Emergency Care For You

Lyme disease: More than a tick and bulls' eye rash

By Chadd Kraus

In Room 2 is a 50 year-old man who works as a lumberjack and is in the emergency department with a “bulls’ eye” rash on his arm that he says is probably from a tick bite. In the waiting room is a 10 year-old girl with a chief complaint of a tick bite. In emergency departments, urgent care centers, and doctor’s offices across Pennsylvania and many other states, the arrival of warmer weather brings along with it the blacklegged tick and cases of Lyme disease.

Lyme disease, caused by the bacterium Borrelia burgdorferi, is the most common vector borne illness in the United States. The bacteria are transmitted to humans through the bite of an infected blacklegged tick. It cannot be transmitted from person to person. A recent study showed that Lyme disease cases increased by 320 percent from 1993 to 2012. Although Lyme disease cases have been reported across the United States, according to the CDC, 14 states in the Northeast, Mid-Atlantic and Upper Midwest account for 95 percent of all cases. Blacklegged ticks are most commonly found in wooded areas; however, they can also be found in urban settings with high grasses and bushes.

Symptoms of Lyme disease can include headaches, fatigue, fever, muscle aches, neck pain, joint pain, and a facial droop called Bell’s palsy. The most common symptom of Lyme disease is a painless, expanding rash at the site of the tick bite that appears as a bull’s eye or target-like rash. This rash, called erythema migrans, usually appears from 3 to 30 days after a tick bite. Approximately 70-80 percent of individuals with Lyme disease will develop erythema migrans. Blood tests can help to confirm a diagnosis of Lyme disease, however, a doctor can often recognize and treat it without lab tests.

Most individuals infected with Lyme disease never noticed a tick on their skin. On the other hand, spotting a tick on your skin or in your hair does not mean that have or that you will get Lyme disease. Ticks usually need to be attached to the skin for 36 to 48 hours or more before the bacteria that cause Lyme disease can be transmitted. Lyme disease can usually be treated with a few weeks of antibiotics. Some individuals have on-going symptoms from Lyme disease, including cardiac and neurologic symptoms, fatigue, and arthritis.

There are steps that can be taken to enjoy the outdoors and reduce the risks of tick bites. Avoiding ticks by staying out of wooded areas and places with high grass and bushes and staying in the center of trails is the best way to prevent tick bites. Wearing light-colored clothing that covers skin and that makes it easy to see ticks is another way to protect yourself. Using bug repellent containing 20-30 percent DEET or permethrin can reduce the likelihood of tick bites. Children and pets should be carefully checked for ticks after being outdoors. Finally, bathing or showering as soon as possible after coming indoors helps to wash off ticks that are crawling on the skin.

If you find a tick attached to your skin, you should carefully remove it by grasping the tick with fine-tipped tweezers as close to the surface of the skin as possible and then gently pulling upward away from the skin. The tick should not be twisted or squeezed. If part of the tick is left in the skin, it should be left to heal and monitored for signs of infection. After removing the tick, dispose of it (without squeezing it between your fingers), wash your hands and clean the area of skin with rubbing alcohol, iodine, or soap and water. Other methods of tick removal such as nail polish, petroleum jelly, or heat should be avoided.

If you live in, have recently traveled to an area where Lyme disease occurs commonly, or develop symptoms of Lyme disease, it is important to talk to your doctor about any necessary testing or treatment.

Note: Information from the Centers for Disease Control and Prevention (CDC) “Lyme disease.” For more useful information on Lyme disease, please visit the CDC website.  

About the Author: Dr. Chadd Kraus is a board-certified emergency physician living in Western Pennsylvania. He is an ACEP Spokesperson, serves on the ACEP Clinical Data Registry Committee, and was a member of the Cost-Effective Care Taskforce that developed ACEP’s Choosing Wisely® recommendations.