Patient information: Lyme disease prevention

LYME DISEASE OVERVIEW

Several measures may help prevent tick bites and tick-borne illnesses, such as Lyme disease. These include personal precautions, such as wearing long pants and long-sleeved shirts, wear tick repellant, and also making changes to areas in your yard where deer ticks are likely to live.

The diagnosis and treatment of Lyme disease are discussed separately. (See "Patient information: Lyme disease symptoms and diagnosis" and "Patient information: Lyme disease treatment".)

More detailed information about Lyme disease is available by subscription. (See "Clinical manifestations of Lyme disease in adults" and "Diagnosis of Lyme disease" and "Evaluation of a tick bite for possible Lyme disease" and "Treatment of Lyme disease".)

PERSONAL PRECAUTIONS

You can take precautions to prevent ticks from attaching to your skin if you who know that you will be spending time in tick-infested areas where Lyme disease and/or other tick-borne illnesses are common.

Wear protective clothing — Ticks can be kept away from the skin by wearing long-sleeved shirts and long trousers tucked into socks. Wearing light-colored clothing will make it easier to spot ticks on clothing.

Use a tick repellent or tick-killing product — Several different commercially available products repel or kill ticks.

DEET — The repellant that is most commonly used against ticks in the United States is DEET (N,N-diethyl-3-methylbenzamide). Products with 10 to 35 percent DEET are adequate in most circumstances and are effective for approximately two hours.

As the concentration of DEET increases, the duration of activity increases; a concentration of about 24 percent provides an average of five hours of protection. Because DEET can wash off with swimming and perspiration, it may be necessary to reapply the product periodically. DEET can cause hives and blister-like lesions in some adults and children.

It is important to talk with a healthcare provider about guidelines for using DEET on children; products with more than 30 percent DEET should not be used. Small children exposed to large amounts of DEET have rarely experienced seizures. Furthermore, DEET should be stored safely out of the reach of children; small children who swallow DEET may experience seizures, coma, and even death.

Picardin — Picaridin is another tick repellent that is available without a prescription in the United States, as a 7 or 15 percent solution (as Cutter Advanced™ and Cutter Advanced Sport™, respectively). This agent has been successfully used for years as a tick repellent at even higher concentrations in Europe and Australia. The Centers for Disease Control and Prevention currently recommends picaridin as an alternative to DEET.

The manufacturer recommends applying picardin every three to four hours. No toxicity in humans has been reported, although liver toxicity has been reported in rats at very high doses. Unlike DEET, picaridin does not usually cause side effects. Picaridin is odorless, non-sticky, and non-greasy; it also does not irritate skin, stain fabrics, or degrade plastics.

Permethrin — Permethrin (sold as Permanone®) is a pesticide that kills ticks and mites. It can be applied to clothes (not directly to skin) and is effective in reducing the risk of tick bites. Permethrin does not appear to be harmful to humans, although it occasionally causes swelling and redness of the skin.

Other products — Although citronella may repel other insects, it probably does not repel ticks. Avon's Skin-So-Soft® does not repel ticks and should not be used for this purpose.

Inspect your clothes and skin — It is important to develop a habit of inspecting the skin (and a child's or significant other's skin) for ticks when coming in from the outdoors. This inspection should include areas where ticks most often bite, including the armpits, groin, backs of the knees, belt line, and the scalp. Showering or bathing may help to detect ticks.

CHANGES TO YOUR ENVIRONMENT

Making changes in the area where you live can reduce the chances of being exposed to ticks outdoors, although personal precautions are still essential after these changes are made.

• Install a tall fence — A tall fence that keeps deer (a carrier of ticks) out of the yard can reduce the number of ticks in an outdoor area.
• Cleaning forest borders and trimming lawns — Mice tend to live in areas that border forests. Cleaning these areas and laying down a 36-inch (approximately one meter) wide border of wood chips can decrease the number of ticks on a lawn. Keeping the lawn well-trimmed and improving exposure to the sun will discourage ticks from residing in grass.
• Treating residential property with tick-killing products — Treating one's property with products that kill ticks can also reduce exposure. These products include diazinon, chlorpyrifos (sold as Dursban®), and carbaryl (sold as Sevin®). These products should be applied to stone walls and areas that border forests; they do not need to be applied to open lawns because ticks dry out rapidly in closely cut, sun-drenched lawns.

Placing permethrin-soaked cotton balls in cardboard tubes outside for white-footed mice (the most common carrier of Ixodes ticks) to use as nesting material may reduce the tick population; ticks feeding on these mice are killed by exposure to permethrin. However, studies have shown conflicting results of the effect of these measures on tick populations [1]. A commercial preparation based on this concept is available by the trade name Damminix Tick Tubes®.

LYME DISEASE VACCINE

A vaccine was previously available to prevent infection with B. burgdorferi. However, it is no longer available.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed every four months on our web site (www.uptodate.com/patients).

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information

Patient information: Lyme disease symptoms and diagnosis
Patient information: Lyme disease treatment

Professional level information

Clinical manifestations of Lyme disease in adults
Diagnosis of Lyme disease
Evaluation of a tick bite for possible Lyme disease
Lyme carditis
Microbiology and epidemiology of Lyme disease
Musculoskeletal manifestations of Lyme disease
Prevention of Lyme disease
Treatment of Lyme disease

The following organizations also provide reliable health information.

• National Library of Medicine

      (www.nlm.nih.gov/medlineplus/lymedisease.html, available in Spanish)

• National Institute of Allergy and Infectious Diseases

      (www3.niaid.nih.gov/topics/lymeDisease/)

• A review of Chronic Lyme Disease

      (www3.niaid.nih.gov/topics/lymeDisease/understanding/chronic.htm)

• Center for Disease Control and Prevention

      (www.cdc.gov/ncidod/dvbid/lyme/)

• American Lyme Disease Foundation, Inc.

      (www.aldf.com/faq.shtml, available in Spanish)

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