Dr Shawn M. Carney
Strategies for the Prevention of Lyme disease and Other Tick-Borne Illness Part 2: Protect Yourself
Updated: Oct 26, 2022
Learn about validated things you can do to decrease your chances of being bit when outdoors including clothing treatments, behavior once home, and how to handle a biting tick if discovered.
Consider 'Dressing Up' for the Occasion!
So you're headed into the great outdoors? What can you do if going beyond the borders of your own previously described tick-management landscape planned yard?
For starters, you might consider permethrin treatments for your clothes. Not all of your clothes, of course; just selective clothing which is often used in those environments. Permethrin-treated clothing and gear at specified locations on the body is highly effective against tick bites and safe to use. Permethrin is a man-made synthetic insecticide whose chemistry is based on natural pyrethrum compounds that are derived from the flowers of the chrysanthemum plant. It is employed topically against lice and scabies. Researchers reported that “subjects wearing permethrin-treated sneakers and socks were 73.6 times less likely to have a tick bite than subjects wearing untreated footwear.” However, the success of permethrin-treated clothing in reducing tick bites varied depending on the specific article of clothing. For example, though permethrin treatments were also tried on shorts and shirts, the chance reduction of a bite was only 2-4x less likely, showing that footwear precautions could make a very significant difference in exposure risks. A different study among workers from the North Carolina Division of Water Quality wearing clothing treated with a factory-based technique had a 99% decrease in the rate of tick bites acquired during work hours and a 93% decrease in the total incidence of tick bites!
Though no statistically significant differences in number of tick bites were detected between commercial permethrin treatment (19.33%) and the do-at-home permethrin application method (24.67%), commercial factory-based treatments seem to have a longer resiliency against washing and degradation over time compared with do-at-home applications. Factory-based permethrin impregnation of clothing may allow for clothes to hold their pesticidal activity against black-legged deer ticks (Ixodes scapularis) for 70 washes whereas self-treated at-home applications may endure for as little as six washes. Some long-lasting commercial treatments were studied and found to last even longer than 1 year!
'What is the safety concerns for people using permethrin?', you may ask. Despite its widespread use globally, there are few recorded cases of human toxicity. Permethrin is highly toxic to fish and cats, and there is one documented case of three pediatric patients under ten years old having neurotoxicity where permethrin was identified as the causative agent; however, they "had bathed a puppy, poured the unknown chemical on a trampoline, then played with it and possibly ingested some of it". This is obviously a much higher exposure than anything discussed in this article.
Even studies that showed reduced permethrin content after as few as 16 washes still showed that tick nymphs were adversely affected and less active, compared to untreated clothing. 
A less well documented but more natural alternative to N,N-Diethyl-meta-toluamide (also called DEET or diethyltoluamide) and clothing treatments using permethrin is Oil of Lemon Eucalyptus (OLE). At the time this article is published, the author could not find any peer review reference for the study in 2020 that claimed this compound was effective at completely keeping away three types of ticks, including the black-legged deer tick, for almost five hours. However, the manufacturer Citrifine outlines the study on their own website, citing it was "[c]onducted for the U.S. Environmental Protection Agency (EPA)" and then report their product sold under the tradename 'Citriodiol' supposedly "provides 100% protection against deer ticks for an average of 290 minutes (almost 5 hours)". Their product reportedly had a 30% concentrated spray formula and is now approved by EPA for use with children of all ages. This data is more encouraging than an older study from 2004 when Citridiol was tested and "[t]he number of reported attached ticks noted below the waist was 13/42 (31%) during the period when the spray was used and 73/112 (65%) when no spray was used", which is a little more than a 50% reduction in questing ticks. So despite a modicum of healthy skepticism, this is at least moving us in the right direction. And, at this time, the EPA does list OLE as a tick deterrent alongside other well known repellants like DEET, so that too is encouraging.
Dry Your Clothes BEFORE You Wash Them
Once you arrive home from venturing in a potential tick habitat, your clothes should be removed and isolated, to prevent 'hitchhikers' from sneaking around the house. Putting clothes immediately into a laundry dryer may not seem intuitive, but it is very effective! High heat kills black legged deer ticks, adults as well as nymphs (the juvenile stage of the lifecycle). Place clothes directly into the dryer on high heat for at least 6 minutes kills ticks. If you choose to wash your clothes first, research from 2016 found that water temperature must be greater than 130°F/54°C to kill ticks. If water temperature less than 130°F/54°C, only 50% of the ticks will be killed by washing, and you must place clothes in a dryer on high heat for 55 minutes to kill the remaining ticks. Cold water washing allowed all ticks tested to survive.
If prompt access to a clothes dryer is not an option, at least consider placing all clothes worn outside into a plastic trash bag, tied shut, so that the garments remain isolated until they can be placed into a dryer at the soonest opportunity.
Conduct a full body check upon return from potentially tick-infested areas and consider use of a mirror to view all parts of your body. When on a potential host, ticks are attracted to areas of greater body heat via a sensor called the 'capsule' part of Haller's organ, hence their attraction to skin folds and crevices. Check these parts of your body and your child’s body for ticks:
Under the arms
In and around the ears
Inside belly button
Back of the knees
In and around the hair
Between the legs
Around the waist
Tick Bite Discovery and Removal
Prompt removal of a biting tick is obviously ideal. This should be done without application of nail polish, petroleum jelly, heat or other compounds in an attempt to make it release and detach from the skin. "These methods do not work and only increase the likelihood the tick will transmit Lyme disease to you. Applying alcohol, nail polish remover, or a hot match can irritate a tick and cause it to regurgitate its gut contents into your skin (which) contain the Lyme disease-causing bacterium". Your goal is to remove the tick as quickly as possible.
Use clean, fine-tipped tweezers or other specialty tick-removal tool such as O'Tom Tick Twister to grasp the tick as close to the skin’s surface as possible. Specialty tools may be better designed to get mouth-parts by using a circular motion, which would not be recommended if tweezers are being used.
Pull upward with steady, even pressure. Don’t twist or jerk the tick if using tweezers; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers, if possible. If you cannot remove the mouth easily with tweezers, leave it alone and let the skin heal.
After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol and soap with water as well as consider specific oral antimicrobials shown to be effective against tick-borne illness.
Also try to best estimate how long the tick had been attached. Though transmission time for Lyme disease from the tick may often take close to 24 hours, it can be in as short as 4 hours if the tick is feeding for a second time, which is what occurs in an estimated 10% of bites.[13,14]
Any tick that has bitten a person should be identified and if it is a known vector for disease, like the black-legged deer tick, it should be tested to see what DNA for infectious microbes it was harboring. If you are in an endemic area, often local health departments offer free testing of the tick. However, the number of possible organisms they test for is usually limited to just a few. Consider private laboratories like Igenex or Med Zu Inc., which runs www.tickreport.com.
Watch for Symptoms
Symptoms can have a wide variety of presentations and a consultation with a knowledgeable physician is most likely warranted.
Miller, N. et al. “Tick Bite Protection with Permethrin-Treated Summer-Weight Clothing,” Journal of Medical Entomology 48, no. 2 (January 2011): 327–33, doi:10.1603/me10158.
Vaughn MF, Meshnick SR. Pilot study assessing the effectiveness of long-lasting permethrin-impregnated clothing for the prevention of tick bites. Vector Borne Zoonotic Dis. 2011 Jul;11(7):869-75. doi: 10.1089/vbz.2010.0158. Epub 2011 Mar 11. PMID: 21395420.
*image credits: https://www.cdc.gov/ticks/avoid/on_people.html Accessed 06-06-2022.
https://www.sawyer.com/products/permethrin-fabric-treatment. Accessed 06-06-2022.
Vaughn MF, et al. Long-lasting permethrin impregnated uniforms: A randomized-controlled trial for tick bite prevention. Am J Prev Med. 2014 May;46(5):473-80. doi: 10.1016/j.amepre.2014.01.008. PMID: 24745637.
Drago, Bonny et al. “Acute permethrin neurotoxicity: Variable presentations, high index of suspicion.” Toxicology reports vol. 1 1026-1028. 20 Sep. 2014, doi:10.1016/j.toxrep.2014.09.007
Connally, Neeta P et al. “Impact of Wearing and Washing/Drying of Permethrin-Treated Clothing on Their Contact Irritancy and Toxicity for Nymphal Ixodes scapularis (Acari: Ixodidae) Ticks.” Journal of medical entomology vol. 56,1 (2019): 199-214. doi:10.1093/jme/tjy138.
https://www.citrefine.com/new-deer-tick-study-news/. Accessed 06-06-2022.
Gardulf A, Wohlfart I, Gustafson R. A prospective cross-over field trial shows protection of lemon eucalyptus extract against tick bites. J Med Entomol. 2004 Nov;41(6):1064-7. doi: 10.1603/0022-2585-41.6.1064. PMID: 15605645.
Nelson CA, et al. The heat is on: Killing blacklegged ticks in residential washers and dryers to prevent tickborne diseases. Ticks Tick Borne Dis. 2016 Jul;7(5):958-963. doi: 10.1016/j.ttbdis.2016.04.016. Epub 2016 Apr 28. PMID: 27156138.
Carr, Ann L, and Vincent L Salgado. “Ticks home in on body heat: A new understanding of Haller's organ and repellent action.” PloS one vol. 14,8 e0221659. 23 Aug. 2019, doi:10.1371/journal.pone.0221659.
https://www.health.ny.gov/publications/2825/ Accessed 06-06-2022.
Shih, C M, and A Spielman. “Accelerated transmission of Lyme disease spirochetes by partially fed vector ticks.” Journal of clinical microbiology vol. 31,11 (1993): 2878-81. doi:10.1128/jcm.31.11.2878-2881.1993.
Richards, S. et al. “Do Tick Attachment Times Vary between Different Tick-Pathogen Systems?,” Environments no. 2 (September 2017): 37, doi:10.3390/ environments4020037.
The content and any recommendations in this article are for informational purposes only. They are not intended to replace the advice of the reader's own licensed healthcare professional or physician and are not intended to be taken as direct diagnostic or treatment directives. Any treatments described in this article may have known and unknown side effects and/or health hazards. Each reader is solely responsible for his or her own healthcare choices and decisions. The author advises the reader to discuss these ideas with a licensed naturopathic physician.