What are the other Names for this Condition? (Also known as/Synonyms)

• Masters’ Disease
• STARI (Southern Tick-Associated Rash Illness)

What is Southern Tick-Associated Rash Illness? (Definition/Background Information)

• Southern Tick-Associated Rash Illness (STARI) is an infectious disease caused by lone star tick bites. The tick is endemic to parts of south eastern/central USA
• It presents symptoms similar to Lyme disease including the characteristic bull’s eye red skin rash. However, unlike Lyme disease, the causative microorganism of Southern Tick-Associated Rash Illness is still unidentified
• Southern Tick-Associated Rash Illness may appear within a week of tick bite. The individual may also present symptoms such as fever, fatigue, and joint pain. No severe complications that are noted in Lyme disease are seen in STARI
• Adequate treatment of the underlying Southern Tick-Associated Rash Illness through the administration of antibiotics can help resolve the condition. The prognosis is good in a majority of cases with early treatment

Who gets Southern Tick-Associated Rash Illness? (Age and Sex Distribution)

• Southern Tick-Associated Rash Illness may occur at any age; both children and adults may be affected
• Both males and females may be affected
• Individuals of all racial and ethnic background can be affected
• However, STARI is prevalent only in certain regions of USA, called the endemic regions, which include eastern, south-eastern, and south central USA

What are the Risk Factors for Southern Tick-Associated Rash Illness? (Predisposing Factors)

The risk factors for developing Southern Tick-Associated Rash Illness are very high in the endemic areas and these may include:

• Frequenting areas that have overgrown grass, bushes, or are heavily-wooded. The lone star ticks reside in heavily-wooded and grassy areas, overgrown bushes, and leaf piles
• Occupations that necessitate being frequently outdoors; undertaking recreational outdoor activities
• Exposed skin while being in tick-infested areas
• Letting pets wander in areas where the ticks may potentially lurk
• Not conducting self-checks and/or checking pets for ticks on the body, after outdoor activities

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Southern Tick-Associated Rash Illness? (Etiology)

Southern Tick-Associated Rash Illness (STARI) is a tick-borne infection caused through the bites of the lone star tick (or Amblyomma americanum). The microorganism causing STARI is yet to be identified.

• The infection resembles Lyme disease, a bacterial infection (caused by the bacterium Borrelia burgdorferi) transmitted through the bites of infected blacklegged ticks
• Some researchers believe that STARI may be caused by the bacterium Borrelia lonestari. However, many individuals with the infection do not show any evidence of the organism
• Hence, it is considered by some scientists that STARI may be caused by another organism that is yet to be discovered. Currently, research is ongoing to identify the pathogen causing Southern Tick-Associated Rash Illness

What are the Signs and Symptoms of Southern Tick-Associated Rash Illness?

The signs and symptoms of Southern Tick-Associated Rash Illness are similar to that of Lyme disease and may include:

• A reddish discoloration and irritation at the site of tick bite
• A small skin rash may develop at any body site that slowly expands; the rash may appear in various forms
• The rash is seen within 7 days of tick bite
• The skin lesions are usually smaller in size (about 6-10 cm) compared to individuals with Lyme disease (that is about 6-28 cm in size)
• The reddish rash has a clearing in the center giving it a characteristic appearance of a bull’s eye
• It can be itchy, but is not usually painful
• Flu-like symptoms, such as fever and chills, muscle and body aches, and tiredness, may be noted

How is Southern Tick-Associated Rash Illness Diagnosed?

No specific blood tests are available to diagnose Southern Tick-Associated Rash Illness, because the exact causative agent is unknown. The diagnosis may involve the following tests and exams:

• A thorough medical history assessment and complete physical examination, including evaluating the individual for recent outdoor activities
• Study of the characteristic signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Tests to rule-out Lyme disease is important
• Skin biopsy, if necessary: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Southern Tick-Associated Rash Illness?

In a majority of cases, significant complications of Southern Tick-Associated Rash Illness are not observed. In some individuals, the following complications may be present:

• Cosmetic issues that result in emotional stress
• Secondary bacterial and fungal infection due to scratching and bleeding
• Alpha-gal syndrome, a rapid onset meat allergy
• A sugar called alpha-gal into human hosts, which can trigger an immune reaction leading to allergy to red meat such as beef or pork

How is Southern Tick-Associated Rash Illness Treated?

• The treatment of Southern Tick-Associated Rash Illness is typically through antibiotics (such as doxycycline)
• It is observed that individuals with STARI respond more quickly to antibiotic therapy than those with Lyme disease

How can Southern Tick-Associated Rash Illness be Prevented?

Southern Tick-Associated Rash Illness may be avoided by taking the following preventative methods:

• Avoid visiting tick-infested areas when possible; taking adequate protection while doing so
• Use insect repellents (such as DEET) and permethrin-treated clothes
• Checking oneself and pets for ticks on skin, immediately after any outdoor activity
• Shower immediately after any outdoor activity
• Full body examination to search for attached ticks, self-exam or by another to search all areas
• Wash clothes worn outdoors separately and dry them in high heat

What is the Prognosis of Southern Tick-Associated Rash Illness? (Outcomes/Resolutions)

• The prognosis for Southern Tick-Associated Rash Illness is usually good with treatment
• Unlike Lyme disease, many cases of STARI respond well to antibiotic therapy

Additional and Relevant Useful Information for Southern Tick-Associated Rash Illness:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse