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Tick bites: symptoms and treatment
Last reviewed: 04.07.2025
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In the United States, most bites to humans come from various species of Ixodidae ticks, which attach to a person and, if not removed, feed on them for several days.
Tick bites most often occur in spring and summer, they are painless. Most bites are uncomplicated and do not transmit infectious diseases. The bite causes the formation of a red papule and may cause hypersensitivity or a granulomatous reaction to a foreign body. When bitten by the Ornithodoros coriaceus (pajaroello) tick, vesicles are formed locally, then pustules, which, when ruptured, leave an ulcer, a scab is formed, and local swelling and pain of varying severity are observed. Similar reactions occur with bites of other ticks.
[ Treatment of tick bites
To reduce the cutaneous immune reaction and the possibility of transmitting infection, the tick should be removed as soon as possible. If the tick is still attached when the patient arrives at the hospital, the best method of removing the tick and all mouth parts from the skin is with a medium-sized, blunt, curved-jaw forceps. The forceps are positioned parallel to the skin to firmly grasp the mouth parts of the tick as close to the skin as possible. Care should be taken to avoid damaging the patient's skin or tearing off the body of the tick. The forceps should be pulled slowly away from the skin and not rotated around the bite site. A curved-jaw forceps is superior because the outer arc of the jaw can be close to the skin while the handle remains far enough away to make the forceps easier to hold. Any mouth parts of the tick that remain in the skin and are visible to the naked eye should be carefully removed. However, if the presence of mouth parts is in doubt, attempts at surgical removal may cause additional trauma greater than that caused by the remaining small jaw parts. Leaving the mouth parts in the bite site does not transmit the infection, it may only prolong the skin irritation. Other methods of tick removal, such as using a lit match (which can damage the patient's tissue) or covering the insect with petroleum jelly (which is ineffective), are not recommended.
After tick removal, an antiseptic is applied. The degree of tick swelling depends on the length of time it has been attached to the skin. If local swelling and skin discoloration occur, antihistamines are prescribed orally. Sometimes the tick is preserved for laboratory testing to detect the pathogen of a tick-borne disease specific to the geographic region where the bite occurred. Antibiotic prophylaxis is not recommended, but in areas with a high prevalence of Lyme disease, some experts consider it advisable (200 mg doxycycline orally once) for Ixodidae bites.
Pajaroello tick bites should be cleaned, moistened with Burow's solution in a 1:20 dilution, surgical treatment if necessary. Glucocorticoids are used only in severe cases. Infection is possible at the ulcer stage, but treatment is most often limited to local antiseptics.
Tick paralysis
Tick paralysis is rare; ascending flaccid paralysis develops after the bite of toxin-secreting Ixodidae ticks that parasitize a person for several days.
In North America, some species of Dermacentor and Amphiomma cause tick paralysis, caused by a neurotoxin secreted into the tick's saliva. During the early stages of tick feeding, there is no toxin in the saliva, so paralysis only develops when the tick has been parasitizing for several days or more. Paralysis can be caused by a single tick, especially if it attaches to the back of the skull or near the spine when it bites.
Symptoms include anorexia, lethargy, muscle weakness, incoordination, nystagmus, and ascending flaccid paralysis. Bulbar or respiratory paralysis may develop. Differential diagnosis includes Guillain-Barré syndrome, botulism, myasthenia, hypokalemia, and spinal cord tumor. Paralysis is rapidly reversible upon removal of the tick(s). If breathing is impaired, oxygen therapy or respiratory support is administered as needed.
Bites from other arthropods
The most common non-tick arthropod bites in the United States include sand flies, horse flies, deer flies, black flies, stingers, mosquitoes, fleas, lice, bedbugs, and water bugs. All of these arthropods, except for the assassin bugs and water bugs, also suck blood, but none are venomous.
The composition of arthropod saliva varies, and the lesions caused by bites range from small papules to large ulcers with swelling and severe pain. Dermatitis may also develop. The most severe consequences are due to a hypersensitivity reaction or infection; in susceptible individuals, they can be fatal. In some people, flea allergens can cause respiratory allergies even without a bite.
Knowing the location and structure of blisters and ulcers can sometimes give clues about the arthropod itself. For example, midge bites are usually located on the neck, ears, and face; flea bites can be numerous, located mainly on the legs and feet; bedbug bites, often in a single line, are usually localized on the lower back.
The bite is cleaned, and if itching occurs, an antihistamine ointment or cream with glucocorticoids is applied. In case of severe hypersensitivity reactions, appropriate treatment is prescribed.