Lyme Disease – Just the Facts!

Provider blog by  Avi Silber, MD, FAAP

Spring is here and as we emerge to enjoy the outside again, here in the Hudson Valley there is always the concern about tick bites and Lyme Disease. There is a lot of information and opinions out there about Lyme Disease, some good, some bad. I want to highlight some of the evidence based facts that people get confused about.


Promptly remove attached ticks with a forcep – if a portion of the mouth or tic is still embedded – do not go digging into the skin – just apply a topical antibiotic. (the embedded piece does not increase risk of Lyme)

Wearing light colored clothing may help you identify ticks, but ticks may be less attracted to dark clothing – so no specific recommendation here.

Insect Repellant containing DEET if used as directed is safe even for children as young as 2 months old.

What do I do after I remove a Tick from myself or my child:

Ticks are not routinely sent for Lyme disease testing except in research studies. Do not bring a tick to your doctor’s office and expect it to be tested for Lyme.

A tick must be attached for 36 hours to transmit Lyme disease, so if you are sure that the tick you removed has only be on for a day, don’t panic – always be cautious and keep an eye on the area.

Antibiotics are not routinely given for tick bites. It is usually the tick that you didn’t find that gives you Lyme.

If you believe you removed a tick that has been on you for more than 36 hours, a single dose of antibiotics can be given to reduce likelihood of transmission of Lyme Disease, call your doctor.

Do not ask your doctor to do routine blood work for a tick bite, lab work is not useful in the first two weeks.

The Lyme Disease Rash

The Lyme Disease Rash (“The Bulls Eye”) usually shows up 7-14 days after a tick bite and is at least 5 cm, usually bigger.

An early rash at the site of the bite in the first few days is usually a reaction to the bite. Observe and if it goes away in 1-2 days it was not Lyme. If it continues to get bigger see your doctor

Not all Lyme Disease Rashes are the classic “Bull’s Eye”, any round or oval rash that continues to expand beyond 5 cm over a few days could be Lyme and you should contact your doctor’s office.

Other Signs of Lyme Disease

Flu Like Illness in the summer time (fevers, aches) can be a sign of Lyme Disease – contact your doctor.

“Bell’s Palsy” – paralysis of one side of your face is another sign of early Lyme disease we sometimes see.

Lyme Arthritis is typically swelling of single joint, typically the knee. Diffuse joint pain is not a typical sign of Lyme Arthritis.