chronic joint and muscle pain, fatigue and numbness/neuropathies, and sometimes heart disease.

What do I do if I find a tick on my skin?

First and foremost, remain calm. Not all tick bites equal Lyme disease. And not all tick bites require treatment beyond removing the tick.

Second, ticks generally need to be attached to your skin for 24-72 hours before they can transmit disease, so if you do find a new tick after a day outdoors, and remove it immediately, it is likely to cause an infection.

If you do find a tick, remove it from the skin by grasping it securely with tweezers held close to the skin surface and pull straight up, without twisting; this is to ensure that you remove the mouthparts.

If you do not know how to identify a tick, put it into a plastic bag and take it to your doctor or Urgent Care, so that it can be identified, in order to determine if you are even at risk for acquiring an infection. Lyme disease is transmitted by deer ticks, which are much smaller than the more common dog tick, and which have characteristic markings.

If the removed tick is identified as an Ixodes tick, then your doctor will offer you oral antibiotics. If you know that it was removed within 24 hours of attachment no further treatment is needed. However, if you cannot be sure or know that it was longer, it must be treated ASAP. If the tick is removed within 72 hours of biting and it has been attached for at least 36 hours, a single dose of antibiotic is given as prophylaxis. If the diagnosis is made based on localized skin symptoms (aka, the a new Bulls-eye rash), treatment involves a 20-day course of oral antibiotics.

How Can I Prevent Getting Bitten by a Tick?

·       Wear light-colored, long sleeved shirts (tucked into pants at the waist) and wearing long, looser fitting pants tucked into socks, when playing or hiking in grassy or wooded areas. This can include hiking, camping, hunting, gardening or even walking the dog in some neighborhoods. 

·       Consider wrapping tape around openings in clothing so that ticks have no access

·       Insect repellents with DEET (20-35%), Picardin (30%) or Oil of Lemon Eucalyptus can dissuade ticks from biting exposed skin. It should be sprayed over clothing and on exposed skin. It does not need to be applied under clothed areas. 

·       Clothing and gear can be treated with permethrin (0.5%). These are generally available as sprays or wash-in boosters for clothing; if spraying, the garment or gear should be thoroughly wet with the product and left to dry in a well-ventilated area.  It can be used to treat boots, clothing, camping gear, and will remain effective through a few washings. You can also purchase permethrin-treated clothing and gear.  

·       Avoid tick-infested areas.

·       Check yourself, your kids and your pets daily for ticks and carefully remove them if you find one. Use a fine-toothed comb to check your hair and have someone check your scalp. Ticks especially like skin folds, so check your armpits, groin and under your breasts. Also, be sure to check (or better yet, have someone else check) in and around your ears, inside your belly button and around your waist, behind your knees and inside your elbow creases. Remember that nymph-stage ticks are the most likely to transmit infections and they can be tiny! Look carefully for pin-point black spots, and not just larger, adult bugs!

·       Shower and wash your clothing in hot water to kill any ticks that may be on you or your clothing.

·       To minimize tick infestations and infections in your pets (dogs): ask your vet about safe spray products for your dog (FYI: they cannot safely be used on cats!!); watch for signs of changed behavior or appetite in your dog, which may suggest infection; check your dogs daily for ticks if they spend time outdoors, and remove any tick immediately and completely (examine around tail, under and between legs and toes, around the eyelids and under the collar; make your yard and neighborhood less hospitable to ticks (see next bullet point for ideas).

·       To safeguard your yard from acquiring ticks or to deter animal hosts that will bring them to your yard: (i) remove debris like leaves, garbage, unused/piled up furniture etc; (ii) Mow the lawn frequently and cut down tall grasses and brush around the house and edges of the lawn/yard; (iii) Create a 3 foot barrier of gravel or wood chips between the edge of the yard and an adjacent wooded area; (iv) Keep kids playground equipment, toys, as well as lawn furniture and decks away from yard edges, if they abut wooded areas; (v) lock up garbage cans and compactors, use chemicals  (or animal urine) to scare away wild animals that can carry ticks (mice, rats, stray dogs, deer, raccoons), and consider erecting a fence to keep them out of the yard/property. Pesticides can be sprayed, as well (you must check local agriculture official guideline about those permitted in your city; note that you should still do the other things as well, and not rely solely on spraying as complete protection. 

**NOTE: This information in this post should is not to be used instead of seeking medical attention, if warranted.

For further reading, check out Dr Shainhouse’s advice in these publications:

https://m.kidshealth.org/CHOC/en/parents/tick-bites-sheet.html

http://www.bayareafamilytravel.com/index.php?pr=ConsumerLkOutBugs

https://www.thehealthy.com/first-aid/how-to-identify-bug-bites/