Tick Bite

Symptoms

DEFINITION

• A tick (small brown bug) is attached to the skin
• A tick was recently removed from the skin

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General Information

• The bite is painless and doesn't itch; so ticks may go unnoticed for a few days. Ticks eventually fall off on their own after sucking blood for 3 to 6 days.
• Ticks can transmit many diseases, including Lyme disease, Rocky Mountain spotted fever (RMSF), and Colorado tick fever.
• The Wood Tick (dog tick) is the size of a watermelon seed and can sometimes transmit Rocky Mountain spotted fever and Colorado tick fever.
• The Deer Tick (black-legged tick) is between the size of a poppy seed (pin head) and an apple seed, and can sometimes transmit Lyme disease.
• Engorged ticks: After feeding on blood, both ticks become quite swollen (engorged) and easy to see.

Lyme Disease

• Lyme disease has become the most common tick-borne illness in the United States. The risk of Lyme disease following a recognized deer tick bite is estimated to be 1%.
• The majority of cases of Lyme disease start with a bull's eye rash ("erythema migrans") at the site of the tick bite. The rash can occur days to weeks (typically 7-10 days) after a tick bite. Treatment with antibiotics is indicated if this rash appears. Flu-like symptoms may accompany the rash, including: fever, chills, headaches, muscle aches, and fatigue.
• Removing ticks promptly may prevent Lyme disease.

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See More Appropriate Topic (instead of this one) If

• SPIDER BITE
• Bite and not from a tick or spider, see INSECT BITES

Should I Call?

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• You can't remove the tick
• You can't remove the tick's head that has broken off in the skin
  Note: if the removed tick is moving, it was completely removed)
• Widespread rash occurs 2 to 14 days following the bite
• Fever or severe headache occurs 2 to 14 days following the bite
• Bite looks infected (e.g., spreading redness, pus)
  Note: infection doesn't start until at least 24-48 hours after the bite

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

• You think you need to be seen
• Red-ring or bull's eye rash occurs around a tick bite
• Probable deer tick and it was attached for more than 24 hours (or tick appeared swollen, not flat) and Lyme disease is common in your area
• Fever occurring within 2 weeks of a tick bite
• Headache or widespread rash occurring within 2 weeks of a tick bite
• No tetanus booster in more than 10 years

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Tick bite with no complications and you don't think you need to be seen

Care at Home

HOME CARE ADVICE

Home Care Advice for Tick Bite

1. Wood Tick Removal:
   • Use a pair of tweezers and grasp the wood tick close to the skin (on its head). Pull the wood tick straight upward without twisting or crushing it. Maintain a steady pressure until it releases its grip.
   • If tweezers are not available, use fingers, a loop of thread around the jaws, or a needle between the jaws for traction.
   • Note: covering the tick with petroleum jelly, nail polish or rubbing alcohol doesn't work. Neither does touching the tick with a hot or cold object.
2. Tiny Deer Tick Removal:
   • Needs to be scraped off with a knife blade or credit card edge.
   • Place tick in a sealed container (e.g., glass jar, zip lock plastic bag), in case your doctor wants to see it.
3. Tick's Head Removal:
   • If the wood tick's head breaks off in the skin, it must be removed. Clean the skin. Then use a sterile needle to uncover the head and lift it out or scrape it off.
   • If a very small piece of the head remains, the skin will eventually slough it off.
4. Antibiotic Ointment: Wash the wound and your hands with soap and water after removal to prevent catching any tick disease. Apply an over-the-counter antibiotic ointment (e.g., bacitracin) to the bite once.
5. Expected Course: Tick bites normally do not itch or hurt. That is why they often go unnoticed.
6. Call Your Doctor If:
   • You can't remove the tick or the tick's head
   • Fever or rash occur in the next 2 weeks
   • Bite begins to look infected
   • You become worse

How to Prevent a Tick Bite

1. Prevention - General:
   • Prevention is important if you are hiking in tick-infested areas.
   • Wear long pants and a long shirt. Tuck your shirt into your pants. Tuck the cuffs of your pants into your socks or boots. Light-colored clothing is better because the ticks can be seen more easily.
   • Inspect your entire body and your clothing every couple hours. Ticks like to hide in your hair; so be certain to check your scalp, neck, armpits, and groin.
   • A shower at the end of a hike will help rinse off any tick that is not firmly attached.
2. Prevention with Insect Repellent - DEET:
   • DEET is a very effective tick repellent. It also repels mosquitoes and other bugs.
   • Apply to exposed areas of skin. Do not apply to eyes, mouth or irritated areas of skin. Remember to wash it off with soap and water when you return indoors.
   • Pregnant and breastfeeding women may use DEET. No problems have been reported. [Source: Insect Repellent Use and Safety, Centers for Disease Control and Prevention]
   • Be certain to read the package instructions on any product that you use.
3. Prevention with Insect Repellent for Your Clothing - Permethrin:
   • Permethrin-containing products (e.g., Duranon, Permanone, and Congo Creek Tick Spray) are highly effective mosquito repellents. They also repel ticks.
   • An advantage over using DEET is that they are applied to and left on clothing instead of skin. Apply it to clothes before putting them on. You can also put it on other outdoor items (shoes, mosquito screen, sleeping bags).
   • Do not apply permethrin to skin (Reason: it's rapidly degraded on contact with skin).
   • Be certain to read the package instructions on any product that you use.

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Photo Example

Wood Tick in Scalp

This photos shows an engorged (full with blood) wood tick hiding in the hair on the back of the head.

Adult Deer Tick

This adult Deer tick is about the size of an apple seed. The tick is flat and has not yet begun feeding.

Deer Tick (Black-Legged Tick)  

The Deer Tick (black-legged tick) is between the size of a poppy seed (pin head) and an apple seed.

The deer tick is found on a wide rage of hosts including mammals, birds and reptiles.

This tick can transmit Lyme disease to humans and animals during feeding; this occurs when the the tick insert its mouth parts into the skin of a host and slowly ingests the host's blood.

Wood Tick (Dog Tick)

This is a picture of a female American brown Wood Tick.

The Wood Tick (or dog tick) is the size of a watermelon seed and can sometimes transmit Rocky Mountain spotted fever and Colorado tick fever.

First Aid - Removing a Tick

Wood Tick Removal:

• Use a pair of tweezers and grasp the wood tick close to the skin (on its head). See image.
• Pull the wood tick straight upward without twisting or crushing it. Maintain a steady pressure until it releases its grip.
• If tweezers aren't available, use fingers, a loop of thread around the jaws, or a needle between the jaws for traction.

Tiny Deer Tick Removal:

• Needs to be scraped off with a knife blade or credit card edge.
• Place tick in a sealed container (e.g., glass jar, zip lock plastic bag), in case your doctor wants to see it.

Note: Covering the tick with petroleum jelly, nail polish or rubbing alcohol doesn't work. Neither does touching the tick with a hot (like a match) or cold object.

Erythema Migrans Rash

The majority of cases of Lyme disease start with a bull's eye rash ("erythema chronicum migrans") at the site of the tick bite. The rash can occur days to weeks (typically 7-10 days) after a tick bite.

Treatment with antibiotics is indicated if this rash appears.

It is thought that Lyme Disease can be prevented if the tick is removed within 24 hours of attachment.