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Tick Tock, Tick Tock: You Found A Tick, Now What?

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By Robert S. Berger, MD FAAD, FASDS,FRSM; Meghan Berger Pocius, PAC; Maria Ready, PAC

Charles County Dermatology Associates, White Plains, Maryland

You are toweling off after a shower and notice a tick. What should you do? First remove it. The best way is with a removal tool that looks like an ice cream scoop with a v notch-works very well and easily found. If not available, simple traction with tweezers. If not completely removed, an allergic reaction may recur, which may result in the parts having to be surgically removed. Do you have to worry? Depends.

The most common infection caused by ticks (deer ticks) is Lyme's disease. For infection to occur, the tick must be attached for 36-72 hours. Less time almost precludes infection. Blood tests for Lyme's disease can be inaccurate for recent infections, but become very accurate for infections over 2 months old. How do you know if infected ?-the vast majority of people do not have any symptoms-for example, the Lyme rash (bullseye) is not unique to Lyme's disease and is only seen in 20% of patients infected. Any rash is suspicious, as are any constitutional symptoms (i.e. flu-like).

Early treatment ranges from 1-3 days up to 3 weeks, depending upon when the bite occurs and treatment begins (earlier is easier to treat). Chronic Lyme disease can be difficult to treat. Doxycycline is the treatment of choice, but can cause severe sun hypersensitivity reactions (sunburn). Amoxicillin is used in children and pregnant women. Unfortunately, there are many other conditions caused by different ticks in different regions. Relapsing fever is seen in the Western US. Rocky Mountain Spotted Fever (wood tick) is seen in the East/Southwest US.

Erlichiosis and Alpha Gal allergy(not an infection but an allergy to ANY meats consumed, causing severe itching/hives) from lone star tick, seen in Southern Atlantic/South Central US. Tularemia is seen in the Southeast, South Central and Western US. Viral infections include Powassan virus (deer tick virus) and febrile illness (lone star tick fever) - the latter seen in Missouri/Tennessee. Colorado tick fever is seen in Western US, and a hemorrhagic fever is seen in Europe and Africa. Protozoan infections include Babesiosis (Northeast and Western US) and Cytauxzoonosis from the dog tick, seen in South/Southeast US. Finally, there is "tick paralysis" caused by a toxin.

Due to the warm winter, 2017 has been a banner year for tick bites. So, what do you do? Removing the tick as soon as you can is critical, but does not prevent all diseases. Any symptoms should by promptly reported to your physician as soon as possible. A Lyme blood test is needed if there is a history of >/= 36 hours of exposure or multiple bites. There are usually 2 tests needed, one to check for exposure up to 2 months prior to the test, and repeated 2 months later. Perhaps an annual test thereafter. Treatment depends upon length of time after bite, the sooner after the bite the easier the treatment. Any rash or symptoms usually require initiation of therapy.

Prevention is the best policy. Avoid high grassy areas/wooded areas. Long pants to cover tops of shoes/socks and bloused. Apply 100% DEET to clothes (NOT SKIN) and regular DEET to exposed areas, and check your skin as soon as you can after coming home from such areas. Report bites and symptoms to your physician.

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