Bitten by a Tick? How to Know

Ticks seem to be everywhere these days, and Lyme disease occurs in every state except Hawaii. (1) And there’s good reason you’re likely hearing more and more about the bugs and the bite-related infections that they spread.

In 2021, an estimated 476,000  Americans were diagnosed with Lyme disease, and the number of Lyme disease cases reported to the Centers for Disease Control and Prevention (CDC) has more than quadrupled since 1990. (1) While it’s not clear what’s causing the upswing in tick populations and bite-related infections, ticks have been expanding their geographic range.

Despite the prevalence of ticks and the exposure they’ve garnered in the news, many people are still in the dark about tick-borne diseases. The CDC reports that a national survey shows that 20 percent of people living in an area where Lyme disease is common were not aware of the risks. And those risks are substantial. “Somewhere between 20 and 40 percent of blacklegged ticks carry Lyme,” says Richard Ostfeld, PhD, a disease ecologist at the Cary Institute of Ecosystem Studies in New York.

Here’s a primer on the best ways to avoid ticks, how to identify their bites, and what to do about a bite if one is discovered.

Ticks are not fliers or jumpers. (2) They’re crawlers — and poor ones at that, Dr. Ostfeld says. “They don’t move fast at all,” he says.

To get onto your body, ticks like to climb over low plants, foliage, logs, or other close-to-the-ground objects. From there, they grasp the object with their back legs while reaching out with their front legs in an act researchers call “questing.”

When you brush past, the questing tick grabs hold of your shoes or pants or skin and then makes its way upward until it finds a safe, inconspicuous spot to sink its mouthparts into your flesh, Ostfeld says. “They like those tucked-away places where the skin is soft and where they can hide without being detected,” he adds, mentioning the backs of the knees, the armpits, the back of the neck, and the groin as favorite locations.

Once attached to your skin, a tick will stay there for several days, slowly gorging itself on your blood before dropping off on its own. Ticks must feed on a host at every stage of their life cycle in order to survive.

Detecting tick bites can be tricky. Unlike the bites of mosquitoes and other insects, tick bites do not tend to cause itching or immediate skin irritation.

“Every blood-feeding arthropod and insect introduces saliva into the wound,” explains Jonathan Day, PhD, an emeritus professor of medical entomology at the University of Florida. In the case of mosquitoes and some other biting insects, this saliva contains proteins that prevent the bite wound from clotting, which would slow the outflow of blood and therefore disrupt feeding, Dr. Day explains.

Apart from preventing your blood from clotting, these proteins also trigger a reaction from your immune system. This reaction produces redness, swelling, itching, and all the other unpleasant skin irritations that come with bug bites, Day explains.

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But tick bites are different. “Ticks suppress that reaction with immunosuppressants in their saliva,” Ostfeld explains.

Since you can’t feel a tick’s bite, you can detect it in one of two ways:

1. By spotting or feeling a tick on your skin
2. By identifying a bite once the tick has dropped off

If the Tick Is Still Attached

Finding a tick on your skin can be quite difficult, Ostfeld says — especially during the spring and early summer months when ticks are in their nymph stage, and so are roughly the size of a poppy seed. You have to closely examine your skin — and then ask someone to scan the places you can’t see — in order to spot them. While adult ticks are a little larger, they’re still difficult to identify.

Running your hands over those parts of your body ticks tend to bite is another way to find them before they’ve dropped off. (They’ll feel like small, unfamiliar, hard nodules on your skin.)

If the Tick Has Dropped Off

While tick bites don’t immediately itch like other bug bites, they can still cause a red welt or itchy lesion to rise on the skin after the tick has dropped away, Ostfeld says.

The size and quality of this lesion can vary a lot from person to person, he says, and so it may be impossible to differentiate a tick bite from a mosquito bite. If the tick that bit you was not carrying Lyme disease or some other infection, the bite is likely to resemble a mosquito bite and quickly fade away.

RELATED: What’s Causing Your Skin Rash?

But if you find a tick on your skin or notice an itchy lesion that doesn’t go away within a few days, that could indicate Lyme disease or some other kind of tick-borne infection. (3) The same is true of a large, bull’s-eye-shaped skin lesion — something that looks like a red welt surrounded by one or more outer rings of inflamed red skin. (3) This bull’s-eye rash is a hallmark of Lyme disease.

If you find a tick on your body, you’ll want to remove it as soon as possible. In general, a tick needs to be attached to your body for at least 36 hours to transmit Lyme disease, but other infections can be transmitted within hours or even less time. (4)

If you can get to your primary care doctor or dermatologist quickly, he or she can remove the tick with appropriate tools that are sure to get the full tick out.

If removing yourself, use tweezers or commercially available tick-removal tools. “Grab the tick’s mouthparts as close to the skin as possible and pull straight out,” Ostfeld says. Don’t worry if you squish the tick or leave a small speck of black on your skin. “That’s not a big deal. Swab it with alcohol or something else to prevent infection,” he says.

(Despite rumors floating around online, killing or mashing the tick during extraction will not cause it to inject more saliva or fluid into your body.)

“The longer they’re in you, the more likely they are to transmit pathogens, so you want to get them out as quickly as possible,” Ostfeld adds.

Do the same if you notice a bite — either from a tick you found or from an unknown source — that’s not acting like a mosquito bite. “If the rash is any bigger than a highly localized red spot — like a mosquito bite — then go see a doctor,” he says. Likewise, see your doctor if you feel any flu-like symptoms, muscle aches, or chills within a week to 10 days of the bite, all of which can be indicative of tick-borne infections, he adds.

If a doctor suspects you may have contracted Lyme or some other type of infection, he or she will prescribe antibiotics, either oral or possibly intravenous, to treat the problem. (5)

Ticks can thrive in a variety of environments. “Ticks are found in thickets and coastal areas, or in low grasses and herbaceous vegetation,” Ostfeld says. “But they’re predominantly forest creatures.” Grassy, bushy, and especially heavily wooded areas are all prime real estate for ticks. Staying away from those environments is your best defense, he says.

But if you do venture into such areas, wear long pants and boots, and take them off as soon as you get home. Ostfeld recommends throwing any clothing you were wearing into the dryer — turned to high heat — as soon as possible. Ticks love humidity, and they’ve been shown to survive washing and drying. But toss your clothes in the dryer without wetting them, and the dry, hot conditions should kill them off, he says.

You can also use DEET and other bug repellents to effectively keep ticks away, he says. A chemical called permethrin is available as a spray, and when applied to your boots or hiking pants, it can kill ticks on contact.