Lyme disease is a bacterial illness and inflammatory disease that spreads through infected tick bites. Deer (Ixodes) ticks house the spirochete bacterium (Borellia species) in their stomachs. When one of these ticks bites the human skin, it may pass the bacteria into the body. These ticks tend to be attracted to creases in the human body, so Lyme disease may often first appear in the skin of the armpits, the nape of the neck, or the back of knees. If left untreated, Lyme disease can go on to cause abnormalities in the heart, joints and nervous system.
Lyme disease was first identified in 1975 in Old Lyme, Connecticut, and hundreds of thousands of cases have been reported to the Centers for Disease Control since then. Cases have been reported from every state, although it is more commonly seen in the Northeast, Upper Midwest and Pacific Coast. Lyme disease has also been reported in European and Asian countries as well.
There are three phases to the disease:
Early Localized Phase. During this initial phase, the skin around the bite develops an expanding ring of redness. The ring may have a bull’s eye appearance (erythema migrans) with a bright red outer ring surrounding clear skin in the center. Most people don’t remember being bitten by a tick. More than one in four patients may never get a bull's eye rash. The skin redness may be accompanied by fatigue, chills, muscle and joint stiffness, swollen lymph nodes and/or headaches.
Early Disseminated Phase. Weeks to months after the initial rash disappears, the bacteria spread throughout the body, impacting the joints, heart, and nervous systems. Symptoms include multiple erythema migrans-like rashes, migrating pain in the joints, neck ache, tingling or numbing of the extremities, enlarged lymph glands, sore throat, abnormal pulse, fever, changes in vision, or fatigue.
Late Dissemination (Chronic) Phase. Late in the dissemination of the disease, patients may experience an inflammation of the heart, which can lead to heart failure. Nervous system issues can develop, such as paralysis of facial muscles (Bell’s Palsy) and diseases of the peripheral nerves (peripheral neuropathy). It is also common for arthritis and inflammation of the joints to appear, which cause swelling, stiffness and pain.
Lyme disease is diagnosed through a combination of a physical examination, skin biopsy or tissue culture, and various blood tests designed to detect the Lyme bacteria itself or Lyme disease antibodies. Most cases of Lyme disease are curable using antibiotics, but the longer the delay, the more difficult it is to treat. Your dermatologist may also prescribe medications to help alleviate joint stiffening or pain.
The best form of prevention is to avoid tick bites. Use insect repellent containing DEET. Wear long sleeves and pants when outdoors. Tuck the sleeves into gloves and pants into socks to keep your skin covered. After a hike, check the skin and look for any tick bites, especially on children. If you do find a tick, don’t panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination.