Harvard Health Blog

My first tick sighting was a mixture of horror and fascination. It happened during my one and only experience with summer camp, on the shores of Alma Lake in north central Wisconsin.

One of my cabin mates discovered a big, fat tick burrowed into the skin of his belly. "Gross!" we chorused, unable to stop looking. Ideas for how to remove the tick swirled fast and furious. The leading contender was to light a match, blow it out, and touch the hot tip to the back end of the tick. As we scurried around looking for matches, cooler heads prevailed and the kid went off to the nurse for a more effective form of tick removal.

Knowing how to remove a tick is a useful skill for anyone who spends time outdoors, or who cares for someone who does. The sooner a tick is removed--correctly--the less likely the critter can deliver microbes that cause Lyme disease or other tick-borne diseases.

DON'T FALL FOR THE MYTHS

There are several folk remedies for removing a tick. Touching it with a hot match is a common one. Others include covering it with petroleum jelly or nail polish (in theory to suffocate it), or freezing it off. These are all supposed to make the tick "back out" of the skin on its own. But they often have the opposite effect, forcing the tick to hold tight, burrow deeper, and possibly deposit more of its disease-carrying secretions into the wound, which increases the risk of infection.

The best way to remove a tick? Here's what the U.S. Centers for Disease Control and Prevention recommend: Use a pair of fine-tipped tweezers to grasp the tick as close to the skin as possible. Then pull it out with a steady motion. Once the tick has been removed, clean the skin with soap and water. Dispose of the tick, which is probably still alive, by placing it in alcohol or flushing it down the toilet.

A tick feeds by way of a two-pronged mouthpart (hypostome) held in place with salivary cement and secured with tiny backward-pointing barbs. To remove the tick, use narrow-tipped tweezers and grasp it as close to the skin as possible; then pull upward slowly and steadily. If the mouthpart remains in the skin, try to remove it. If you can't, check with your clinician. Wash your skin and hands with soap and warm water. Try not to crush or squeeze an attached tick.

For most people who are bitten by a tick, removal ends the saga. For others, though, it is just beginning.

TICK-BORNE DISEASES

In the United States, the most common tick-borne disease is Lyme disease. It is caused by (begin italics) Borrelia burgdorferi (end italics), a bacterium carried to humans by infected blacklegged ticks, also known as deer ticks. Most cases of Lyme disease follow the bite of an immature deer tick, which is about the size of a poppy seed. Adult deer ticks can also transmit (begin italics) Borrelia burgdorferi (end italics), but they are larger and more likely to be seen and removed before they've had time to infect a person.

Lyme disease continues to spread across the Northeast and upper Midwest, and is now found in most states. The CDC has an interactive map that shows its spread from 2001 to 2011.

Infection with (begin italics) Borrelia burgdorferi (end italics) often--but not always--causes a rash that looks something like a red bull's eye soon after the tick bite. Treatment with antibiotics can usually prevent any short- or long-term repercussions. If the infection isn't treated, problems can develop in other parts of the body, including the joints, heart, and nerves. It can also cause arthritis that persists months or years after the tick bite.

Some people with Lyme disease and some community doctors have argued that (begin italics) Borrelia burgdorferi (end italics) can somehow evade courses of antibiotics and become a chronic infection that needs long-term antibiotic treatment--even though conventional antibody tests are negative. Chronic Lyme disease has been blamed for causing pain, fatigue, muscle aches, loss of memory and thinking skills, and a host of other problems.

Most Lyme disease experts don't believe active infection persists after antibiotic treatment and once blood tests are negative for antibodies. They've been critical of what they see as unreliable tests for infection and unwarranted, possibly harmful, long-term antibiotic therapy.

A recent front-page article in the Boston Globe highlighted the controversy around Lyme disease and its treatment.

Other tick-borne diseases include: babesiosis, ehrlichiosis, Rocky Mountain spotted fever, tularemia, tickborne relapsing fever

AIM FOR PREVENTION

The only foolproof method for staying tick free is avoiding areas where they lurk. That means staying out of brush and high grass in and around wooded areas.

If you like to be outdoors and find yourself frequenting those environments, the Connecticut Agricultural Experiment Station has published an excellent comprehensive handbook about tick management. If you don't have the time to read all 80 pages, here are some tips for protecting yourself from ticks, culled mainly from that handbook:

1. Wear light-colored clothing. Light colors make ticks easier to spot, especially tiny deer tick nymphs.

2. Tuck your pants inside your socks. It may not be a flattering look, but it creates a physical barrier against ticks.

3. Use insect repellent. Most of the chemicals that repel mosquitoes are somewhat effective against ticks, although it may take a heavier concentration of DEET -- between 30 percent and 40 percent -- to really keep them away. Permethrin is a stronger chemical that kills ticks as well as repels them. Products containing permethrin should be sprayed on clothes, not on the skin. Picaridin repels mosquitoes and other insects but not ticks.

4. Stay in the middle of the path (or fairway). Ticks can't fly or jump, so they can only get on you if you come into contact with the kind of environment they live in: moist, often shady, wooded areas, with leaves, low-lying plants, and shrubs.

5. Think sunny. Ticks don't do well in dry, open areas. Lawn furniture and playground equipment should be set back from the edge of wooded, shady areas. If you're picnicking, pick a patch of well-tended lawn or some open ground.

6. Inspect yourself and your children (and your pets), especially the legs and groin. Ticks usually get picked up on the lower legs and then climb upward in search of a meal. The odds of contracting Lyme or other tick-borne disease are minimized if a tick is removed soon after it's attached, and there's no risk if it's still crawling around. The shower is a good place to conduct a tick check. Feel for any new bumps on soaped-up skin.

(Patrick Skerrett is editor of the Harvard Health Blog and executive editor of Harvard Health Publications.)