Do tick lumps go away

By Isabella Storyclaire

last updated September 14, 2024

Contributions sourced from

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Tick Bite Granuloma: Recommendations for Surgical Treatment

Yonago Acta Med. 2015 Mar; 58(1): 5152.

Published online 2015 Mar 27.

Tick Bite Granuloma: Recommendations for Surgical Treatment

Division of Dermatology, Department of Medicine of Sensory and Motor Organs, School of Medicine,Tottori University Faculty of Medicine, Yonago 683-8504, Japan

*Both authors contributed equally to this report.

Corresponding author: Yuichi Yoshida, MD

pj.ca.u-irottot.dem@1ufihyxy

Received 2014 Nov 20; Accepted 2014 Dec 10.

Abstract

Tick bite is known as a possible cause of some infectious diseases such as Lyme disease, spotted fever and related illnesses. The reaction to a tick bite may persist for several months to several years and can sometimes cause histopathological granuloma. The long-term reaction to salivary extracts from the tick could be responsible for development of granuloma in our patient. We recommended complete resection as the only sure way to treat formed granuloma.

Keywords: granuloma, histopathology, tick, treatment

Tick bite is known as a possible cause of Lyme disease and spotted fever related illnesses.¹ Sometimes it also causes an immune reaction resulting in granuloma formation, even in the absence ofparts of the tick's mouth remaining in the skin.² We report a case oftick bite granuloma and discuss its pathogenesis and treatment.

PATIENT REPORT

Focal parakeratosis, spongiosis and acanthosis in the epidermis and granulomatous dermatitis(hematoxylin and eosin). Bar = 500 m.

Mixed cell granulomas composed with lymphocytes, eosinophils and histiocytes are seen(hematoxylin and eosin). Bar = 20 m.

A 3-year-old boy was referred to our clinic for evaluation of a red nodule on the right forehead.A tick on his forehead had been removed by hand 5 months before. Although he had been treated withtopical steroid ointment for 2 months, the response was poor. Physical examination revealed a red nodule withcrusts, 13 8 mm in diameter, on the right forehead ().His general condition was good and his personal past medical his-tory was unremarkable. The lesion was excisedunder local anesthesia. Histopathological examination showed focal parakeratosis, spongiosis and acanthosisin the epidermis (). In addition, there were mixed cell granulomascomposed of lymphocytes, eosinophils, plasma cells and histiocytes in the dermis(). Fragments of the tick were not involved in the resected tissue.

A red nodule with crusts on the right forehead.

DISCUSSION

Tick bite rarely causes granuloma. The progression of tissue reaction can be classified into three stages:acute, subacute and chronic phases.³ Predominant featuresin the acute phase are dilation of superficial vessels, perivascular lymphocytic inltrates, and intense epidermaland subepidermal infiltration of eosinophils. In the subacute phase, diffuse edema and dense infiltration of lymphocytes,neutrophils, eosinophils and histiocytes are seen, followed by an increase in fibrous tissue and the sporadic burst ofgiant cells in the chronic phase. The reaction to the bite of arthropods may persist for several months to severalyears. Stimulating agents of the arthropod somehow persist actively in these lesions for a remarkably long time.The history of an insect bite may not be reported by the patient after a lapse of many months. In such patients,it is possible for clinicians to misdiagnose the lesion as a malignant lymphoma, pyrexia Hodgkins granulomaor pseudolymphoma (lymphadenosis benigna cutis). In our patient, atypical lymphocytes or lymphoid follicles were not seenin the lesion.

Attempts to remove the living tick often result in fragments of the tick being left in the skin. It has been speculatedthat the reaction to the fragments of the tick is related to the pathogenesis of granuloma.⁴ On the other hand, the long-term reaction to the salivary extracts from a tick can be responsible fordevelopment of the lesion. It has been reported that frequent biopsies contributed to the eventual disappearance oftick bite granuloma.⁵ In our patient, no fragments of the tick werefound in the resected lesion. Therefore, salivary extracts might be related to the granuloma in our patient.

To our knowledge, there are few reports of treatment for tick bite granuloma. Treatment with topical steroid ointmentwas not effective at all in our patient. Although topical injection of corticosteroids to the granuloma can be used fortreatment, it is likely that the effect would appear only temporally if the remaining fragments have not been removed.Oral administration of corticosteroid is less recommended due to its systemic side effects, particularly in children.Accordingly, we recommend complete resection as the only way for treating formed granuloma regardless ofwhether tick fragments re-mained or not since it is assumed that it takes a long time for spontaneous regression.

Owing to these facts, in unusual cases in which dermatitis follows a tick bite, excision of any remaining embedded tickfragments and associated lesion is needed in order to reduce the likelihood of the development of granulomas.

Notes

The author declares no conflict of interest.

REFERENCES

Elston DM..Tick bites and skin rashes..Curr Opin Infect Dis..2010;23:132-8. . [PubMed] [Google Scholar]

Castelli E, Caputo V, Morello V, Tomasino RM.Local reactions to tick bites.Am J Dermatopathol.2008;30:241-8. . [PubMed] [Google Scholar]

Winter LH, Strakosch EA.Tick bites-dermacentor variabilis.J Invest Dermatol.1941;4:249-58. [Google Scholar]

Patterson JW, Fitzwater JE, Connell J.Localized tick bite reaction.Cutis.1979;24:168-9, 172. . [PubMed] [Google Scholar]

Goldman L.Tick bite granuloma: failure of prevention of lesion by excision of tick bite area.Am J Trop Med Hygv.1963;12:246-8. . [PubMed] [Google Scholar]

What to Do After a Tick Bite

Removing the Tick

You cant get sick from a tick that is crawling on you but has not yet attached. Ticks must bite you to spread their germs. If the tick is attached it will be hard to pull off.

Tick attachment time is important. Removing ticks as soon as possible reduces the risk of infection. If you or a loved one is bitten, remove the tick promptly. Heres how:

Grasp the ticks mouthparts against the skin, using pointed tweezers.
Be patient; the long mouthpart is covered with barbs, so removing it can be difficult and time consuming.
Pull steadily without twisting until you can ease the tick head straight out of the skin.
DO NOT pull back sharply; this may tear the mouthparts from the body of the tick and leave them embedded in the skin.
If this happens, dont panic! Embedded mouthparts do not transmit Lyme disease.
DO NOT squeeze or crush the body of the tick; this may force infected body fluids from the tick into the skin.
DO NOT apply substances such as petroleum jelly, nail polish, or a lighted match to the tick while it is attached. They may agitate the tick and force more infected fluid into the skin.
Once you have removed the tick, wash the wound site and your hands with soap and water, and apply rubbing alcohol or antiseptic to the site.
If you have found a tick on you, its a sign there may be others. Do a careful tick check.
Observe the bite site over the next two weeks for any signs of an expanding red rash or flu-like symptoms. (see below)
Consult with your PCP about sending your tick to a lab, such as TickCheck or TickEncounter, to be tested for pathogens. (see below)

Tick Testing

Consider the utility of sending the tick for identification and analysis of the potential infectious agents of Lyme disease and other tickborne pathogens.

CDC strongly discourages using results from these tick tests when deciding whether to use antibiotics after a tick bite. Positive results can be misleading. Even if a tick contains a pathogen, it does not mean that you have been infected by that pathogen. Negative results can also be misleading. You might have been bitten unknowingly by a different infected tick.

What to do after removing an attached tick that has bitten you.

In general, the CDC does not recomment taking antibiotics prophylactically after tick bites to prevent tickborne diseases. However, in certain circumstances, a single dose of doxycycline after a tick bite may lower your risk of Lyme disease. Consider talking to your healthcare provider if you live in an area where Lyme disease is common to discuss prophylaxic doxycycline and other options.

What to do in the weeks following the tick bite

Recognizing the Rash After a Tick Bite

It is important to understand that a rash is not always present or easily recognizable in early Lyme disease, and this can lead to delayed diagnosis and treatment.

Please refer to our poster of varied Lyme disease rash manifestations as a helpful identification tool.

When present, it is wise to take a picture of the rash with the date for your medical record, since a rash compatible with erythema migrans rash should prompt urgent evaluation and treatment. Lyme disease is most successfully treated in this first stage.

If you have a suspicious rash or your symptoms persist, please seek medical care immediately.

The erythema migrans Lyme disease rash is:

Round or oval, enlarges in size over days/weeks, & will not fade in a few days
Usually greater than 2 inches in diameter, often 6-8
Usually uniformly red
Sometimes but not often, a bulls eye rash with a red ring surrounding a clear area and red center
Minimally tender, minimally itchy (much less itchy than poison ivy), and sometimes warm
Often confused with spider bites

The incubation period from tick bite to rash is usually 3-10 days but can be 30 days.

The Lyme rash can spread through the bloodstream to other areas of the skin.

Sometimes blisters develop in the center of the rash.

Tick bite reactions are often confused with the rash of Lyme disease.

Tick bite reactions:

Are small red bumps, less than 1-2 in size
Appear at the site of the bite, often in the groin, belt area, arm pits, or behind the knee
Do not expand in size when observed over 24-48 hrs
May feel warm and tender to the touch
Can last days, even weeks

Requesting and Receiving Care For the Tick Bite

If you have a tick bite, watch for an expanding red rash or lesion at the site of the tick bite or an unexplained feverish, achy, fatiguing illness within 1 to 4 weeks after the tick bite. If you are concerned about symptoms or a rash, take a picture of the rash and contact your physician.

Bitten by a tick and have a rash?

Call our RASH HOTLINE at 410-870-5963 for a rash evaluation appointment.

Diagnosing Lyme Disease:

Lyme disease is a clinical diagnosis made by a doctor or nurse by examining the patient.
Acute Lyme disease is not a laboratory diagnosis; a negative Lyme blood test does not exclude Lyme disease in the first few weeks of the illness.
Many with Lyme disease have a flu-like illness and NO rash.
Fever, aches, and abrupt and severe fatigue can be the main symptoms of acute Lyme.
Lyme disease is different from a respiratory cold.
A runny nose and prominent cough are NOT symptoms of Lyme disease.
Blood tests do not accurately diagnose Lyme disease in the first few weeks of infection, so being vigilant about looking for symptoms is a more reliable way to identify an early case of Lyme disease.

If you have additional questions, please contact your Primary Care Physician or health care provider to discuss.