Southern Tick-Associated Rash Illness (STARI)
Southern tick-associated rash illness (STARI) is a rash that can appear after a bite from the Lone Star tick (Amblyomma americanum). Its hallmark is a red rash at the bite site that slowly grows and is sometimes shaped like a bull's-eye. Some people also have mild tiredness, headache, fever, or aches. STARI is not Lyme disease, and its exact cause is not known. Most people recover, but a licensed doctor should check any rash after a tick bite.
Last reviewed
What it is
STARI is a rash illness that can follow the bite of a Lone Star tick. It was first recognized in the southern United States. It was found in people who had a Lyme-like rash but did not have Lyme disease. Its main feature is a red, round rash at the bite site that grows over time. Mild flu-like symptoms sometimes come with it. Unlike Lyme disease, STARI has no confirmed cause and no proven lab test. It is generally thought to be mild and to clear up on its own. This page is for learning, not medical advice.
Symptoms
- A red, round rash at the bite site that grows, sometimes clear in the center like a bull's-eye or target
- A rash that usually grows to about 3–12 inches (8–30 cm) across
- Fatigue
- Headache
- Fever
- Muscle and joint aches
How soon symptoms appear
The STARI rash usually appears within about 7 days of the Lone Star tick bite (CDC). In practice, reported timing ranges from a few days to roughly two weeks. Each case is different.
Diagnosis
No blood test can confirm STARI. A doctor judges it based on how the rash looks and when it appeared. They also consider a known or possible Lone Star tick bite, and whether you live in or visited an area where these ticks are common. The STARI rash looks a lot like the Lyme disease rash. So your doctor will also weigh which tick and which region are involved. Only a licensed doctor can evaluate a rash after a tick bite.
Treatment
STARI usually clears up on its own, and people generally recover quickly. The rash can look like early Lyme disease, and the cause is not known. So some doctors choose to treat it with antibiotic pills. It has not been shown whether antibiotics are needed or helpful for STARI. A licensed doctor makes any treatment decision. This page does not give a treatment plan.
Prevention
The best protection is avoiding Lone Star tick bites. Use an EPA-registered repellent, and treat clothing and gear with permethrin. Avoid tall grass and brushy areas. Check your whole body for ticks after being outdoors, and shower soon after coming inside. Remove any attached tick right away with fine-tipped tweezers.
Where it occurs
STARI is reported most often in the southeastern and eastern United States. This matches the range of the Lone Star tick, which is widespread across the South and has spread into the Midwest and Northeast. STARI tends to occur where Lyme disease is uncommon. This is one clue doctors use to tell the two apart.
When to seek care
See a licensed doctor for any rash that develops after a tick bite, or if you have a fever, spreading redness, or feel unwell. Save a photo of the tick if you can, and note the date and place of the bite. The STARI rash can be mistaken for early Lyme disease, so getting checked quickly matters. Do not try to tell the two apart on your own. For emergencies such as trouble breathing or anaphylaxis, call emergency services.
Common questions
Is STARI the same as Lyme disease?
No. STARI is linked to the Lone Star tick, which does not carry Lyme disease. Lyme is spread mainly by blacklegged (deer) ticks. The rashes can look very similar, so a doctor should check any rash that follows a tick bite.
Can a Lone Star tick give me Lyme disease?
No. The Lone Star tick is not considered a carrier of Lyme disease in the United States. A bull's-eye-type rash after a Lone Star tick bite may be STARI, a different condition. Only a doctor can tell them apart.
What causes STARI?
The cause is not known. An earlier theory pointed to a bacterium called Borrelia lonestari, but further research did not support it. Research is ongoing.
How soon does the STARI rash appear?
Usually within about a week of the bite. Reported timing ranges from a few days to roughly two weeks. Watch the bite area, and see a doctor if a rash or other symptoms develop.
Is STARI dangerous?
Usually not. STARI is generally mild, and most people recover quickly, some without treatment. Serious complications have not been linked to it. Still, a doctor should check any rash after a tick bite, since look-alike conditions can be more serious.
Sources
- 1.Tickborne Diseases of the United States (STARI) (opens in a new tab) · CDC
Southern Tick-Associated Rash Illness (STARI) follows some Lone Star tick bites; cause not established and it is not Lyme disease.
- 2.Lyme Disease (opens in a new tab) · CDC
Spread by blacklegged (deer) ticks, NOT the Lone Star tick. Early sign is often an expanding erythema migrans rash.
- 3.Where Ticks Live (opens in a new tab) · CDC
The Lone Star tick is widely distributed in the Northeast, South, and Midwest U.S.
- 4.
- 5.
This page is here to help you learn. It is not medical advice. Only a doctor can diagnose a tick-borne illness. Read our sources and disclaimer.