About all

Itchy red tick bite: Symptoms of Tickborne Illness | Ticks


LymeMD :: Learn About Lyme

Learn About Lyme Disease


Although Lyme disease is transmitted by the bite of a tick, (See http://www.cdc.gov/lyme/transmission/index.html)
knowledge of any given tick bite is not helpful to predicting whether or not you may have Lyme disease: the majority of individuals that contract Lyme disease will not remember the tick bite. Also, only 2% of tick bites result in Lyme disease. Late spring and early summer are the highest risk season for Lyme disease, when the nymphal stage of the ticks emerge. Adults ticks are present year round and can be feeding any time when temperature exceed 40 degrees. Although both genders and all ages are susceptible, Lyme disease is most common among boys aged 5-19 and adults 30 or older.

If you think you may have Lyme disease,

it is important to consult your health care provider

The prognosis for recovery is best when Lyme disease is diagnosed and treated in its earliest phase. But remember, treatment doesn’t make you immune; you can get Lyme again if another infected tick bites you.

What To Do After a Tick Bite
Removing Ticks

If you or a loved one is bitten, remove the tick promptly. Here’s how:

  • Grasp the tick’s mouthparts against the skin, using pointed tweezers.
  • Be patient; the long mouthpart is covered with barbs, so removing it can be difficult and time consuming.
  • Pull steadily until you can ease the tick out of the skin.
  • DO NOT pull back sharply; this may tear the mouthparts from the body of the tick and leave them embedded in the skin.
  • If this happens, don’t panic! Embedded mouthparts do not transmit Lyme disease.
  • DO NOT squeeze or crush the body of the tick; this may force infected body fluids from the tick into the skin.
  • DO NOT apply substances such as petroleum jelly, nail polish, or a lighted match to the tick while it is attached. They may agitate the tick and force more infected fluid into the skin.
  • Once you have removed the tick, wash the wound site and your hands with soap and water.
  • Observe the bite site over the next two weeks for any signs of an expanding red rash.
  • Tick attachment time is important; removing ticks within 36 hours of attachment reduces the risk of infection.
  • Testing ticks for infection is possible, but not recommended on a routine basis.
    You should consult your physician to see if you should save; the tick after removal
    for further evaluation.
Recognizing the Rash

      If you are bitten by a tick, a small red bump may appear in a few days to a week, usually at the site of the bite
      — often in the groin, belt area or behind the knee. This bump may feel warm and tender when touched. If this tick bite has transmitted Lyme disease
      the redness may expand over the next weeks and form a round or oval red rash, usually bigger than 5 centimeters in size.
      It may resemble the classic bull’s eye, with a red ring surrounding a clear area and a red center.
      More often the rash lesion is uniformly red or reddish-blue, is minimally tender and minimally itchy (much less itchy than poison ivy).
      This rash, called erythema migrans, is a hallmark of Lyme disease and appears in about 70-80% of infected people.

    • If the rash is Lyme disease, it will continue to grow over days or weeks and will not fade in a few days.
    • The Lyme rash is often confused with a spider bite.

  • Tick bite reactions are often confused with the rash of Lyme disease.

    – Only 2% of tick bites result in Lyme disease.

    – Tick bite reactions are small, less than 1-2” in size.

    – Surrounding redness does not expand when observed over 24-48 hrs.

    – Reaction at site of tick bite can last days, even weeks.
  • Lyme rash occurs at the site of the tick bite in 80% of people with early Lyme disease.
  • Incubation period from tick bite to rash is 3-30 days (usually 3-10 days).
  • Lyme disease rash is:

    – Round or oval, enlarges in size over days/weeks

    – Red, sometimes warm.

    – Usually greater than 2” inches in diameter, often 6-8”

    – Rarely bull’s eye, usually uniformly red

    – Often confused with spider bites
Requesting and Receiving Care
  • Diagnosing Lyme Disease

    – Lyme disease is a clinical diagnosis made by a doctor or nurse by examining the patient

    – Acute Lyme disease is not a laboratory diagnosis; a negative Lyme blood test does not exclude Lyme disease in the first few weeks of the illness.

    – 20% of people have a flu-like illness and NO rash.

    – Fever, aches, and abrupt severe fatigue can be the main symptoms of acute Lyme.

    – Lyme disease is different from respiratory “cold”.

    – A runny nose and prominent cough are NOT symptoms of Lyme disease.

If you have a tick bite, watch for an expanding red rash or lesion at the site of the tick bite or an unexplained feverish, achy, fatiguing illness within 1 to 4 weeks after the tick bite. If this doesn’t happen, you are probably among the 98% of people who don’t develop Lyme disease after a tick bite. If you are concerned about any of these findings, take a picture of the rash and contact your physician.

Symptoms of Lyme Disease
Flu-like symptoms
  • Fever, chills, fatigue, body aches, swollen glands, and a headache may accompany the rash.
  • In some cases, these may be the only symptoms of infection and there is no rash.
Neurological problems
  • In some cases, inflammation of the membranes surrounding the brain (meningitis), temporary paralysis of one side of the face (“Bell’s palsy), numbness or weakness in limbs, and impaired muscle movement may occur weeks or months, after an untreated Lyme disease infection.
  • Other problems can occur months to years later and include difficulty with short-term memory, migraines, dizziness, ‘brain fog’, poor sleep, lack of verbal fluency, confusion or disorientation, and decreased ability to concentrate.
  • Lyme has also been found to mimic several psychiatric disorders.

    Joint pain

    • Untreated, the infection may cause severe joint pain and swelling from several weeks to months after infection.
    • Knees are often affected, but the pain can shift from one joint to another.
    Other Symptoms

    • Some people experience irregular heartbeat several weeks after infection, rarely lasting more than a few days or weeks.
    • Eye inflammation, hepatitis, shooting pains, and severe fatigue are also possible.

When To See a Doctor

If you are bitten by a tick and develop the rash or symptoms of Lyme disease — especially if you live or vacation where Lyme is prevalent, contact your doctor immediately. Treatment is most effective if begun early. Although only a small number of tick bites lead to Lyme disease: the longer the tick remains attached to your skin, the greater your risk of getting the disease.

How Lyme Disease is Diagnosed

Lyme disease is a clinical diagnosis made by a doctor or nurse examining the patient. Early Lyme is not a laboratory diagnosis: a negative Lyme blood test doesn’t rule out Lyme in the first few weeks of the illness. Also, 20% of people have no rash, only a “flu like” illness. Fever, aches and abrupt severe fatigue can be the main symptoms of acute Lyme disease. Lyme is different from a respiratory “cold” and does not cause a runny nose or a prominent cough.

Tick bite reactions are small and do not get bigger over several days. If you have a tick bite, watch the site for signs of a growing red rash in the next 1 – 3 weeks. Small, red reactions less than 1-2” in size (the size of a dime) are common do not represent Lyme disease. These are tick-bite reactions, often confused with the rash of Lyme disease. With a tick-bite reaction, the red area does not expand over 24 to 48 hours. Small reactions at the bite site can last days to weeks.

The earliest stage of Lyme disease occurs at the site of the tick bite. If the rash is Lyme, it will get bigger over days or weeks and will not fade over the next few days. Only 2% of tick bites result in Lyme disease. A Lyme rash occurs at the site of the tick bite in 80% of people who have early Lyme disease. The incubation period from a tick bite to the development of a rash is 3-30 days (usually 3-10 days).

The Lyme rash is red and round or oval and is called erythema migrans. It may have the distinctive bull’s-eye appearance. Often, the rash is uniformly red and usually more than 2” across – often as large as 6-8”. It is sometimes confused with a spider bite.

What Is Not Lyme Disease
  • Small, red areas about the size of a dime are common after tick bites. They are not Lyme disease.

  • With a non-Lyme tick bite reaction, the surrounding redness does not expand over 2 to 4 days.

  • These small reactions from a tick bite can last from several days to weeks.

Tick Bite

Is this your child’s symptom?

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

Symptoms of a Tick Bite

  • A tick bite does not cause pain or itch. So, ticks may not be noticed for a few days.
  • After feeding on blood, ticks get swollen and easier to see.
  • Ticks fall off on their own after sucking blood for 3 to 6 days.
  • After the tick comes off, a little red bump may be seen.
  • The red bump or spot is the body’s response to the tick’s saliva (spit).
  • While it’s sucking blood, some of its spit gets mixed in.

Causes of Tick Bites

  • The wood tick (dog tick) is the size of an apple seed. After feeding, it can double or triple in size. Sometimes, it can pass on Rocky Mountain spotted fever or Colorado tick fever.
  • The deer tick is the size of a poppy seed. After a feeding, it can triple in size. Sometimes, it can pass on Lyme disease.

Lyme Disease

  • Over 95% of people who get Lyme disease live in or have traveled to 14 high-risk states. Lyme disease mainly occurs in the Northeast, Mid-Atlantic and upper Midwest. Many states do not have Lyme disease. The CDC reports over 30,000 new cases per year (2015).
  • About 80% of Lyme disease starts with a bull’s eye rash called erythema migrans. The rash starts at the site of the tick bite. It starts on the average at 7 days. It grows larger quickly, to more than 2 inches (5 cm) wide. It can become as large as 12 inches (30 cm). It lasts 2 or 3 weeks. Treatment of this rash with an antibiotic is advised. This almost always prevents the later stages of Lyme Disease. If Lyme Disease isn’t treated, heart, joint and neurologic problems can occur.
  • Giving antibiotics after deer tick bites to prevent Lyme Disease depends on the risk. The risk is low with brief attachment. The risk is high if the deer tick was attached for longer than 36 hours. It’s also higher if the tick is swollen, not flat. Ask your doctor for advice.
  • The risk of Lyme Disease after a deer tick bite is low. Even in high risk areas, only 2% of deer tick bites cause Lyme Disease.

When to Call for Tick Bite

Call Doctor or Seek Care Now

  • Can’t remove the tick after trying this care advice
  • Widespread rash starts 2 to 14 days after the bite
  • Fever or headache starts 2 to 14 days after the bite
  • Fever and bite looks infected (spreading redness)
  • Weak, droopy eyelid, droopy face or crooked smile
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Deer tick was attached for more than 36 hours
  • Deer tick is swollen, not flat
  • New redness starts more than 24 hours after the bite. Note: bacterial infection is rare. It does not start until at least 24-48 hours after the bite.
  • More than 48 hours since the bite and redness now getting larger
  • Red-ring or bull’s eye rash occurs around a deer tick bite. Note: the rash of Lyme disease starts 3 to 30 days after the bite.
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Wood tick bite
  • Deer tick bite
  • Preventing tick bites

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Care Advice

Treating Tick Bites

  1. What You Should Know About Wood Tick Bites:
    • Most wood tick bites are harmless.
    • The spread of disease by wood ticks is not common.
    • If the tick is still attached to the skin, it needs to be taken off.
    • Try one of the methods described below to take out the tick.
  2. Wood Tick – How to Remove with Tweezers:
    • Use tweezers. Grasp the tick as close to the skin as possible (on its head).
    • Hold the tweezers sideways next to the top of the skin.
    • Pull the wood tick straight upward without twisting or crushing it.
    • Keep a steady pressure until the tick lets go of its grip.
    • If you don’t have tweezers, you can use your fingers.
    • Other options. You can use a loop of thread around the jaws. You can also use a needle pushed between the jaws for traction. Jaws are the part of the head attached to the skin.
    • Not helpful: Covering the tick with petroleum jelly or nail polish doesn’t work. Neither does rubbing alcohol or a soapy cotton ball. Touching the tick with a hot or cold object also doesn’t work.
  3. What You Should Know About Deer Tick Bites:
    • Most deer tick bites are harmless.
    • The spread of disease by deer ticks is not common.
    • Even in high risk areas, only 2% of deer tick bites cause Lyme disease.
    • Most people who get Lyme disease live in or have traveled to 14 high-risk states. Lyme disease mainly occurs in the Northeast and upper Midwest. Many states do not have Lyme disease.
  4. Deer Tick – How to Remove:
    • If it is swollen, try to remove with a tweezers. See wood tick advice.
    • Tiny deer ticks need to be scraped off.
    • You can remove them with the edge of a credit card.
  5. Tick’s Head – When to Remove:
    • If the wood tick’s head (mouth parts) breaks off in the skin, remove any large pieces.
    • Clean the skin with rubbing alcohol.
    • Use a clean tweezers or needle to scrape it off.
    • If a small piece remains, the skin will slowly heal and shed it.
  6. Antibiotic Ointment:
    • After the tick is removed, wash the wound with soap and water. Also, wash your hands after you are done.
    • This helps to prevent catching any infections carried by the tick.
    • Use an antibiotic ointment (such as Polysporin). No prescription is needed.
    • Put it on the bite once.
  7. What to Expect:
    • Most often, tick bites don’t itch or hurt.
    • That’s why they may not be noticed.
    • The little bump goes away in 2 days.
    • If the tick transferred a disease, a rash will occur. It will appear in the next 4 weeks.
  8. Call Your Doctor If:
    • You tried and can’t remove the tick
    • Fever or rash happens in the next 4 weeks
    • Bite starts to look infected
    • You think your child needs to be seen
    • Your child becomes worse

Prevent Tick Bites

  1. Prevent Tick Bites:
    • After being outdoors in deer tick areas, check for ticks. Remove any that are attached. Also, take a shower soon after coming inside.
    • Tumble any clothing in a hot dryer for 10 minutes. That should kill any ticks left in the clothing.
    • When hiking outside where there are ticks, wear long clothing. Tuck the ends of pants into socks.
    • Use a bug repellent to shoes, socks and exposed skin.
  2. Tick Repellent for Clothing – Permethrin:
    • Permethrin products (such as Duranon) work well to repel ticks.
    • Unlike DEET, these products are put on clothing instead of skin. They also can last through many washes. Use it on pant cuffs, socks and shoes. You can also put it on other outdoor items (bug netting, sleeping bags).
    • Do not put it on skin. Reason: Sweat changes it so it does not work.
  3. Tick Repellent for Skin – DEET:
    • DEET also works well to repel ticks. It can be used on the skin not covered by clothing.
    • Use 20-30% DEET for children and teens (AAP). Note: 30% DEET protects for 6 hours.
    • DEET is approved for use in children over 2 months of age (AAP).

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 04/05/2021

Last Revised: 03/11/2021

Copyright 2000-2021. Schmitt Pediatric Guidelines LLC.

What to do after a tick bite