Tick Bite Identification: Removal, Rash, Warning Signs

The CDC's instruction is to remove an attached tick immediately and not to wait to see a healthcare provider first. Grasp the tick as close to the skin's surface as possible using clean, fine-tipped tweezers, then pull away from the skin with steady, even pressure. Do not twist or jerk it.

Afterwards, dispose of the tick by sealing it in a container, wrapping it tightly in tape, flushing it, or putting it in alcohol — and do not crush it with your fingers. Clean the bite area and your hands thoroughly with soap and water, rubbing alcohol, or hand sanitizer.

Then check the rest of your body. The CDC's reasoning is direct: if you found one attached tick, there may be others, and they should be found and removed promptly.

The CDC names the folk remedies specifically and says why they are a bad idea. Do not use petroleum jelly, heat, nail polish or other substances to try to make the tick detach on its own, because this may agitate the tick and force infected fluid from it into the skin.

The CDC also advises against tick testing, for four reasons it lists: laboratories that test ticks are not required to meet the quality-control standards of clinical diagnostic labs; a positive result showing the tick carried a pathogen does not mean you were infected; a negative result can give false reassurance; and symptoms usually appear before the results come back. Treatment decisions should not be based on tick test results.

Photograph the tick before disposal if you want the species recorded; photograph it and the app identifies it.

The CDC says to contact a doctor if you develop a rash or fever within several weeks of removing a tick, and to tell them about the recent tick bite, when it happened, and where you likely picked the tick up.

For Lyme disease specifically, the CDC describes the erythema migrans rash as beginning at the bite site after a delay of 3 to 30 days, averaging about 7, and expanding gradually over several days to reach up to 12 inches (30 cm) or more across. It sometimes develops central clearing that gives a target-like pattern, but it does not always take the classic bull's-eye form. It occurs in approximately 70 to 80 percent of infected people — so no rash does not mean no infection.

Early symptoms in the same 3-to-30-day window include fever, chills, headache, fatigue, muscle and joint aches and swollen lymph nodes, and can appear with no rash at all.

The CDC lists the common US species with their ranges and the diseases they can carry.

• Blacklegged tick, widely distributed in the eastern United States: anaplasmosis, babesiosis, Lyme disease, hard tick relapsing fever, ehrlichiosis and Powassan virus disease. Greatest risk of bites in spring, summer and fall
• Western blacklegged tick, Pacific coast and particularly northern California: anaplasmosis, Lyme disease, hard tick relapsing fever
• American dog tick, east of the Rocky Mountains: tularemia and Rocky Mountain spotted fever, with highest risk of being bitten in spring and summer
• Lone star tick, Northeast, South and Midwest: Bourbon virus, ehrlichiosis, Heartland virus, tularemia, STARI and alpha-gal syndrome. The CDC calls it a very aggressive tick that bites humans
• Rocky Mountain wood tick, Rocky Mountain states at 4,000 to 10,500 feet: Rocky Mountain spotted fever, Colorado tick fever, tularemia
• Gulf Coast tick, southeastern US with focal populations elsewhere: Rickettsia parkeri rickettsiosis

The CDC's threshold is a rash or fever within several weeks of a tick bite. The NHS says to see a GP for a tick bite followed by flu-like symptoms, or a round or oval rash that may look like a bullseye. The American Academy of Dermatology adds that a red, donut-shaped rash after a tick bite could indicate Lyme disease and needs antibiotics, and that a fever with a red or black spotty rash that spreads could indicate Rocky Mountain spotted fever, which should be treated immediately.

Tell the clinician when the bite happened and where you were. Geography narrows the list of likely pathogens more than the bite mark does.

This page summarises what public health sources publish. It is not a diagnosis, and any tick bite followed by feeling unwell is a reason to be seen.