June 22, 2010: How do you avoid a “STARI, STARI” night?

With the time of year that brings delicate lightening bugs out at dusk, also brings one of my nemeses:  ticks. My many summers as a camp counselor had certain rituals associated with the usual daily activities of swimming, canoeing, archery, horseback riding, campfires, etc. Every night after showers, I lined up the kids to do the dreaded “tick check”. Of course, if I found one, that meant I had to pull it off.  While I am not fearful of arachnids or any bug for that matter, I just don’t like ticks. Luckily for the campers, I chose not to use my mother’s “tried and true” recommendation of the “lighted match to the tick” technique for removal. Tweezers were my prized possession during those months. Afterwards, I would keep an eye on the camper for fever or a rash. The good news is I never found either.


However, here in The South, tick borne illnesses are certainly in season during the summer months. Rocky Mountain Spotted Fever (RMSF), Southern Tick-Associated Rash Illness (STARI), and Ehrlichiosis are endemic here in TN while Lyme disease is not. STARI and Ehrlichiosis are associated with the lone star tick.


Reducing exposure to these biting arachnids is key. Check yourself and your kids each day after being outdoors. This can be particularly difficult on the scalp when the child has long or thick hair. I find it is easier for me to “feel” the tick on the scalp with my fingertips than see them. Don’t forget the areas such as the groin and the backside which may not be as easily visible. If you find an attached tick, remove with fine-tipped tweezers.  http://www.cdc.gov/ncidod/dvbid/lyme/ld_tickremoval.htm


Using an insect repellent such as DEET (N,N-diethyl-m-toluamide) may be helpful for  ticks but probably works better on those pesky mosquitoes. DEET can be applied directly to the skin as directed on the product label instructions with the following considerations for young children:

            Not recommended for children under 2 months of age.

Don’t apply to children’s hands. Don’t spray directly onto children’s faces and don’t apply around the eyes or mouth.

Children 6 months to 2 years should be limited to one application per day

Children 2-12 years should be limited to 3 applications per day

The maximum concentration used should be 10% or less for children up to 12 years of age.  These low concentrations are effective for 2-3 hours. A second application of DEET may be warranted if the child is out of doors for more than 12 hours.

After returning indoors, wash the skin with soap and water.

Permethrin is another available product that is used as an insecticide, acaricide (kills ticks and mites), and also considered an insect repellant. Permethrin is a synthetic derivative of natural pyrethrin which comes from chrysanthemums. Permethrin is applied to clothing, mosquito netting, etc, but not the skin when used for this purpose. While topical permethrin has an incredible safety profile in most mammals including humans, it should never be used on cats and is also very toxic to fish.

Happy camping!

Question prepared by:  Saralyn R. Williams, MD  Medical Toxicologist


I am interested in any questions you would like answered in the Question of the Week.  Please email me with any suggestion at donna.seger@vanderbilt.edu


Donna Seger, M.D.

Medical Director

Tennessee Poison Center

Website: www.tnpoisoncenter.org

Poison Help Hotline: 1-800-222-1222