Southern Tick Associated Rash Illness (STARI), also called Masters Disease, produces a bull's eye rash and is often mistaken for Lyme disease.

Lone Star Tick
Lone Star Tick

Ticks that Carry It

STARI is carried by lone star ticks.


Feder, Jr, H. M. et al. Clinical Infectious Diseases Southern Tick-Associated Rash Illness (STARI) in the North: STARI Following a Tick Bite in Long Island, New York Nov 15, 2011 Bull’s eye-like eruptions, which were of unknown etiology, often followed the bite of the Lone Star tick (Amblyomma americanum) and the rash is called STARI (southern tick-associated rash illness). Although the Lone Star tick is found in the Lyme disease–endemic areas of New England and Mid-Atlantic regions of the United States, STARI has been reported only once from the Northeast and Mid-Atlantic regions. We report a child from Connecticut who visited Long Island, New York, and developed a rash that was thought to be associated with Lyme disease. Because the patient failed to respond to antibiotics used to treat Lyme disease, an investigation ensued, and the diagnosis of STARI was established.

Wormser, G. P. et al. Clinical Infectious Diseases Prospective Clinical Evaluation of Patients from Missouri and New York with Erythema Migrans—Like Skin Lesions Oct 1, 2005 An illness associated with an EM-like skin lesion, but which is not caused by B. burgdorferi, occurs in many southern states in the United States (southern tick—associated rash illness [STARI], also known as Masters disease). Among Missouri cases, the peak incidence of EM-like skin lesions occurred earlier in the year than it did among New York cases. The time period from tick bite to onset of the skin lesion was shorter among Missouri case patients (6.1 ± 4.2 days and 10.4 ± 6.1 days. Missouri case patients were less likely to be symptomatic than were New York case patients, and less likely to have multiple skin lesions. EM-like lesions in Missouri cases were smaller in size than those in New York cases , more circular in shape, and more likely to have central clearing..

Nicholson, W. L. et al. Clinical Microbiology and Infection Preliminary serologic investigation of ‘Rickettsia amblyommii’ in the etiology of Southern tick associated rash illness (STARI) Dec, 2005 Southern tick associated rash illness (also known as STARI) has been recognized in the southern and south-central regions of the United States. The disease is characterized by a migrating erythematous rash, often with central clearing, that occurs 2–15 days following a tick bite. Lesions are usually solitary, although multiple lesions may develop. The etiology of STARI has been investigated for nearly a decade, yet no clear microorganism has been identified as the causative agent of this illness.

Molins, C. R. et al. Science Transitional Medicine Metabolic differentiation of early Lyme disease from southern tick–associated rash illness (STARI) Aug 16, 2017 Lyme disease, the most commonly reported vector-borne disease in the United States, results from infection with Borrelia burgdorferi. Early clinical diagnosis of this disease is largely based on the presence of an erythematous skin lesion for individuals in high-risk regions. This, however, can be confused with other illnesses including southern tick−associated rash illness (STARI), an illness that lacks a defined etiological agent or laboratory diagnostic test, and is coprevalent with Lyme disease in portions of the eastern United States. These findings revealed metabolic dissimilarity between early Lyme disease and STARI, and provide a powerful and new approach to inform patient management by objectively distinguishing early Lyme disease from an illness with nearly identical symptoms.