With predictions of a longer and more widespread tick season, cases of tick-borne illnesses, especially Lyme disease, will continue to increase. Victoria A. Cirillo-Hyland, MD, a board-certified dermatologist in the Philadelphia area, provides advice and education about Lyme disease.

Lyme disease is the most commonly reported vector-borne illness in the United States. A “vector-borne” disease refers to any infection that can be spread through a “vector”, i.e., a disease-carrying organism. In the case of Lyme disease in the United States, deer ticks and western black-legged ticks are its vectors, as they transmit the Borrelia burgdorferi bacteria to humans through their bite. A tick must be attached to your body for 24 to 36 hours to spread the bacteria to your blood.

According to the Centers for Disease Control and Prevention (CDC), cases of Lyme disease have more than doubled between 1995 and 2015. While the disease seems to be spreading to other parts of the United States, 2015 statistics show that the large majority (95 percent) of Lyme disease cases were reported from 14 states, including Pennsylvania.

The increasingly warm winters have improved conditions for ticks to thrive on deer and mice, the animals that perpetuate the life cycle of ticks. The earlier arrival of spring this year has also awakened dormant ticks sooner than expected. These factors are contributing to further spread of Lyme disease, making recognition and early treatment very important.

Typical symptoms of the disease include headache, fatigue, fever, and a particular skin rash known as erythema chronica migrans (ECM). Most individuals who develop Lyme disease will exhibit a round red bull’s eye rash within a few days to weeks at the site of the tick bite. Some may never develop a rash, while others may develop ECM in multiple areas.

This rash does not represent an allergic reaction to the bite, but rather a skin infection with the Lyme bacteria, Borrelia burgdorferi. It is a pathognomonic sign: a physician-identified rash warrants an instant diagnosis of Lyme disease and immediate treatment without further testing, even by the strict criteria of the Centers for Disease Control and Prevention. Such target lesions are characteristic of Borrelia infections, and no other pathogens are known that cause this type of rash.

Lyme disease progresses in stages, and the symptoms experienced can vary for each stage. Symptoms may start to occur anywhere between a few days to a month after bites from infected ticks.

Stage 1 – ECM rash (discussed above) and inflammation may occur at the site of a tick bite. Without treatment, it can last four weeks or longer. Stage 1 is called early localized Lyme disease. The bacteria have not yet spread throughout the body. Symptoms of stage 1 begin days or weeks after infection. They are similar to the flu and may include:

Fever and chills
Joint pain
Muscle pain
Stiff neck

Stage 2 – Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body. Symptoms may occur weeks to months after the tick bite, and may include:

Numbness or pain in nerves
Paralysis or weakness in the muscles of the face
Heart problems, such as skipped heartbeats (palpitations), chest pain, or shortness of breath

Stage 3 – Stage 3 is called late disseminated Lyme disease. The bacteria have spread throughout the body. Symptoms of stage 3 can occur months or years after the infection. The most common symptoms are muscle and joint pain. Other symptoms may include:

Abnormal muscle movement
Joint swelling
Muscle weakness
Numbness and tingling
Speech problems
Cognitive problems

A blood test can be done to check for antibodies to Borrelia burgdorferi. The most commonly used, is the ELISA test for Lyme disease. An immunoblot test is done to confirm positive ELISA results. Be aware, in the early stage of infection, blood tests may be normal. Furthermore, if you are treated with antibiotics in the early stage, your body may not make enough antibodies to be detected by blood tests.

In areas where Lyme disease is more common, your health care provider may be able to diagnose early disseminated Lyme disease (stage 2) without doing any lab tests.

Other tests that may be done when the infection has spread include:

MRI of the brain
Spinal tap/lumbar puncture to examine spinal fluid

If you have been bitten by a tick, visit your dermatologist for a thorough skin examination. If you find a tick attached to your skin, it should be removed immediately to reduce the likelihood of infection.

First, use a dry cotton ball to rub the tick in a counter-clockwise direction for one minute to make the tick release its mouth. Use gloves and a clean pair of tweezers as close to the skin as possible to remove the tick. Do not twist – pull the tick straight out gently but steadily. Do not use a heat source, petroleum jelly, or other substances to help you remove the tick, as this could irritate the tick and make it regurgitate infected fluids into the wound.

Once you remove the tick, clean the area with alcohol, warm water, and soap. Save the tick in a container to be taken to your dermatologist’s office for further identification. Take a photo of the tick if you cannot keep it.

If the tick seems to have burrowed into the skin, or you are unable to remove it, see a dermatologist immediately. Otherwise, visit a dermatologist if you develop the symptoms described above within a month after a bite.

If you are diagnosed with Lyme disease, you will be prescribed antibiotics. The type of medication, delivery method (e.g., oral, intravenous) and length of treatment period will depend on which stage is being treated.

Patients who are diagnosed early and treated with appropriate antibiotics typically recover well, with symptoms resolving quickly. If treated at later stages, NSAIDs (non-steroidal anti-inflammatory drugs) may be prescribed along with antibiotics to calm symptoms such as painful, swollen joints. Additional treatments may also be required to address heart or nervous system problems that may occur during the latest stages.

Without timely treatment, chronic issues with the heart, nervous system, and joints may occur.

Dermatologist Victoria A. Cirillo-Hyland, MD, FAAD recommends taking precautions when entering areas where ticks may be present.

Light shades of clothing should cover as much of your body as possible. Wear long sleeves, long pants, and high-top socks. Insect-repelling clothing has been recommended by the CDC for preventing illnesses (note that while ticks are often referred to as insects, they are actually arachnids, along with scorpions, spiders, and mites).

While products containing picaridin and DEET are effective and can be applied on the skin, the CDC has also suggested natural ingredients such as garlic oil, mixed essential oils, nootkatone, and 2-undecanone.

Periodically scan your body for ticks while outside, as they can be as small as poppy seeds and hard to spot. Take a hot shower within two hours of returning indoors and check your skin for any suspicious bumps.

Dr. Cirillo-Hyland and the team at the Bryn Mawr Skin & Cancer Institute would be happy to offer advice and assistance to anyone who is concerned or would like to learn more about Lyme disease or other insect- and skin-related infections. To request a consultation with a dermatologist in Bryn Mawr or Newtown Square, contact the practice online or call 610.525.5028.

Original Article on Plastic Surgery Journal

Victoria A. Cirillo-Hyland