Management of the bite

The main symptoms of tick bites are:

• Itching
• Swelling
• Blistering
• Bruising

Patients may also experience pain at the site of the bite.

You can advise the patient on self-care to manage these symptoms. Patients should be advised to avoid scratching the bite and keep the area clean to help prevent infection. You can also advise use of simple first aid measures such as cold compresses which may help reduce local pain and swelling.

There are lots of products that could be recommended to support symptom management if simple first aid measures aren’t enough for the patient. Products such as paracetamol or ibuprofen may relive pain and oral antihistamines or topical corticosteroids e.g. hydrocortisone 1% cream may relieve itching. There are also a variety of products targeted specifically at bites and sting relief. Some contain the products mentioned above but some may also include topical antiseptics, topical antihistamines, topical anaesthetics and soothing compounds such as zinc sulphate. There is limited clinical evidence of the efficacy of these products Scenario: Management in primary care | Management | Insect bites and stings | CKS | NICE, but patients may still wish to purchase them. Care should be taken to check the age range these are suitable for and also the other ingredients as some may cause skin irritation in some patients. You should familiarise yourself with the products stocked in your pharmacy and their specific instructions.

If the bite is infected the patient could be seen in the pharmacy under Pharmacy First or if that isn’t possible then refer to a GP. Topical corticosteroids should not be recommended if the bite appears infected or the skin is broken. You can find out more about topical corticosteroids from Corticosteroids - topical (skin), nose, and eyes | Health topics A to Z | CKS | NICE

When does a tick bite need referral?

NICE Recommends the following:

Patients presenting with the following after a tick bite should seek urgent referral to A and E:

• Suspected systemic reaction – angio-oedema (swelling of a body part), anaphylaxis, airway compromise, difficulty breathing, seizure, swelling of mucous membranes.
• The bite site is on the face or mucous membrane and there is a risk of airway obstruction or compromised vision.
• The patient is immunocompromised and showing signs/symptoms of infection
•  Fever and was bitten outside the UK

Patients presenting with the following after a tick bite should seek referral to their GP:

• Fever
• Flu-like symptoms
• Round or oval shape rash (erythema migrans) appearing at least 48 hours after the bite
• Swollen lymph nodes
• Significant collection of fluid or pus at the bite site
• They have had a previous allergic reaction to a tick bite
• They were bitten by a tick in a country outside the UK