Published: 28/03/24

As part of tick bite prevention week our colleague and pharmacist Arlene Bailey from the Lyme Resource Centre has put together the following article to inform community pharmacists on Lyme Disease.

Does your team know enough about Lyme disease if anyone were to ask…..well, let us give you a quick resume of the basics so you give correct information and advice,  identify possible cases and refer to GPs in that critical ‘window of opportunity’ for antibiotic treatment.

So here’s a quick summary:

Lyme disease is a bacterial infection caused by the bite of an infected tick. Tick bites are usually painless and nymph ticks are tiny and may go unnoticed. There is no proven minimum time needed for the transmission of infection, so ticks should be carefully removed as soon as possible.

Most people don’t remember having a tick bite- so obtaining a travel /activity history is key here. Were they in places where ticks could have been? The Scottish Highlands are still a hotspot, but ticks are now commonly found all across Scotland, even in city parks and back gardens. If the tick is still attached, give advice on removing it safely.

Pharmacy follow-up/action:

1. watch a video on safe tick removal

2. stock tick removers and know how to use them

3. download the tick awareness leaflet for patients.

The Bullseye rash (Erythema Migrans or EM rash) is diagnostic of Lyme disease but is probably absent in at least 30% of cases. The rash can present as a typical bullseye, or an expanding reddish rash, or can be so faint it’s almost unnoticeable. You can see examples of EM rashes here and note the differences in darker skins. The rash isn’t normally itchy nor has a pus-type centre – but can be; and it may appear from 3-30 days on average after infection, sometimes on different parts of the body than where bitten. It can often be misdiagnosed as any insect bite, cellulitis, ringworm or an allergic reaction. Since an EM rash is diagnostic of Lyme disease a blood test is not required ie refer for three weeks antibiotic treatment immediately as per NICE Guideline 95