Normal bite reaction
A small red spot at the site of the bite, like an insect bite. The redness and irritation can last a few days and then fade. The spot does not spread.
Infection
Medically reviewed by Dr. A.M. van Coevorden, dermatologist, on
± 7 min read
Tick bitea red ring after a tick bite
A tick bite is usually harmless: a small red spot that fades after a few days. If a red or blue-red patch or ring appears and keeps growing, it may be erythema migrans, the first sign of Lyme disease.
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- What is a tick bite?
- How do you get Lyme disease from a tick?
- Tick bite with a red ring: what does erythema migrans look like?
- Is Lyme disease contagious?
- How does the doctor diagnose erythema migrans?
- Treating a tick bite: how it works
- Does erythema migrans go away?
- What can you do yourself against tick bites?
- When to see a dermatologist or GP?
- Frequently asked questions about tick bites
What is a tick bite?
A tick is a small creature that attaches to the skin and sucks blood. You pick up ticks in green areas: woods, dunes, parks and gardens. More than 1 in 5 ticks in the Netherlands carry the Borrelia bacterium, which causes Lyme disease. Of the roughly 1 million people bitten by a tick each year, about 27,000 become ill. Most tick bites therefore have no consequences.
How do you get Lyme disease from a tick?
The bacterium enters your skin through the bite. The longer the tick stays attached, the higher the chance that the bacterium is passed on. That is why a tick should be removed as soon as possible, preferably within 24 hours. In about 4 out of 5 people who get infected, the illness starts with a skin sign: erythema migrans.
Tick bite with a red ring: what does erythema migrans look like?
The difference between a normal bite reaction and erythema migrans lies in the size and the course.
Erythema migrans
A red or blue-red patch or ring that grows over a few days, usually to more than 5 centimetres. The centre often becomes lighter, creating a ring. The patch appears days to 3 months after the bite, on average after 1 to 2 weeks, and can grow to 30 to 40 centimetres. On darker skin the colour looks more blue. The patch may itch or burn, but it is usually not painful.
Other forms
On the face you more often see a streak than a ring, especially in children. The patch can also appear somewhere other than the bite. Sometimes several patches develop.
Alongside the patch you may feel flu-like: fever, headache, muscle pain, joint pain and fatigue. These symptoms come days to weeks after infection. An ordinary tick bite looks like an insect bite; a growing ring is the difference.
Is Lyme disease contagious?
N
No. You only get the bacterium through a tick bite. Erythema migrans does not pass from person to person.
How does the doctor diagnose erythema migrans?
The doctor makes the diagnosis by looking. If the doctor sees a red or blue-red patch or ring that is slowly growing, that is Lyme disease and treatment starts. A blood test is not useful for erythema migrans: in the first weeks there are often no antibodies in the blood yet, even when you are infected. A blood test right after removing a tick is not needed either.
At 247dermatologist you send photos of the patch and answer questions about the bite and the date. Take the photo with something next to it for scale, such as a coin, and repeat the photo after a few days. That shows the dermatologist whether the patch is growing. Within 12 to 48 hours the dermatologist assesses whether it is a normal bite reaction or whether it fits erythema migrans.
Treating a tick bite: how it works
A tick bite without a patch needs no treatment. A growing patch or ring does, always with antibiotics from a doctor.
Remove the tick straight away
Grip the tick with pointed tweezers or a tick remover as close to the skin as possible, at the head. Pull the tick out calmly. Do not twist and do not squeeze the body. Do not apply alcohol, oil, nail polish or soap first: the tick may then release infected saliva into the skin. If part of the head stays behind, it will work its way out by itself, like a splinter.
Disinfect and note the date
Disinfect the small wound afterwards. Write down the date of the bite and take a photo of the spot.
Watch the spot for 3 months
Look out for a new patch or ring at the bite site or elsewhere on your skin, and for fever, muscle pain or joint pain.
Growing patch: antibiotics from the doctor
Erythema migrans is treated with a course of antibiotic tablets, usually doxycycline. If that is not possible, for example in young children, pregnancy or allergy, the doctor chooses amoxicillin or azithromycin. The doctor decides on the medicine and the length of the course.
Tick attached for more than 24 hours?
Then you can decide together with your GP: a short preventive course of antibiotics, started within 72 hours of removal, or watchful waiting while keeping a close eye on the spot. If the tick was attached for less than 24 hours, no medicine is needed.
Does erythema migrans go away?
With a course of antibiotics, erythema migrans usually heals completely and permanently. Fatigue can linger for a while after the course and usually passes by itself. Without treatment the patch also disappears, within weeks to months, but the bacterium stays in your body. Months to years later, problems can develop in the joints, nerves, heart or skin. That is why erythema migrans is always treated, even if the patch is already shrinking.
What can you do yourself against tick bites?
Ticks are active from March to November. This is how you reduce the risk of a bite and of Lyme disease:
- check yourself and your children for ticks after a day outdoors, especially the groin, buttocks, edges of underwear, armpits, backs of the knees, behind the ears and along the hairline
- in green areas wear long trousers tucked into your socks, closed shoes and long sleeves
- use an insect repellent containing DEET on skin or clothing
- remove a tick as soon as possible, preferably within 24 hours
- watch the spot for 3 months after a bite
When to see a dermatologist or GP?
Contact a doctor within 3 months of a tick bite if:
- a red or dark purple patch or ring appears that grows over a few days, at the bite site or elsewhere
- you develop fever, headache, muscle pain or fatigue
- you get painful, swollen joints
- you get pain, tingling, weakness, double vision or a drooping face
- the tick was attached for more than 24 hours
Not sure whether the red patch is a normal bite reaction or erythema migrans? Send photos of the patch and a dermatologist at 247dermatologist assesses them within 12 to 48 hours, no referral needed. If the picture fits erythema migrans, the dermatologist can prescribe antibiotics. That is decided case by case, and a consultation does not guarantee a prescription.
Frequently asked questions about tick bites
Not sure whether this needs a look? Have a dermatologist assess it: you get an answer within 12 to 48 hours, no referral needed. In an emergency, contact your GP straight away or call 112.
How long after a tick bite does the red ring appear?
Days to 3 months after the bite, on average after 1 to 2 weeks. So keep watching the spot for 3 months. A red spot straight after the bite is a normal reaction, not erythema migrans.
How big is the red ring in Lyme disease?
Usually more than 5 centimetres, and the patch grows over a few days. It can reach 30 to 40 centimetres. The centre often becomes lighter, but not always: a plain patch that keeps growing counts too.
Is a red spot after a tick bite always Lyme disease?
No. A small red spot that fades after a few days is a normal reaction to the bite. Only when the patch or ring grows is it erythema migrans. If in doubt, take photos over a few days and have them assessed.
Do I need antibiotics after a tick bite?
Not as standard. Antibiotics are needed for a growing patch or ring. If the tick was attached for more than 24 hours, you can choose with your GP to take a short preventive course within 72 hours of removal. If the tick was attached for less than 24 hours, no medicine is needed.
Can I get a blood test after a tick bite?
Straight after a bite it is pointless: antibodies are not yet measurable. For erythema migrans a blood test is not needed either; the doctor makes the diagnosis by looking.
How do I remove a tick?
With pointed tweezers or a tick remover, as close to the skin as possible. Pull calmly and straight out, do not twist. No alcohol, oil or soap beforehand. Disinfect the skin afterwards and note the date.
What if the tick's head stays in the skin?
That is not a problem. The fragment works its way out by itself, like a splinter. Keep watching the spot for 3 months.
Have a dermatologist look at your skin
Upload photos and answer a few questions. A BIG-registered dermatologist replies within 12 to 48 hours, no referral needed, from € 39.
If more is needed, the dermatologist refers you to a medical specialist.
Want to know what a dermatologist does, when you can see one and how quickly that can happen? Read more about the dermatologist.
Sources and more information
- Wat te doen bij een tekenbeet? (rivm.nl)
- Verwijderen van een teek (rivm.nl)
- Hoe verwijder ik een teek? (thuisarts.nl)
- Ik heb de ziekte van Lyme (thuisarts.nl)
- Ziekte van Lyme, erythema migrans (nvdv.nl)
- Erythema migrans (huidziekten.nl)
Source: RIVM, Thuisarts.nl (NHG) and the Dutch Society of Dermatology and Venereology (NVDV).
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