Lyme Disease: Early Signs, the Rash, Tick Bites and When to See a Doctor

Lyme disease is an infection caused by bacteria that can be spread to humans by infected ticks [1]. A common early sign is a rash around a tick bite, but not everyone gets one [1][2].

What Is Lyme Disease?

Ticks are tiny spider-like creatures that live in woods, areas with long grass and sometimes in urban parks and gardens [1].

Not all ticks in England carry the bacteria that causes Lyme disease, but it is still important to be aware of ticks and to remove them safely as soon as possible [1].

The Lyme Disease Rash

When It Appears

The rash can appear up to 3 months after being bitten by an infected tick, but usually appears within 1 to 4 weeks, and it can last for several weeks [1].

The US Centers for Disease Control and Prevention (CDC) says the rash (called erythema migrans) occurs in approximately 70 to 80 percent of infected people. It begins at the site of a tick bite after a delay of 3 to 30 days (average is about 7 days) [2].

What It Looks Like

• It is a circular or oval shape around the tick bite [1].
• It expands gradually over several days, reaching up to 12 inches (30 cm) or more across [2].
• It may feel warm to the touch but is rarely itchy or painful [2].

The rash may look like a bullseye on a dartboard [1], but it does not always appear as a classic bull's-eye rash [2].

The Rash on Different Skin Colours

The rash may be flat or slightly raised, and on white skin it may look pink, red or purple. It can be harder to see the rash on brown and black skin, and it may look like a bruise [1].

Redness That Is Not Lyme Disease

A small bump or redness at the site of a tick bite that occurs immediately and looks like a mosquito bite is common. This irritation generally goes away in 1-2 days and is not a sign of Lyme disease [2].

Ticks can spread other organisms that may cause a different type of rash [2].

Other Early Symptoms

Some people also get flu-like symptoms a few days or weeks after they were bitten by an infected tick [1]:

• a high temperature, or feeling hot, cold or shivery [1]
• headache [1][2]
• muscle and joint pain [1][2]
• tiredness and loss of energy [1]
• chills [2]
• swollen lymph nodes [2]

These early symptoms may occur in the absence of rash [2].

Later Symptoms

Some people with Lyme disease develop more severe symptoms months or years later, and this is more likely if treatment is delayed [1]. These more severe symptoms may include heart problems and trouble with memory or concentration [1].

Later signs and symptoms can appear days to months after the tick bite [2]. They can include:

• severe headaches and neck stiffness [2]
• additional EM rashes on other areas of the body [2]
• facial palsy, which is loss of muscle tone or droop on one or both sides of the face [2]
• arthritis with severe joint pain and swelling, particularly the knees and other large joints [2]
• heart palpitations or an irregular heartbeat [2]
• episodes of dizziness or shortness of breath [2]
• intermittent pain in tendons, muscles, joints and bones [2]
• nerve pain [2]
• shooting pains, numbness or tingling in the hands or feet [2]

How to Remove a Tick Safely

If you find a tick attached to your skin, remove it as soon as possible [1][3]. Do not wait to go to a healthcare provider to remove it [3].

1. Grasp the tick as close to the skin's surface as possible, using clean fine-tipped tweezers [3][4] or a tick-removal tool [1].
2. Pull the tick away from the skin slowly, with steady, even pressure, taking care not to squeeze or crush it [1][3]. Do not twist or jerk the tick [3][4]. This can make the mouthparts break off and stay in the skin, where they may cause irritation, but your body should push them out over time as the skin heals [3][4]. You can also remove the mouthparts with tweezers, but if you cannot remove them easily, leave them alone [3].
3. Dispose of the tick, for example by placing it in a sealed container or wrapping it tightly in tape. Do not crush the tick with your fingers [3].
4. Thoroughly clean the bite area and your hands with soap and water [1][3].
5. If you find one tick, there may be others, so do a careful tick check on your entire body and remove any others promptly [3][4].

Do not use petroleum jelly, heat, nail polish or other substances to try and make the tick detach from the skin [3][5].

Should the Tick Be Tested?

Testing a removed tick is not generally recommended [3][5]. Some commercial groups offer it, but laboratories that test ticks are not required to have the high standards of quality control used by clinical diagnostic laboratories, and the results should not be used for treatment decisions [3].

A positive result does not necessarily mean that you have been infected. A negative result can give false assurance, because you may have been bitten by a different tick that was infected without knowing it [3]. If you have been infected, you will probably develop symptoms before the tick test results are available, and if you become ill you should not wait for those results before starting appropriate treatment [3].

After the Bite

The chance of getting ill is low. You do not need to do anything else unless you notice a rash or become unwell [1]. See your doctor if a rash or fever develops within several days to weeks after removing a tick [3].

When to Get Medical Help

In the UK, the National Health Service (NHS) says:

"Ask for an urgent GP appointment or get help from NHS 111 if: You've been bitten by a tick or visited an area in the past 3 months where infected ticks could be, and you either:

• feel unwell with flu-like symptoms - such as feeling hot or cold, feeling shivery, headaches or aching muscles
• have a round or oval shape rash" [1]

In the US, the CDC says: "Seek medical attention if you observe any of these symptoms and have recently had a tick bite, live in an area known for Lyme disease, or have recently traveled to an area where Lyme disease occurs." [2]

When you see a doctor, tell them about your recent tick bite, when the bite occurred and where you most likely acquired the tick [3].

How Lyme Disease Is Diagnosed

At the appointment, a GP considers your symptoms and any rash or recent tick bites you know about [1]. Lyme disease can be difficult to diagnose, because it has similar symptoms to other conditions and there is not always an obvious rash [1].

2 types of blood test are available to help confirm or rule out Lyme disease, but these tests are not always accurate in the early stages of the disease. You may need to be retested if you still have symptoms after a negative result [1].

Treatment and Recovery

Treatment for Lyme disease comes from a GP, and it is more effective if it is started as soon as possible [1]. Most people with Lyme disease get better after treatment [1][6]. If you have severe symptoms, you may be referred to a specialist in hospital so treatment can be given directly into a vein [1].

Most people with Lyme disease get better after treatment. This can take months for some people, but the symptoms should improve over time [1].

The NHS warns that "Some websites offer tests and treatment for Lyme disease that may not be supported by scientific evidence." [1] Speak to a doctor for advice before buying tests or treatment online [1].

Ongoing Symptoms

A few people who are diagnosed and treated for Lyme disease continue to have symptoms, like tiredness, aches and loss of energy, that can last for years [1]. It is not clear why this happens to some people and not others, so there is also no agreed treatment [1]. Speak to a doctor if your symptoms come back, or do not improve, after treatment [1]. If symptoms last a long time after treatment, you may get a referral to a hospital specialist for advice and more blood tests [1].

How to Avoid Tick Bites

You can reduce your risk of getting Lyme disease by avoiding tick bites and removing any tick quickly if you do get bitten [1].

Where and When Ticks Are Found

The NHS says ticks that may cause Lyme disease are found all over the UK, but high-risk places include grassy and wooded areas in southern England and the Scottish Highlands [1]. In the WHO European Region, ticks are mostly active from April to October when the weather warms up, but can be found all year-round [4].

Steps to Lower Your Risk

• Cover your skin while walking outdoors and tuck your trousers into your socks [1].
• Use insect repellent on your clothes and skin [1].
• Stay on clear paths whenever possible [1].
• Wear light-coloured clothing so ticks are easier to see and brush off [1].
• After outdoor activities, check yourself, your children and pets for ticks [1][4].

Is There a Vaccine?

New vaccines against Lyme disease are in development [4].

Medical Disclaimer

This article is for general information and does not replace advice from a qualified health professional. If you think you need urgent medical care, get emergency help straight away.