Lyme Disease: Tick Bites, the Rash to Look For and How to Protect Yourself

A tick bite can be smaller than a poppy seed and completely painless. Most bites are harmless, but in parts of North America, Europe and Asia, ticks can carry the bacteria that cause Lyme disease. Caught early, it’s easily treated with antibiotics. Missed, it can affect joints, nerves and the heart.

Imagine a weekend hiking in the woods. A week later you notice a red patch on the back of your knee. Over a few days it grows wider, with a paler centre, like a target. It doesn’t itch or hurt, so you almost ignore it. Then you remember pulling something tiny off your leg after the hike. That rash is the classic early sign of Lyme disease.

How to remove a tick safely

1. Use fine-tipped tweezers or a tick removal tool.
2. Grip the tick as close to the skin as possible.
3. Pull upwards slowly and steadily without twisting or squeezing the body.
4. Clean the bite and your hands with soap and water or antiseptic.
5. Don’t burn it, cover it in petroleum jelly or use alcohol on it. These can make it release more saliva.

The sooner a tick is removed, the lower the risk. In most cases, a tick has to be attached for more than a day to pass on the infection.

Symptoms to watch for

• Erythema migrans rash: a red or dark patch that spreads out from the bite, often 5 cm or more across, sometimes with a clearer centre. It usually appears 3 to 30 days after the bite. On brown and black skin it can look more like a bruise and be harder to see.
• Flu-like symptoms: fever, tiredness, headache, muscle and joint aches
• Later symptoms if untreated: facial drooping (facial palsy), nerve pain, swollen and painful joints, and heart rhythm problems

Not everyone gets the rash, so see a doctor or nurse if you feel unwell in the weeks after a tick bite or time in tick areas.

Treatment

Lyme disease is treated with antibiotics, usually for two to four weeks. If you have the typical rash after a tick bite, treatment usually starts without waiting for a blood test, because tests are often negative early on. Most people recover fully, especially when treated early.

But how can I avoid tick bites?

• Stick to paths and avoid long grass and dense undergrowth
• Wear long sleeves and trousers tucked into socks, preferably light-coloured
• Use an insect repellent that works on ticks, such as DEET
• Check yourself, children and pets carefully after being outdoors, including armpits, groin, behind knees, along the hairline and behind ears
• Shower soon after coming indoors

Sources: US Centers for Disease Control and Prevention (Lyme disease), NHS (Lyme disease), European Centre for Disease Prevention and Control, World Health Organization. This guide is for general information and does not replace advice from your own nurse, doctor or pharmacist.