Clearing up misinformation about deer ticks, Lyme disease
I think a lot about ticks and Lyme, spending so much time in an area of the state where the disease is rampant. Seems like everyone I know these days has either dealt with Lyme personally or with a family member who suffered or suffers with it.
In a recent issue of Pennsylvania Outdoor News, we ran what I thought was a pretty accurate and complete story about the status of the disease in our state. In response, Dr. David Adams contacted us to alert our readers to some additional information.
" I would like to give some useful pointers to supplement your recent article on deer ticks and Lyme disease. This practical information will fine-tune some misinformation seen in articles written by well-meaning but inexperienced or less-experienced folks in the prevention, diagnosis and treatment of Lyme disease," he said. "To give you some confidence in my experience and credentials, I am a life-long outdoorsman — hunting, fishing, trail running — and dermatologist practicing at Penn State Hershey Medical Center."
Adams noted that he has diagnosed and treated dozens of cases of early Lyme Disease successfully (early is the first two months after the tick bite when the patient has skin findings). He has removed and identified many Pennsylvania ticks (deer ticks – Ixodes scapularis, dog Ticks – Dermacentor variabilis and an occasional lone star tick – Amblyomma americanum) from his patients, family , friends and self.
" After two months, if not diagnosed or treated, the rash generally is gone and the patient may experience the chronic health issues including fatigue and joint pain," he said. "The No. 1 error I note in articles over the years is the term “bull’s-eye“ rash. I can tell you that over 80 percent presenting with the first stage Lyme rash called erythema migrans present with a large pink-red macule (a fixed, big, red, round or oval area usually on the body core/torso or upper thigh area)."
Adams explained that this starts as what looks like a typical “bug bite” around the tick or where the tick was several days after transmission of the Borella bacteria. If Lyme is not transmitted, it will generally stop at what looks like a typical insect bite. If Lyme is transmitted, it will expand to greater than 2 inches diameter, but the usual is 3-4 inches, but on occasion 12 inches or more, and then resolves within the first month.
"Only 20 percent or less present with central clearing to qualify as a “bull’s-eye” appearance. I truly believe that all – yes all – patients present with a rash, but it is either not seen due to the location or is very faint/subtle in some."
Sometimes during the first but nearly always during the second month the patient is sick, with flu-like symptoms including fatigue, fever, joint pain and sometimes headache, neurologic or cardiac issues, according to Adams. Occasionally, the patient then presents with what looks like 6-12 or more monomorphic (all look the same) red areas scattered on central body. If unrecognized and untreated these will generally be gone by the end of the second month but the patient will remain ill.
" Remember, during the first two months, if treated Lyme is curable. If the disease goes beyond two months, the skin findings are gone and at this point my window of opportunity for diagnosis by skin exam is gone and patients generally end up seeing other health care specialists for the other health issues," he said.
Adams stressed the importance of prevention, pointing out that our story was only partially helpful. Protective clothing is always good and DEET applied to the skin is effective but evaporates quickly and needs reapplication, he stressed. DEET applied to the clothing is not ideal and can ruin many synthetic fabrics.
"The most effective is clothing pretreated with permethrin. It will not ruin fabric, has no odor once dried and is 100 percent effective as a tick repellant and can last up to six washings. The system of clothing treated with permethrin and skin with DEET is used by the military for troops in heavy insect areas," he said.
" You can easily treat your own clothing with permethrin 0.5 percent spray available at most sporting goods stores under various brands. I have been using this for years and when I don’t cheat, have never removed a tick. But some of those time I’ve cheated, I have picked up a number of ticks, some attached and some not."