Symptoms, Diagnosis and Treatment, Southern Tick-Associated Rash Illness (STARI), CDC

Symptoms, Diagnosis and Treatment


STARI rashes take many forms.

The rash of STARI is a red, expanding “bull’s-eye” lesion that develops around the site of a lone star tick bite. The rash usually appears within 7 days of tick bite and expands to a diameter of 8 centimeters (3 inches) or more. The rash should not be confused with much smaller areas of redness and discomfort that can occur commonly at the site of any tick bite. Patients may also experience fatigue, headache, fever, and muscle pains. The saliva from lone star ticks can be irritating; redness and discomfort at a bite site does not necessarily indicate an infection.


STARI is diagnosed on the basis of symptoms, geographic location, and possibility of tick bite. Because the cause of STARI is unknown, no diagnostic blood tests have been developed. Researchers once hypothesized that STARI was caused by the spirochete, Borrelia lonestari; however, further research did not support this idea. External


It is not known whether antibiotic treatment is necessary or beneficial for patients with STARI. Nevertheless, because STARI resembles early Lyme disease, physicians will often treat patients with oral antibiotics.

Signs and Symptoms of Acne

Casey Gallagher, MD, is board-certified in dermatology and works as a practicing dermatologist and clinical professor.

The symptoms of acne begin with a plugged pore, which then causes a lesion on the skin. This can range from non-inflamed bumps and blackheads to inflamed, red pimples and pustules. The most severe symptoms are seen in cystic acne, which can lead to scarring.

Frequent Symptoms

Blemishes are the core symptom of acne, and you can easily see or feel them on yourself, your kids, or other people in your care. Most people have a combination of both non-inflamed and inflamed blemishes.  

Acne blemishes very often appear on the face, but acne can also develop on other areas of the body, like the neck, chest, shoulders, back, and butt.

Non-Inflamed Acne Symptoms

Non-inflamed acne, also called comedonal acne, doesn’t cause blemishes that are red or painful. Symptoms of non-inflamed acne include bumps or bumpiness across the skin’s surface or uneven skin texture. The lesions are comedones—blocked skin pores that may be open (blackheads) or closed (milia or whiteheads).   Even if comedones are not easily visible, they will make the skin feel rough or like sandpaper.

Non-inflamed acne breakouts include:  

  • Blackheads (open comedones)
  • Milia (non-inflamed whiteheads)
  • Closed comedones (non-inflamed bumps)
  • Microcomedones (pore blockages too small to see)

Inflamed Acne Symptoms

Inflamed acne breakouts result in red, swollen pimples. Inflamed acne can be mild, with just occasional breakouts here and there, or it can be more severe, resulting in deep blemishes. These blemishes may not only be swollen, but they can also ooze, crust, and scab over.

Inflamed acne breakouts commonly include:  

  • Papules (red, raised bumps that may be small or large)
  • Pustules (red, inflamed, with a white head)

While nodules and cysts—which are larger than a typical pimple and develop in deeper layers of the skin—are less common forms of inflamed acne lesions, they can be seen in more severe cases.

Timing of Breakouts

Acne breakouts are often related to hormone levels, which is a reason that they are seen in the teenage years. In women, ongoing acne breakouts are common in the week before menstruation and may continue to occur until menopause.   Pregnant women often get acne outbreaks as well.

Rare Symptoms

Cystic acne is the most serious form of inflamed acne.   People with nodulocystic acne develop acne cysts and nodules that are significant in terms of quantity and severity.  

  • Acne cysts feel like soft, fluid-filled, painful lumps under the skin’s surface.
  • Acne nodules are hard, painful, substantial-size lumps under the skin’s surface. They take a long time to heal.

Moderate to severe acne is seen in 14% of high schoolers.  

Complications/Sub-Group Indications

Acne can lead to complications, or it may be of special concern in certain populations.

Excoriated Acne

Excoriated acne is a complication of picking at or scratching your acne lesions (or imagined lesions) to the point of wounding the skin. This problem occurs more frequently in women, and it may be part of obsessive/compulsive excoriation disorder.  

Constantly squeezing or picking at the skin causes angry red bumps, open red sores, scratches, crusts, and scabs. This can progress to a nodule or cyst.

Post-Inflammatory Hyperpigmentation

Post-inflammatory hyperpigmentation is the medical term used to describe dark, discolored spots left behind after an acne blemish has healed. It’s a very common problem and most people with acne will develop these marks to some degree.   Luckily, post-inflammatory hyperpigmentation is not a true scar and, in most cases, will fade over time.


Inflamed acne breakouts can often cause depressed or pitted scarring, or ice pick scars (long, narrow impressions in the skin). For some people, acne blemishes also cause hypertrophic, or raised, scars.  

Acne in People With Diabetes

Inflamed acne breakouts are of increased concern for people with diabetes because they have less resistance to skin and soft tissue infections. Some types of prescription treatments for acne, such as Zenatane (isotretinoin, a vitamin A derivative), may affect blood sugar levels and your doctor may want to monitor you closely if you use them.  

Acne in Pregnant Women

Due to the hormonal fluctuations of pregnancy, a woman may develop acne or have a new breakout. Some prescription acne drugs are not recommended during pregnancy as they can cross the placenta and lead to birth defects, miscarriage, and stillbirth.  

When to See the Doctor

The more severe the acne, the higher the chances of scarring, so it’s important to treat inflammatory acne as quickly as possible. This often means seeing a dermatologist for help.

As acne is very rare in children ages 1 to 7, a child should be seen by a doctor to determine the cause of the rash.   Pre-teens who develop acne often get more severe acne in their teen years, so beginning treatment early may help reduce problems later.

A sudden outbreak of severe acne in older adults might be a symptom of an underlying disease. This should be addressed by seeing a doctor for a full check-up or discussion of how ongoing conditions are being managed.

A Word From Verywell

You are likely to experience the symptoms of acne at some point in your life. A blemish or brief outbreak before an important occasion might be distressing, but it should heal if you take good care of your skin and avoid scratching or pinching the lesions. Ongoing or more severe outbreaks can be treated so they will occur less frequently and you can prevent scarring.

Tick Paralysis: Causes, Symptoms, Diagnosis, Treatment, Prevention

Tick Paralysis is unwellness that causes tingling and symptoms everywhere the body in individuals bitten by ticks. The symptoms will result in weakness.

While the symptoms may be awful, treatment is simple: take away the tick, and you’ll sometimes feel higher in a very few hours.
Tick palsy isn’t common, however, you must take it seriously as a result of in terribly rare cases, if untreated, the unwellness will have an effect on your lungs and create it exhausting to breathe. which will be fatal.

In the U.S., tick palsy is commonest within the geographic region, the chain states, and therefore the Southeastern a part of the country. The yank dog tick, chain Dermacentor variabilis, and Dermacentor ticks area unit presumably to cause tick palsy. however forty sorts of ticks will cause tick palsy, and therefore the symptoms rely on the species of tick that bit you.

Tick palsy will have an effect on anyone, however, it’s most frequently found in kids beneath eight years recent.


When you’re bitten by a tick and it hangs onto you for many days, it will unleash a neurolysin through its spit. consultants don’t fully perceive, however, however the neurolysin messes along with your systema nervosum.


Tick palsy sometimes starts with the symptom or tingling in your legs. you’ll even have muscle pain and feel tired and irritable. If your kid has it, you’ll notice that he or she is walking in Associate in a Nursing odd manner, as if drunk.

From there, the symptom moves up your body and is followed by palsy that starts in your feet and moves upward. It will simply have an effect on one aspect of you, however, that’s less common. It then spreads to the arms and probably lungs. you’ll conjointly feel tired and irritable and have muscle pain.

While tick palsy is never fatal, it’s Associate in Nursing emergency if it weakens your diaphragm and makes it exhausting to breathe.

Tick palsy symptoms area unit terribly on the brink of those of Landry’s paralysis (GBS), which is once the body’s system affects nerves, resulting in palsy.


The first step is that if you discover one or additional ticks connected to your body, or wherever a tick has recently bitten you.

The treatment is straightforward. Once the tick is removed — the whole tick, as well as the pinnacle and every one element of its mouth — you’ll get disembarrass what’s inflicting the symptoms, and you must feel higher quickly.

You can take away ticks by victimization tweezers to know the tick as on the brink of your skin as potential. Pull the tick get in a slow however steady upward motion. do not handle the tick with clean hands once it’s out of your body, and clean your hands and therefore the bite web site later on.

If the tick palsy affects your respiration, your doctor might have you ever use a device till the symptoms ease. If you have got hassle respiration, decision 911 or move to the ER now.

The first step is that if you discover one or additional ticks connected to your body, or wherever a tick has recently bitten you.

Ticks will bite anyplace, however the foremost common spots area unit on your scalp, particularly at the hairline on your neck. Ticks conjointly usually attach to the bodily cavity, between fingers and toes, or around the reproductive organ and body part.

Tick Bites In Children: How To Identify And What To Do

Ticks are small insect-like creatures that attach to the human skin. They belong to the arachnid class and hence might possess a few features similar to that of mites, spiders and scorpions. You might have heard that tick bites are actually harmless and do not need any specific medical treatment. However, it is essential to know that certain ticks such as wood tick, deer tick and a few others might possibly carry harmful germs and possess the power to infect the bitten person seriously.

Not providing medical attention to such tick bites can lead to diseases such as Lyme disease and Rocky Mountain spotted fever as ticks are potential carriers of microbes. Deer ticks appear to be extremely tiny, something like that of a pencil point. The other kind of tick bites are visibly larger and can be easily spotted on the skin.

Usually, children are the ones on whom we find such tick bites commonly. If you find a tick attached to your kid’s skin, your first step should be that of trying to remove it. Do not panic as this might frighten your child further. Read on to know more about identifying tick bites, its diagnosis and treatment.

How To Identify A Tick Bite?

Being aware of how to identify a tick bite can help you seek medical attention on time so that health risks can be avoided. The following pointers will help you understand the process of identifying a tick bite:

• How a tick looks like: Ticks appear to be different during different stages of their life cycle.

•They have four stages: egg, larvae, nymph and adult. They shed their outer skin via a process known as molting during each stage of their life cycle. Although there are dozens of species of ticks, they all appear similar.

• Look of a tick bite: It is difficult to immediately know once a tick bites you. This is so because they are painless. As it enters, it releases an anaesthetic into the skin. This prevents its immediate detection and in turn allows the tick to continue feeding. However, you can spot a tick bite if you happen to find the tick still attached to your skin. The head of the tick would be burrowed inside the skin. The skin around looks inflamed. If the tick has been feeding for a long time, it would appear quite large to be spotted easily. These are referred to as engorged ticks.

• Unlike other insect bites, tick bites are not fluid-filled.

• Ticks mostly bite on the scalp, groin, legs and at the back of the neck.

• Ticks usually bite once unlike other insects which can bite multiple times.

• A bulls-eye rash is a typical sign of a tick bite. A ring of redness forms at a distance from the site of the bite.

Tick-borne Illnesses

Ticks are carriers of pathogens that can cause various illnesses, especially in children. Some of the most common ones are as follows:

• Rocky Mountain spotted fever

• Colorado tick fever

• Southern Tick Associated Rash Illness (STARI)

Symptoms Of Tick-borne Illnesses

Symptoms of Lyme disease:

• A few people might find a circular form of rash at the site of the bite. This is usually the first sign of infection for a few people and something that generally begins to occur within a week or two after the bite. The rash might get bigger taking form of an expanding ring of redness. The site might be warm to touch along with a burning and itching sensation. A few people also have flu-like symptoms.

• If left untreated, the infection might spread to other parts of the body. There could be irregular heart rhythm along with palpitations and dizziness.

• When left untreated, especially in kids, the infection can take the form of arthritis, which affects primarily the knee and at times other joints as well.

Symptoms of STARI:

• It appears like an expanding bull’s eye rash caused due to the star tick bite. The rash ideally appears about a week after the bite.

• Apart from the rash, the affected person might show signs of fatigue, muscle pain, fever and headache.

Symptoms of Rocky Mountain spotted fever:

• Rash appears about three days after the bite.

• Rash usually appears on the ankles and wrists. It then spreads to the legs, trunk, soles and palms.

• Vomiting along with nausea

Symptoms of tularemia

• Formation of skin ulcer at the bitten site

• Swollen lymph nodes at the site of infection

Symptoms of ehrlichiosis:

• The signs are quite similar to that of flu.

• Development of rash in some cases

• Vomiting and nausea

Diagnosis Of Tick-borne Illnesses

Diagnosis of Lyme disease:

Laboratory tests are conducted to reach a conclusion about the diagnosis of Lyme disease. The following tests might be suggested by the doctor:

• Enzyme-linked immunosorbent assay (ELISA) test: This test is able to detect antibodies to B. burgdorferi. However, this test alone cannot be the sole conclusive test as it can lead to false-positives. This test might not be effective especially during the early stages of this illness.

• Western blot test: This test is done once the ELISA test shows a positive in order to reach a perfect conclusion. This test is a two-step approach. The test works by detecting antibodies to various proteins of B. burgdorferi.

Diagnosis of STARI

Symptoms play a major role in diagnosing STARI. The cause of STARI is unknown and therefore there are no specific blood tests for its diagnosis. It is primarily identified through geographic location and the likelihood of coming across a tick bite.

Diagnosis of Rocky Mountain spotted fever

The early signs of this illness are quite similar to other diseases, thus making the identification of this disease quite difficult during the initial days. Blood sample can be tested to conduct a diagnosis in case symptoms are observed. In some cases the rash specimen or the tick itself are used in the form of evidence to reach a conclusive diagnosis. Early treatment is advised to prevent worsening of symptoms.

Diagnosis of tularemia

This disease is quite rare and most of the time, its symptoms are mistaken for some other illness. It is therefore essential to be aware of any kind of exposure to tick bites. The chances of contracting this illness are high in case the child has come in contact with a sick or dead animal. Diagnosis of this illness is primarily done through blood tests and cultures.

Diagnosis of ehrlichiosis

Ideally, this illness is confirmed after blood test reports are evaluated by a doctor. Blood tests are conducted in case the doctor doubts the symptoms that you specify and the probable cause of another illness with similar signs. However, conclusive test results may take weeks to show up. Most of the time doctors do not wait for the test results. Instead, they choose to begin antibiotic therapy as soon as possible.

Treatment Of Tick-borne Illnesses

How to treat Lyme disease?

Antibiotics are the most opted method of treating this illness.

• Oral antibiotics can easily treat the early stages of Lyme disease. For children older than 8 years of age, doxycycline is the best medicine. For younger children, amoxicillin or cefuroxime is preferred. The usual course of the antibiotics last from 14 to 21 days.

• In case the infection has affected the central nervous system, then intravenous antibiotics are the chosen form of treatment. These antibiotics can, however, have side effects, such as reduction of white blood cell count, mild diarrhoea, etc.

How to treat STARI?

As STARI closely resembles Lyme disease, doctors often choose to treat STARI using oral antibiotics.

How to treat Rocky Mountain spotted fever?

It is best if the person developing symptoms of this illness is treated within the first five days. This is the reason why most doctors do not wait to receive test reports but instead choose to begin antibiotic therapy to treat this illness. The most commonly prescribed drug is doxycycline. However, this might not be suitable for young children. For younger kids, doctors usually prescribe chloramphenicol as an alternative treatment medication.

How to treat tularemia?

The duration of the treatment through antibiotics usually lasts 10 to 21 days. However, the duration is dependent on the severity and stage of the illness. The most commonly prescribed drugs are gentamicin, doxycycline, ciprofloxacin and streptomycin.

How to treat ehrlichiosis?

Early signs of this illness can be easily treated with the use of antibiotics. The most recommended antibiotic treatment suitable both for adults and children is the use of doxycycline.

Home Remedies For Tick-borne Illnesses

• In case the tick is still attached to your child’s skin, then the first step would be to remove it. Grasp the tick with tweezers and remove the head and its mouthparts. Pull it out straight and gently. Remember to wash your hands properly using soap and warm water after you have removed the tick.

• The bitten area should be cleansed using warm water and a mild soap.

• Infection can be prevented by applying alcohol on the bitten site.

• Use natural antibacterial supplements, such as cloves, mullein, Oregon grape, thyme, garlic, oregano essential oil, colloidal silver, rosemary, juniper berries, etc.

• The liver is the body’s main filter and using milk thistle is the best way to cleanse the liver. Repairing organ damage and restoring blood are best facilitated with the use of hawthorn, dandelion root, marshmallow and red clover.

• You can apply a thin layer of petroleum jelly such that the bite does not stick to the bandage that covers the site of the bite,

• You can clean the wound using rubbing alcohol or hydrogen peroxide to prevent any kind of infection.

• In case your tick bite itches a lot, baking soda bath might be helpful. Being alkaline, it neutralizes the pH levels of the bitten site. In a tub of warm water, add about one cup of baking soda. Soak in it for about half an hour.

Most of the tick bites do not seem to be much harmful and most probably you would not even have an infection post the tick bite. However, it is always better to be safe than sorry. Approach a doctor in case flu-like symptoms develop or the signs of the bite do not seem to go away even after several days.

In case the redness of the region keeps expanding along with the swelling, then it is time to seek medical advice so that immediate antibiotic therapy can be started.

How Acne Is Diagnosed

Casey Gallagher, MD, is board-certified in dermatology and works as a practicing dermatologist and clinical professor.

Many people can diagnose acne on their own, particularly in mild cases; most people recognize the symptoms of this very common skin condition. But while you may be familiar with what an occasional zit looks like, there is actually a wide range of severity. Seeing a dermatologist to formally diagnose acne can be very helpful, as different grades of acne usually require different types of treatments. There are also several other skin conditions that mimic acne, which may need a different approach entirely.


Acne isn’t something you need to do a purposeful check for, like you do skin cancer. Rather, it often makes itself well-known when you simply look in the mirror or take a shower.

Symptoms may include blackheads (comedones), whiteheads (pustules), and sometimes inflamed nodules or cysts. All of these symptoms occur due to blockage of a pore.  

Mild acne often doesn’t require medical consultation and can be treated at home using over-the-counter products. However, if you are unsure if what you are experiencing is acne, or if your acne seems severe or is changing characteristics, see a dermatologist.

Labs and Tests

Acne is diagnosed by a simple visual inspection by your doctor. There is no test for acne. Rarely, a doctor may take a swab or scraping of a lesion or pustule for microbiological examination or culture to rule out other sources of infection.

For women, hormone blood tests may be ordered to look for conditions such as pregnancy, excessive prolactin, Cushing syndrome, and high testosterone (an indicator of polycystic ovaries).


Imaging is not used in diagnosing acne. But if there are indications of predisposing conditions such as ovarian cysts, ovarian tumor, or adrenal tumor, the doctor may order X-rays, CT scans, or MRI studies.

Differential Diagnoses

Some skin conditions can look remarkably similar to acne, although their causes and treatments are different. If you are unsure, it is always wise to consult a dermatologist. They will consider these options and systematically rule them out during your examination.


Rosacea is sometimes mistakenly referred to as «adult acne,» but it is caused by a different mechanism than acne in adults. You may need to see a dermatologist to distinguish these conditions early on.

Rosacea causes red, flushed skin with papules and pustules, especially in the nose and cheek area, and may lead to the classic enlargement and bumpiness of the nose, for which it is best known. It is uncommon before the age of 30 and occurs more often in fair-skinned individuals and women (though it tends to be more severe in men).  


Folliculitis is a condition in which the hair follicle is inflamed and bumps or pustules may result. It is usually caused by bacteria (e.g., strep or staph) and is treated with topical or oral antibiotics.  

Keratosis Pilaris

Keratosis pilaris is a rash marked by small, rough, «goose-flesh» like bumps most often found on the upper arms, thighs, and buttocks, and sometimes the face. It commonly occurs at the same time in life when acne is prevalent, and roughly 50% of teens have some degree of the condition.  

Miliaria Rubra

Miliaria rubra is a rash characterized by small red bumps on the surface of the skin and is caused by excessive heat exposure. It is also known as heat rash or prickly heat.  

Rashes Due to Certain Cancer Drugs

Some targeted therapy drugs for cancer, such as Tarceva (erlotinib), cause a rash that closely resembles acne.   People who are taking these medications may frantically try using acne preparations but with no success, since the rash is due to a mechanism unrelated to that of acne.

If you have a rash that looks like acne while going through cancer treatment, talk to your oncologist.

Acne Grades

When a dermatologist lands on a diagnosis of acne, it is classified into one of four grades. Dermatologists evaluate the types of comedones (blackheads) present, amount of inflammation present, breakout severity, how widespread the acne is, and what areas of the body are affected.

Through this, they will also decide what class of acne a case falls into:

  • Non-inflamed acne breakouts have open and closed comedones (blackheads)
  • Inflamed acne breakoutshave papules, pustules, nodules, and/or cysts
Acne Grade Severity
I Mild
II Moderate
III Moderate to severe
IV Severe (cystic)

Grades of acne are classified as follows:

  •  Grade I: The mildest form of acne is referred to as grade I. With grade I acne (mild acne), the skin will display blackheads, whiteheads or milia, and occasionally minor pimples. There is no inflammation (minimal redness, swelling, or tenderness). Grade I acne can usually be cleared with over-the-counter treatments.
  • Grade II: Grade II acne is considered moderate acne. A greater number of blackheads and whiteheads are present on the skin than with grade I. Papules and pustules (whiteheads) are more frequently found. Grade II acne may also be treated with over-the-counter products. However, if there is no improvement after six to eight weeks, consult your doctor.
  • Grade III: Grade III acne is considered moderate to severe acne. The difference between Grade II and Grade III acne is the amount of inflammation present. Papules and pustules will be more numerous and there will be a greater amount of redness and inflammation found on the skin. Nodules are often present. This type of acne should be evaluated by your dermatologist, as it can be both painful and leave behind scars.
  • Grade IV: Grade IV acne is the most severe grade of acne. With grade IV acne the skin will display many pustules, nodules, and cysts. Blackheads and whiteheads are usually numerous. There is pronounced inflammation, and breakouts likely extend to areas other than the face, such as the neck, upper chest, and back. Grade IV acne, also called cystic acne, must be treated by a dermatologist.

A Word From Verywell

A proper diagnosis of acne includes not only a confirmation of the classic findings but a description of the severity of the rash. Determining the severity is important in choosing the best treatment options to improve your comfort and minimize scarring. If you are coping with acne that is grade II or higher, or even if you have mild acne that is not responding to over-the-counter medications, make sure to consult a dermatologist. Fortunately, treatment options are available for even the most severe types of acne.

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