Tick Bite First Aid: How to Remove a Tick, Lyme Disease Signs and When to See a Doctor

Quick answer: remove an attached tick as soon as you find it. Use clean, fine-tipped tweezers to grasp the tick as close to the skin as possible and pull straight up with steady, even pressure, without twisting or jerking. Clean the bite and your hands with soap and water or rubbing alcohol, and dispose of the tick by sealing it in a bag or container, wrapping it in tape or flushing it. Do not use petroleum jelly, nail polish or heat. Watch for fever, a spreading rash, headache or joint pain for several weeks, and see a doctor if any appear or if you are not sure how long the tick was attached.

Ticks are not only a problem for hikers. They live in parks, backyards, community gardens and the edges of wooded areas inside cities and suburbs, and they can hitch a ride home on pets, clothing and backpacks. Finding one attached to your skin is unsettling, but the steps to deal with it are simple and well established. This guide is part of our emergency first aid guide for city households. It explains how to remove a tick, what to watch for afterward and how to lower the chance of future bites.

Sources: Centers for Disease Control and Prevention (CDC) pages on tick removal, Lyme disease, tick-borne diseases and preventing tick bites; Infectious Diseases Society of America (IDSA) guidance on Lyme disease prophylaxis; U.S. Environmental Protection Agency (EPA) guidance on insect repellents; American Academy of Pediatrics (AAP) HealthyChildren.org information on ticks. This article is general information, not medical advice. Contact a health care provider about any concerns.

What Ticks Are and Where They Live

Ticks are small arachnids, related to spiders and mites, that feed on the blood of animals and people. They do not jump or fly. Instead, they climb onto grass, shrubs and leaf litter and cling to anything that brushes past, in a behavior called questing. Once on a person or pet, they crawl to a warm, protected spot, such as the scalp, behind the ears, the armpits, the groin, the waistband or behind the knees, and then attach.

Ticks go through several life stages, from larva to nymph to adult. Nymphs are about the size of a poppy seed, which is why many people never notice them. Adults are larger, about the size of a sesame seed or an apple seed, depending on the species and how much they have fed.

Common ticks in the United States

• Blacklegged tick (deer tick): spreads Lyme disease, anaplasmosis, babesiosis and Powassan virus. Common in the Northeast, Upper Midwest and parts of the Southeast.
• American dog tick: can spread Rocky Mountain spotted fever and tularemia.
• Lone star tick: can spread ehrlichiosis, and its bite has been linked to alpha-gal syndrome, a condition that can cause an allergy to red meat.
• Brown dog tick: can spread Rocky Mountain spotted fever in some regions.
• Western blacklegged tick: spreads Lyme disease on the Pacific coast.

Ticks are most active in warmer months, but adult blacklegged ticks can be active on mild winter days when temperatures are above freezing, so a single cold month does not end the risk.

How to Remove a Tick

The CDC recommends this method. The faster you remove the tick, the lower the chance of infection, because many disease-causing germs take time to pass from tick to person.

What you need

• Clean, fine-tipped tweezers
• Soap and water or rubbing alcohol
• A small container, zip-top bag or tape to hold the tick

Step-by-step

1. Grasp the tick with the tweezers as close to your skin’s surface as you can.
2. Pull upward with steady, even pressure. Do not twist or jerk the tick, because this can break off mouthparts and leave them in the skin.
3. Check the site. If mouthparts remain in the skin, try to remove them with the tweezers. If you cannot remove them easily, leave them alone and let the skin heal.
4. Clean the bite area and your hands with rubbing alcohol, an iodine scrub or soap and water.
5. Dispose of the tick by putting it in alcohol, sealing it in a bag or container, wrapping it tightly in tape or flushing it down the toilet. Never crush a tick with your fingers.

Do not use folk remedies

Some old advice is not only ineffective but may make things worse. Do not:

• Paint the tick with nail polish
• Cover it with petroleum jelly
• Burn it with a match or hot object
• Try to freeze it off
• Squeeze or twist the body

These methods can stress the tick and cause it to release more of its stomach contents into the bite, which may raise infection risk. Pulling it out quickly with tweezers is better.

Tick removal tools

Specialized tick removal tools, such as small hooks and loops, work for some people, especially for small ticks, and can be kept in a first aid kit. If you do not have one, tweezers are fine. Our guide on building a first aid kit for a small apartment lists items worth keeping on hand.

Should You Save the Tick?

Many people want to keep the tick to show a doctor. It can help the doctor identify the species and estimate how long it was attached, which depends on how swollen it looks. You can place it in a sealed bag or container with a damp cotton ball and note the date and place of the bite. The CDC does not recommend using test results from the tick itself to decide whether you need treatment, because a negative result does not rule out infection and a positive result does not prove you are infected. Symptoms matter more.

If you do not want to keep the tick, taking a photo before disposal can help a clinician identify it.

What to Do After a Tick Bite

• Mark the date on a calendar, and write down where the bite happened.
• Watch the site and your health for 30 days.
• Do not scratch or pick at the bite.
• Check yourself and family members for more ticks.
• Call your doctor if you are unsure how long the tick was attached, if you live in an area with Lyme disease or if you develop symptoms.

Possible preventive treatment

In certain situations, a doctor may offer a single dose of the antibiotic doxycycline to help prevent Lyme disease after a tick bite. The IDSA guidance describes conditions such as the tick being identified as an adult or nymphal blacklegged tick, evidence that it was attached for at least 36 hours, the dose being given within 72 hours after the tick was removed and the bite occurring in an area where Lyme disease is common. This is a medical decision, and it is not suitable for everyone, so call a health care provider promptly if you think it applies.

Symptoms of Tick-Borne Illness

Symptoms can appear within days or up to a few weeks after a bite. Call a doctor if you notice:

• A rash: the classic Lyme rash, called erythema migrans, is a red patch that expands over days. It may have a clearing in the middle that looks like a bull’s-eye, but many rashes do not. The rash appears in a large share of people with Lyme disease, but not everyone gets it.
• Fever and chills
• Headache and fatigue
• Muscle and joint aches
• Swollen lymph nodes
• Facial drooping, severe headache or neck stiffness, which can signal more advanced Lyme disease
• Nausea, vomiting, abdominal pain or a spotted rash on wrists and ankles, which can be signs of Rocky Mountain spotted fever

Rocky Mountain spotted fever can become serious quickly, so do not wait if you develop fever and rash after a possible tick bite. Early antibiotic treatment is important for many tick-borne diseases.

Alpha-gal syndrome

Some people who have been bitten by a lone star tick develop alpha-gal syndrome, an allergy to a sugar found in red meat and some other products from mammals. Reactions can include hives, stomach pain or even anaphylaxis, often several hours after eating. If you develop symptoms like this, talk with a doctor. For emergency steps during a severe allergic reaction, see our guide to anaphylaxis first aid.

When to See a Doctor

Contact a health care provider if:

• You develop a rash, fever, severe headache, muscle aches or fatigue within a month of a tick bite
• The tick was attached for more than a day or you do not know how long
• You live in or visited an area where Lyme disease is common
• You cannot remove the tick, or parts of it remain and the area looks infected
• The bite site has increasing redness, warmth, swelling or pus
• The bite is on a young child, a pregnant person or someone with a weakened immune system

Seek emergency care for trouble breathing, swelling of the face or throat, fainting, confusion or a severe rash with high fever.

How to Prevent Tick Bites

Before you go outside

• Know the habitat. Ticks live in wooded, brushy and grassy areas, and in leaf litter. Parks and trails inside cities count.
• Use an EPA-registered repellent. Products with DEET, picaridin, IR3535, oil of lemon eucalyptus, para-menthane-diol or 2-undecanone are listed by the CDC for tick protection. Follow the label directions, and ask a pediatrician about use on children. Oil of lemon eucalyptus products should not be used on children under three.
• Treat clothing with permethrin. Products containing 0.5 percent permethrin can be used on boots, pants, socks and gear, and some clothing is sold pre-treated. Do not apply permethrin to skin.
• Dress to protect. Wear light-colored clothing, which makes ticks easier to see, and tuck pants into socks.

While you are outside

• Walk in the center of trails.
• Avoid brushing against tall grass and brush.
• Sit on a blanket or chair rather than directly on the ground or on logs.

After you come inside

• Check your whole body. Look at the scalp, behind the ears, the neck, armpits, groin, belly button, waistband and behind the knees. Use a mirror or ask someone to help.
• Shower soon. Showering within two hours of coming indoors can wash off unattached ticks and gives you a chance to check.
• Dry clothes on high heat. The CDC recommends tumbling dry clothes on high heat for 10 minutes to kill ticks. If the clothes are damp, they may need more time. Washing alone may not kill ticks.
• Check gear and pets. Ticks ride in on backpacks, jackets and animals.

At home

• Keep grass short, and clear leaf litter and brush.
• Place wood chips or gravel between lawns and wooded areas.
• Keep playground equipment and seating away from yard edges.

Ticks and Pets

Dogs and cats can bring ticks into the home and can get tick-borne illnesses themselves. Talk with a veterinarian about tick preventives suited to your pet. Check pets after outdoor time, and remove ticks with the same method used for people. Our guide to pet emergency planning for apartment dwellers covers other pet safety steps, and our guide on animal bites first aid explains what to do after other bites.

Tick Bites Versus Other Bites

Not every bite is a tick bite. Mosquito and flea bites itch and appear quickly, while spiders leave different marks. See our guide to spider bite first aid for those. A tick bite is usually painless, and many people discover the tick later.

Quick Checklist for Your First Aid Kit

• Fine-tipped tweezers
• A small tick removal tool
• Rubbing alcohol wipes or soap
• Small zip-top bags and tape
• A card with the steps above
• A phone number for your doctor or a nurse advice line

Frequently Asked Questions

How long does a tick need to be attached to spread Lyme disease?

The CDC notes that the Lyme bacteria usually are not transmitted until a blacklegged tick has been attached for at least 36 to 48 hours, which is why prompt removal and daily tick checks matter.

What should I do if the head of the tick is left in my skin?

Try to remove the mouthparts with clean tweezers. If you cannot, leave them alone and let the skin heal, and keep the area clean. See a doctor if it looks infected.

Do I need antibiotics after every tick bite?

No. Many bites need no treatment, but a doctor may offer a single dose of doxycycline in certain situations, such as when a blacklegged tick has been attached for at least 36 hours in an area where Lyme is common. Call a provider promptly to find out whether it applies.

Does a bull's-eye rash always appear with Lyme disease?

No. The rash can be a solid red patch or have a different shape, and some people never see a rash. Watch for other symptoms as well.

Can ticks live in cities?

Yes. Ticks live in parks, green spaces and backyards in many cities, and pets can carry them indoors.