While the importance of identifying changing moles as a sign for skin cancer is well known, this time of year someone will inevitably make an appointment with a “changing mole” or a “blood blister” that is in fact an engorged tick! While tick bites can be unpleasant, the most concerning consequence of a tick bite is the risk of being infected with Lyme disease.
Two things that you are probably not doing but should be.
First is prevention. The most important way to avoid Lyme disease is to avoid getting bitten by ticks in the first place. After you have been hiking in fields or woods, it is important to check yourself and especially children for ticks. Make sure to include looking in armpits and hair. Some ticks are so small they are easily mistaken for freckles.
There are 3 FDA approved insect repellents for human use. While most people are familiar with DEET, many are not familiar with picaridin or permethrin. DEET is a particularly harsh insect repellent and may not be the best option for children. Picaridin repels insects, ticks and chiggers. It is a synthetic compound first made in the 1980s. It was made to resemble the natural compound piperine, which is found in the group of plants that are used to produce black pepper. Picaridin has been widely used as an insect repellent in Europe and Australia, but has only been available in the United States since 2005. Picaridin can be used on human skin or clothing to repel mosquitoes, biting flies, ticks, fleas, and chiggers. Fortunately, it can also be used on children. Permethrin is an insecticide in the pyrethroid family. Pyrethroids are synthetic chemicals that act like natural extracts from the chrysanthemum flower. Permethrin insect-killing repellent for your clothing is effective against ticks, chiggers, mites and mosquitoes; as effective as 100 percent DEET. Permethrin lasts up to 6 weeks (or 6 washings); will not stain or damage clothing, fabrics, plastics, finished surfaces, or outdoor gear. This is great for kids going off to camp this summer who might not be consistent about using insect repellent!
If you do identify a tick attached to the skin, the proper way to remove it is with tweezers. Grasp the tick at its head, as close to the skin as possible and pull upwards with gentle, even pressure. Try to not twist the tick and avoid home remedies such as touching with a hot match, nail polish, freezing it off or smothering it with petroleum jelly. Flush the tick down the toilet after you remove it.
Second is treatment. In most areas of the US, Lyme disease rates have risen proportionally with the growth of the tick population. Lyme disease is caused when the tick transmits the bacteria borrelia burgdorferi. After removing a tick from the body, record the date and location of the tick bite so it can be monitored for Lyme disease symptoms. Redness or itching after removing a tick is an allergic reaction to the tick saliva. The initial presentation of Lyme disease develops 7-14 days after the bite and appears as a red, expanding, ring-like rash with a “bulls-eye” appearance. It is of the utmost importance that Lyme disease is diagnosed and treated immediately. If left untreated, the infection can spread internally and cause organ and nervous system damage.
The CDC provides guidelines for antimicrobial prophylaxis for the prevention of Lyme disease following tick bites. This treatment may be beneficial in certain circumstances. A single dose of doxycycline can lower the risk of Lyme disease when the tick bite occurs in a state where Lyme disease incidence is high or in an area where >20% of ticks are infected with borrelia burgdorferi. Contact your local health department for information about tick infection rates in your area. The estimated time of attachment is ≥36 hours based on the degree of tick engorgement with blood or likely time of exposure to the tick. Prophylaxis can be started within 72 hours of tick removal when the patient has no contraindication to doxycycline. While Kansas and Missouri are not on the high exposure list, Minnesota, Wisconsin, and all of New England are. So if traveling to those areas this summer, be aware!
Most tick bites will not transmit Lyme but it’s important to call your dermatologist if you develop a rash at the site of the bite. If a tick bite is concerning you, give our office a call today to make an appointment with Dr. Kaplan and the team.