January 9, 2018

Identifying Tick Bites

A tick bite is never something to brush off, forget about, and deal with later. Many ticks carry microbes that can cause a variety of diseases.

If diseases caused by tick bites are left untreated, they can lead to serious health problems that could potentially affect your muscles, joints, brain, heart, vision, and nervous system. Many tick-borne illnesses can have serious consequences that alter your lifestyle and activities by limiting your mobility, cognition, and overall quality of life. Knowing how to identify a tick bite and recognizing the general symptoms of tick-borne diseases can alert you to possible health risks sooner, so you can consult with your healthcare provider about appropriate next steps as soon as possible.


How to spot a tick

The first step in identifying tick bites is to know what ticks look like. Ticks will look different at each stage of their life cycle. Belonging to the arachnid class (scorpions, spiders, mites), ticks begin their life as an egg then hatch as a larva, which grows into a nymph and finally an adult tick. Dozens of tick species exist, but all are similar in appearance.

Photo taken by Christopher Paddock. Image Source: https://phil.cdc.gov/Details.aspx?pid=10879
Ticks generally have four stages of life: egg, larvae, nymph and adult. Ticks advance through each of these stages by molting, a process during which they shed their outer skin.

What a tick bite looks like

Tick bites are painless, so it’s likely you won’t immediately know that you’ve been bitten. The tick injects an anesthetic into the skin at its point of entry, which helps it avoid detection so it can continue feeding. Many patients with the tick-borne Lyme disease don’t recall having a bug bite of any kind.

So how do you know if you have a tick bite? The following photos may help. Take a moment to review each one closely and read through the accompanying descriptions to better spot and identify potential tick bites on you or your loved ones.

In this photo, the tick is still attached, having burrowed its head into the skin to feed. The redness around the tick indicates inflammation in the skin.

 

In this photo, the tick is still attached to the skin and appears larger because it has been feeding longer. This is an example of an engorged tick, so called because it has been gorging on blood.

 

Other bug bites can sometimes resemble tick bites, and therefore, it isn’t always easy to know whether you or a loved one have been bitten by a tick. The following guidelines can help, but it is always best to consult with your healthcare provider if you suspect a tick bite.

  • Tick bites are not fluid-filled, whereas bites from ants and other insects are typically pus-filled.
  • Location can sometimes help distinguish tick bites from other insect bites because ticks most commonly bite the back of the neck, scalp, groin, and legs.
  • Other insect bites may be multiple in number. Ticks typically bite once then burrow their head under the skin.

Rashes May (or May Not) Indicate a Tick-Borne Infection

A bulls-eye rash is often a telltale sign—not only of tick bite but of a potential Lyme disease infection. Other insect bites typically do not produce a rash with this distinctive pattern.

The skin is reddened in the area immediately surrounding the tick bite in this picture. Look closely and you’ll also see another “ring” of redness farther out from the site. This is called a bulls-eye rash – also known technically as Erythema Migrans (EM) rash – and appears only about 33 percent of the time when a person has been infected with Lyme disease.
In this photo, you see the bull’s-eye rash (EM) but no tick.1Chaaya, G., Jaller-Char, J.J., and Ali, S.K. “Beyond the Bull’s Eye: Recognizing Lyme Disease.” Journal of Family Practice 65, no. 6 (June 2016): 373–9. https://www.ncbi.nlm.nih.gov/pubmed/27474818.
In this photo, you see the rash caused by bartonella.

Rashes may also indicate other types of tick-borne diseases, including tick-borne relapsing fever, Rocky Mountain spotted fever, Ehrlichiosis or Bartonella.

If you see this or any other rash pattern near a site, notify your healthcare provider immediately.


How to Safely Remove a Tick

If you see a tick still attached to the skin, remove it immediately. There are many ways to remove ticks, but some are more effective than others.

First, preserving the tick can help your doctor determine whether it carries a potential disease in the event that you develop any symptoms following the bite. Smashing a tick that is attached to your skin can also release more toxins into your body, which can further expose you to potential infectious diseases. So even though your initial inclination may be to squash a tick that has attached to your skin, try instead to keep it intact.

The following steps can help you remove the tick quickly and carefully:

  • Grab the tick with pointed tweezers close to the skin where it has burrowed in.
  • Do not squeeze the tick—that may cause more pathogen-laced saliva to enter the body.
  • Pull upward with steady, even pressure. Do not twist or jerk the tick; this can cause mouth parts to break off and remain in the skin. Tick removal can get tricky if the tick’s body breaks apart during removal. If this happens, try to tweeze out the remainder of the tick body or leave it in place and have a healthcare provider remove it as soon as possible.
  • You may hear a pop when the tick is removed.
  • Place the tick in a ziplock bag and close it tightly. Keep it in the freezer.
  • Clean the skin with alcohol and wash your hands.
  • Do NOT use cigarette butts or matches.
Grab the tick with pointed tweezers close to the skin where it has burrowed in.

General symptoms of tick-borne diseases

If infected with a tick-borne illness, symptoms generally start to present a few days after the bite. Although the symptoms vary based on the type of tick and the disease it may be carrying, general signs to watch for include the following:

  • Mild itching
  • Reddened area on the skin
  • Very specific type of bulls-eye rash (EM) for Lyme
  • Non-EM rash for other tick-related infections
  • Fever

Some of the diseases carried by ticks include borreliosis (Lyme disease and tick-borne relapsing fever—TBRF), babesiosis, ehrlichiosis, bartonellosis, anaplasmosis, tularemia, and rickettsiosis (including Rocky Mountain spotted fever). With certain diseases, symptoms may worsen over time. These may include memory loss, muscle weakness, fatigue, fevers that come and go, and declining cognitive functions.

Careful observation is an important first step after identifying any tick bite. Write down dates and circumstances of any bites you or a loved one encounter, along with any symptoms that present immediately or over time. If you see signs of a potential tick-borne illness, be sure to share this information with your healthcare provider. In many cases, patients and their doctors simply don’t realize that a tick bite from several weeks or months ago is responsible for their illness. Alerting healthcare providers as quickly as possible to any exposure to ticks may contribute to an earlier diagnosis of tick-borne illnesses.

References   [ + ]

1. Chaaya, G., Jaller-Char, J.J., and Ali, S.K. “Beyond the Bull’s Eye: Recognizing Lyme Disease.” Journal of Family Practice 65, no. 6 (June 2016): 373–9. https://www.ncbi.nlm.nih.gov/pubmed/27474818.

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