However, for some people, the after-effects of the disease can linger for months and sometimes even years. Theyre common in woodland and moorland areas, but can also be found in gardens or parks. When the symptoms of Lyme disease return in a flare-up, they will be similar to those that appeared during the initial infection. This can be done by always taking precautions against ticks and checking for ticks after spending time in wooded areas. Is it true that you can get Lyme disease anywhere in the U.S.? Antibody-based Lyme disease tests have excellent sensitivity in patients with Lyme arthritis. Description: Bluish hued without central clearing. Treatment may be longer depending on your symptoms. A study published in the New England Journal of Medicine indicates that patients with chronic neurologic Lyme disease were ill for up to 14 years. However, there are some general guidelines, which anyone with Chronic Lyme could follow to promote a healthier lifestyle and thus, less flares. Can you catch Lyme disease from dog saliva. So, when someone is diagnosed with a condition that has no known cause, the cause is sometimes Lyme. If you see a rash or another sign of Lyme disease on your skin, see your primary doctor right away. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. One classic characteristic of Lyme Disease is that symptoms come and go. The type of Lyme disease common in Europe can cause a skin condition called acrodermatitis chronic atrophicans. You can search by location, condition, and procedure to find the dermatologist thats right for you. Although short-term antibiotic treatment is a proven treatment for early Lyme disease, studiesexternal icon funded by the National Institutes of Health (NIH) have found that long-term outcomes are no better for patients who received additional prolonged antibiotic treatment than for patients who received placebo. Dunwidit. Additional antibiotics have not been shown to improve these symptoms, and patient referral to a rheumatologist should be considered. What causes Lyme disease flare-ups though? These changes usually appear on a hand or foot. Most people who develop a rash, get it within days or weeks of being bitten by a tick. Where you see signs on your skin: If you were in Europe when bit by a tick, you may see changes to your skin in this late stage. When the rash and symptoms begin: According to the Centers for Disease Control and Prevention (CDC), the rash begins 3 to 30 days after the tick bites you. CDC twenty four seven. What are the symptoms of Lyme disease in a child? This condition is called Post-Treatment Lyme Disease Syndrome (PTLDS). A small bump or redness at the site of a tick bite that occurs immediately and resembles a mosquito bite, is common. Read Also: Medicine Used For Lyme Disease. Do you know which one? J Am Acad Dermatol. One initial flare-up of symptoms can occur at the beginning of treatment and is referred to as a Herxheimer reaction. A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide. "Someone who's even-keeled their whole life and suddenly becomes really irritable, agitated, forgetful, and fearful I would consider a Lyme diagnosis," says Reihman. U.S. Centers for Disease Control and Prevention. If you kept a removed tick, bring it to the appointment. Serology is the most accurate testing method for Lyme disease, despite false negatives that can occur with acute illness. How Do You Detect Lyme Disease - LymeTalk.net Other days your flare-ups keep you in bed. The sensitivity could be so strong that children might have outbursts when they cant tolerate certain feelings against their skin. Accessed Oct. 12, 2022. The Jarisch-Herxheimer reaction -often shortened just to "Herxheimer" or "herxing"happens after you start antibiotic treatment for spirochetal infections like syphilis, Lyme disease, and tick-borne relapsing-fever. Patients with persistent joint inflammation and pain after the first course of antibiotics may require a second course (see tables below). Swelling, hardened skin, and deep lines on the foot of someone who has had Lyme disease for years. And dont get me started on my heart. The antibiotics youre given will depend on your symptoms, but you may need to take them for up to 28 days. Some days you feel well enough to accomplish all your chores and responsibilities. The risk of chronic Lyme increases the longer a Lyme infection goes untreated or undertreated. 2011; 64:619-36. 2021; doi:10.3389/fmed.2021.666554. Seek dependable emotional support and/or a mental health provider to help you deal when traumatic events arise, or you begin to feel overwhelmed. Contact us: contact@lymetalk.net. Awesome, I think, mentally running through all the things that need to be done within the next several days that most certainly will not occur. However, other people with Lyme will get better on antibiotics, since the bacteria are being killed. The skin on the backs of the hands and tops of the feet get discolored and swell. Adults often see a raised growth form around a nipple. Untreated Lyme disease can produce a wide range of symptoms, depending on the stage of infection. Long-term antibiotic treatment for Lyme disease has been associated with serious, sometimes deadly complications, as described in the links below. 7 Unexpected Signs Of Lyme Disease Experts Want You To Know About, Every Single Big & Small Way You Can Fight For Abortion Rights, The 3 Laziest Zodiac Signs, According To An Astrologer, This Is What Happens If You Don't Clean Your Water Bottle. When do you think you were exposed to ticks? * For patients with an initial episode of Lyme arthritis, a full course of oral antibiotics are recommended. The treatment usually lasts 10 to 14 days. A dermatologist is a medical doctor who specializes in treating the skin, hair, and nails. Most rashes appear on the arms, legs, and face. Theories exist about the causes of Lyme flare-ups. Finally, some believe that the symptoms of PTLDS are due to other causes unrelated to the patients Borrelia burgdorferi infection. It can smooth out deep wrinkles and lines, but the results arent permanent. Featured image by Zohre Nemati on Unsplash. Can Alpha-Gal Sufferers Eat Turkey and Chicken? Can Lyme disease stay with you forever? Dr. Bobbi Pritt: You can really saturate your gear. As Lyme disease rates have steadily climbed in the United States since it was first recognized in the mid-1970s, so have reports of a collection of symptoms that patients commonly refer to as chronic Lyme disease. Read Also: Infectious Disease Doctor For Lyme, In a study of 61 people treated for the bacteria that causes Lyme disease, Johns Hopkins researchers conclude that fatigue, pain, insomnia and depression do indeed persist over long periods of time for some people, despite largely normal physical exams and clinical laboratory testing. Common kinds of pain associated with Lyme include joint paint and nerve pains that create shooting or zapping sensations, says Reihman. "If the diagnosis doesn't have a known cause or cure and you're not satisfied with that as an answer, it's worth it to look into getting treatment for Lyme and seeing if that makes a dent in your symptoms," says Reihman. ", Most doctors are not trained to look out for signs of chronic Lyme, and the standard ELISA and Western Blot tests produce many false negatives, Kristin Reihman, MD, family medicine doctor and author of Life After Lyme, tells Bustle. When you suffer with any chronic condition, it is very important to know what types of foods might have an effect negative or otherwise on your body. When diagnosing a Lyme patient, Reihman will take note if they've ever experienced a flareup from antibiotics. So what does a Lyme flare-up feel like? For skin lesions that are typical for erythema migrans, empiric treatment for Lyme disease is recommended. Adverse events associated with antibiotics and intravenous therapies for post-Lyme disease syndrome in a commercially insured sample. The medical name for this condition is acrodermatitis chronical atrophicans. Notice the bite mark in the center of this early rash, which will expand quickly. Even with vaccination, your dog will still need monthly preventatives, and you should still take other preventative measures, like avoiding areas with ticks and manually checking your dog for ticks. Antibiotic treatment is recommended for classic erythema migrans or a possible Lyme presentation with positive serum antibody testing. Seek medical attention if you observe any of these symptoms and have had a tick bite, live in an area known for Lyme disease, or have recently traveled to an area where Lyme disease occurs. Facts What Does A Lyme Flare Up Feel Like By Peter E June 8, 2022 0 0 Colloidal Silver Lyme Disease Treatment Living With Lyme Disease Felt Like Being Unable To Pull Up The Blinds On The Window And See The Sky What's the Difference Between a Herxheimer Reaction and a Flare Up? Question about Lyme Flare Up? - HealingWell.com If you are bitten by this tick and develop Lyme disease, you may see a bulls-eye rash. The findings, published in the December issue of Frontiers in Medicine, could spur further investigation into the cause of persistent symptoms, a source of medical controversy. For some, symptoms may last a few days. Dattwyler RJ, Wormser GP, Rush TJ, et al. Pain, swelling or stiffness may last for a long time. Weeks, months or even years later, patients may develop problems with the brain and nervous system, muscles and joints, heart and circulation, digestion, reproductive system, and skin. Ixoides ricinus Factsheet for experts. What is his deal today? Just answer a few questions and snap a few selfies to help us get to know your skin. Last accessed May 2, 2018. Patients with PTLDS usually get better over time, but it can take many months to feel completely well. The primary treatment is doxycycline, 100 mg twice daily for 10 days in adults, or one of several alternate regimens (Table 1). Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. When do you need to be retested for Lyme disease? Plan C Vs. Plan B: What's The Difference? But there is no definitive, universal answer. What are common causes of Lyme flare-ups? Read Also: What Does A Lyme Disease Headache Feel Like, 2021-2022 Lymetalk.net These folks are not going to be happy about standing up in the shower. Treatment can be initiated immediately afterwards if antibody levels are positive. However, a second round of antibiotics is often required, as the infection may persist through the first round of treatment. Most problems occur in the heart and nervous system, and these can be serious. Lyme disease is more common than many people think. Severe cases of Lyme disease will acquire additional therapy to treat affected kidneys, heart, or nerves, along with supportive care like intravenous fluids. Perhaps practicing meditation would be beneficial. Expert Recommendations for Avoiding Tick Bites. If you're exhibiting these symptoms or any other signs of Lyme, look for a Lyme-literate doctor who will take your concerns seriously. Therefore, the International Lyme and Associated Diseases Society recommends making "a clinical diagnosis based on the history and physical findings, and supported by appropriate laboratory tests when they are indicated.". Without all high-risk features, monitoring for symptoms is as effective as treatment. Centers for Disease Control and Prevention. The infection itself can also be a trigger for a Lyme disease flare-up. Becoming a member is easy. An initial Lyme disease infection feels much like the flu and has non-specific symptoms such as muscle aches, fever, chills, headache, and fatigue. Lyme never sleeps, which means that people with it often have trouble sleeping as well. This condition is called Post-Treatment Lyme Disease Syndrome . The Symptoms Checklist is NOT a self-diagnosis tool. Find out what can help. It's common for those with Lyme to report having trouble falling asleep, waking up throughout the night, and waking up earlier than intended. What causes Lyme disease to flare up? - Hosh Yoga A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Tick removal and testing. The main feature of Lyme arthritis is obvious swelling of one or a few joints. But that term isn't well-defined. Tick Control in Central Mass | Lyme Disease Central Mass, Lyme Disease Prevention Through Tick Control. Most people dont feel a tick on their skin or the bite. In stage 2, the rashes stay the same size rather than grow larger. Tickborne disease. Bobe JR, et al. With your sense of touch on high alert with Lyme disease, certain clothing textures might feel unbearable, and you might recoil from a persons touch. https://www.ecdc.europa.eu/en/disease-vectors/facts/tick-factsheets/ixodes-ricinus. For patients with improving but persistent symptoms after an initial course of oral antibiotics, a second course of the same oral antibiotic or observation alone can be considered. An initial episode of Lyme arthritis should be treated with a 4-week course of oral antibiotics. The sweat glands can die, and the skin often becomes so thin that it tears easily. If Lyme disease is left untreated it can lead to damage in the kidneys, nervous system, and heart. Lyme arthritis typically develops within one to a few months after infection. For whatever reason, even the most benign thoughts leave me with a pressing tightness around my chest. One study in Sleep even found that 100 percent of Lyme patients had sleep issues. If the tick was infected, early treatment can be considered. Lyme disease is not associated with seizures, amyotrophic lateral sclerosis, multiple sclerosis, dementia, or Parkinson disease. Others treat Lyme disease using various methods yet continue to experience flare-ups for years after the initial tick bite. So, many Lyme patients describe themselves as "tired and wired.". Some people develop a lump, which your doctor may refer to as borrelial lymphocytoma. New Member. National Institute of Allergy and Infectious Diseases. In some cases, joint swelling and pain can persist or recur after two courses of antibiotics. Kids can have temper tantrums and refuse to get dressed when the reality is they cant tolerate the feeling of particular kinds of clothing or texture, Leventhal says. Society Space How can Lyme disease last for years? Dr. Bobbi Pritt: It sticks out its legs, and that allows it to grab on to hosts as they walk by. read more, Recommended Reading: Can You Live With Lyme Disease. Generally, youre more likely to become infected if the tick is attached to your skin for more than 24 hours. Your veterinarian will speak to you about different options so that you can come up with the best treatment plan for your dog. Stay hydrated and practice a healthy lifestyle through diet and exercise. Because spirochete transmission occurs after at least 36 hours of attachment, ticks should be removed promptly after discovery. Is deer overpopulation responsible for more deer ticks? Tickborne Diseases of the United States: A Reference Manual for Healthcare Providers. Joints chime in before Ive even firmly planted both feet within the shower stall. In stage 3, few signs of Lyme disease appear on the skin. Lyme disease is caused by infection with the bacterium Borrelia burgdorferi. In a study of 61 people treated for the bacteria that causes Lyme disease, Johns Hopkins researchers conclude that fatigue. Thanks for replying. To remove ticks, fine-tipped tweezers should be used to grasp the mouth parts as close to the skin as possible and steady traction applied directly away from the skin. A 4-to 6-week course of antibiotics will be prescribed for dogs with clinical signs of Lyme disease, as well as for dogs that have a high antibody level, even if they are asymptomatic. Where you see the rash: If you develop a rash, it appears near (or where) the tick bit you. January 6, 2022 0 0 Lyme Disease Doctor San Diego Early Detection Is Key Alternative treatments for Lyme disease symptoms brings new hope to those suffering Lyme disease is easiest to treat at the early or acute stage, within the first 30 days of exposure. What is the best tick prevention for dogs? https://www.uptodate.com/contents/search. This can take months for some people, but the symptoms should improve over time. This can appear in stage 2 of Lyme disease. Doxycycline, 100 mg twice daily for 10 days, Azithromycin only recommended for patients unable to take doxycycline and beta-lactam antibiotics, Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content. What the rash can look like: You may see a spot or bump on the skin, which is the bite mark. It's important to take all pills as directed even if you're feeling better. Posts : 5. Can Lyme disease be transmitted through breast milk? The first key to living with Chronic Lyme disease is finding a doctor and treatment regimen that works for you. Find out why dark spots appear and what can fade them. "A lot of people with Lyme struggle with an immune response that is both robust and ineffective, as if it is targeting the wrong things," says Reihman. Consider year-round tick control for the prevention of Lyme, and seek immediate medical attention if you believe you have been bitten by an infected tick. It can be frustrating for patients when the doctor overlooks Lyme disease as the big picture. Some can treat Lyme with antibiotics and not have any flare-ups. Can Lyme disease be transmitted sexually? continue reading. PCR for Anaplasma can be performed simultaneously if requested. Doxycycline is usually given by mouth twice daily (roughly 12 hours apart) for at least 30 days. Understandably, patients want to know how long do symptoms of Lyme disease last? A diagnosis usually depends on the following: Antibiotics are used to treat Lyme disease. You live in or recently visited an area where Lyme disease is common. Unlike permethrin, many effective repellants are safe to apply to skin including N,N-diethyl- m-toluamide (DEET), picaridin, ethyl-3-(N-n-butyl-N-acetal) aminopropionate (IR3535), oil of lemon eucalyptus, p-methane-3,8-diol (PMD), and 2-undecanone. I think a lot of people with serious, long-standing symptoms of Lyme end up re-treating and keeping Lyme in check off and on for most of their lives (whether it's through diet, herbs, abx, alternatives etc.). Last accessed May 2, 2018. Lyme disease is caused by a bite from a black-legged tick. This condition is called Post-Treatment Lyme Disease Syndrome . Your first month is on usjust pay $4.95 to cover shipping and handling. The same antibiotic can be used to treat repeated recurrences of Lyme disease. The risk of chronic Lyme increases the longer a Lyme infection goes untreated or undertreated. For those who have already contracted and been diagnosed with Lyme disease, getting proper treatment is the best way to deal with, manage, and prevent Lyme flare-ups. Dr. Bobbi Pritt: They get themselves in a position. Other treatments have not been shown to work or haven't been tested. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. "When Lyme is killed, it releases toxins, which are inflammatory to the body and create more symptoms," Reihman says. In a study of 61 people treated for the bacteria that causes Lyme disease, Johns Hopkins researchers conclude that fatigue, pain, insomnia and depression do indeed persist over long periods of time for some people, despite largely normal physical exams and clinical laboratory testing. Ticks, Lyme, Co-infections, health, community, exchange of ideas. Accessed Oct. 13, 2022. Lyme arthritis occurs when Lyme disease bacteria enter joint tissue and cause inflammation. A rash with a very similar appearance to EM occurs with. Lyme disease can only be treated using antibiotics, but sometimes even treatment does not rid the body of the bacteria. I noticed even lyme flare ups dont last too long. Recent progress in Lyme disease and remaining challenges. Dermatologists care for people of all ages. When it comes to how long rosacea flare-ups last, theres no exact timethey vary from person to person! Some patients with chronic Lyme disease flare-ups may also experience new symptoms that werent present during the initial infection stage of the disease. Some believe the bacteria Borrelia burgdorferi triggers the onset of other autoimmune disorders with similar symptoms. Is it diet, mental stress, other illnesses or infections? Basic protection measures include avoiding risky areas, wearing long sleeves and pants, tucking pants into socks, and using clothing treated with permethrin. 2011; 64:619-36. Lyme disease is an infection caused by the bacterium Borrelia burgdorferi. Conditions that can stem from Lyme include Fibromyalgia, Multiple Sclerosis, Irritable Bowel Syndrome, Chronic Fatigue Syndrome, Interstitial Cystitis, Autism, ADHD, Alzheimer's, chronic pelvic pain, Rheumatoid Arthritis, chronic migraines, hyperthyroidism, hypothyroidism, and Amyotrophic Lateral Sclerosis, as well as a number of mental health conditions. How long do the rashes, lump, and symptoms last: If treated with antibiotics, signs and symptoms tend to clear within three weeks. Lyme disease occurs in stages. Lu H. Clinical manifestations of Lyme disease in adults. When the rashes, lump, and symptoms begin: About 30 to 45 days after the tick bites you, you may notice rashes or a lump. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Expanding lesion, no central clearing Photo Credit: Gary Wormser Description: Expanding lesion without central clearing on back of knee. By subscribing to this BDG newsletter, you agree to our. Find out what may be causing the itch and what can bring relief. If the tick was found on the animal it can be sent in for B. burgdorferi PCR. https://www.cdc.gov/lyme/transmission/index.html. This is another early sign of Lyme disease. When the bacteria stays in the body for a long time, Lyme can sporadically flare up in between periods of remission. The best way to prevent a Lyme disease flare-up is by avoiding contracting Lyme disease in the first place. https://www.cdc.gov/ticks/tickbornediseases/index.html. You can also have one of the other rashes shown here. Since Lyme disease is incredibly difficult to treat, and many people are often unaware that they even have it until it has had time to wreak havoc across the entire body, its especially important to avoid contracting the infection where possible. From hair trends to relationship advice, our daily newsletter has everything you need to sound like a person whos on TikTok, even if you arent. When caught early and treated, Lyme disease can be cured with antibiotics and most people recover fully. Strizova Z, Patek O, Vitova L, Horackova M, Bartunkova J. Good luck. Physical injury or surgical procedures could also result in a Lyme disease flare-up. Inflammation of the brain and spinal cord Nerve pain Shooting pains, numbness, or tingling in the hands or feet Diagnosis and Testing More about rashes A small bump or redness at the site of a tick bite that occurs immediately and resembles a mosquito bite, is common. Frontiers in Medicine. When all high-risk criteria are met, prophylactic treatment in adults and children with a single dose of doxycycline within 72 hours of tick removal (Table 1) is recommended. During feeding, the bacteria makes its way into the bloodstream, where it spreads across the entire body and causes widespread symptoms. But there is no definitive, universal answer. If you've done recent outdoor activities and may have had a tick bite or may have a tick-borne illness, be ready to answer these questions: Be prepared to answer these additional questions and write down the answers before your appointment. Dermatologists team up to improve patient care, JAK inhibitors: A newer type of medication, Free materials to help raise skin cancer awareness, Dermatologist-approved lesson plans, activities you can use, Signs and symptoms of untreated Lyme disease. Do not overdo it when you are feeling unwell. It is caused by the spiral-shaped. Triggers may vary, so what causes rosacea to flare up for one person may be different for another. Jeff Olsen: Mayo Clinic parasitic diseases expert Dr. Bobbi Pritt suggests permethrin for your clothing and gear. Are you flaring because you are not sleeping or not sleeping because you are flaring? But there are ways to help prevent them from happening in the first place. 9th ed. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. If the borrelia bacteria manages to evade detection, it can hide in tissues and cause a condition known as chronic Lyme disease. If treated, Lyme disease does not last for years. Mayo Clinic does not endorse companies or products. * The best partyour products are delivered right to your doorstep. And they will climb up the nearest object, like this blade of grass here. It is unknown whether antibiotics are effective in STARI, but STARI and Lyme disease can overlap geographically. Lantos PM, et al. I stink. Without treatment, the symptoms tend to come and go indefinitely, and some people develop stage 3 Lyme disease. Accessed Oct. 6, 2022. Ticks dont jump or fly. Once infected, a dog will always have the bacteria that cause Lyme disease in his or her body. Co-infections, viruses, and illnesses cause flare-ups, as well as what you eat and drink. Lyme Disease Rashes and Look-alikes | Lyme Disease | CDC Questions to Ask Your Veterinarian In addition, here are some symptom patterns that sometimes point toward Lyme. Pace yourself in your everyday activities. Speak with your doctor to explore further treatment and management options for your Lyme disease. Blacklegged ticks are also native to Europe, northern Asia, northern Africa and South America. Can Lyme Disease Flare Up Years Later - LymeTalk.net By Peter E September 2, 2022 0 0 Lyme Disease Doctor San Diego Homes For Sale Old Lyme Ct Symptoms Of Late Stage Lyme Disease Lyme Disease | Pathophysiology, Signs, and Treatment Your suffering has moved from an occasional inflammation flare-up to chronic pain in your muscles, tendons, and joints. The body cannot heal itself without real rest. Patients often report having extreme fatigue, sleep disturbances, mood disturbances, poor memory and concentration, headaches, dizziness, neck pain, tingling in hands and feet, and joint pain. In some patients, symptoms, such as fatigue, pain and joint and muscle aches, persist even after treatment, a condition termed "Post Treatment Lyme Disease Syndrome (PTLDS)". Patel R, Grogg KL, Edwards WD, Wright AJ, Schwenk NM. 2. So what does a Lyme flare-up feel like? Unorthodox alternative therapies marketed to treat Lyme disease. Some people develop a bluish-red lump. Only a serological test will confirm whether transmission of B. burgdorferi occurred and the animal was infected. A flare-up can come and go and vary in intensity. Accessed Oct. 6, 2022. Get Even More From Bustle Sign Up For The Newsletter. Its important to finish the course, even if you start to feel better. A Herx reaction is often a sign that someone has killed off Lyme bacteria without properly supporting their body's detox mechanisms. The reaction was first described in 1895 by Adolf Jarisch, an Austrian dermatologist, and later in 1902 by Karl . However, most people's symptoms improve. Even when they do get lots of sleep, the fatigue caused by Lyme can make people feel like they haven't slept at all. Dr. Bobbi Pritt: That's why you want to stay away from the tall grasses. read more. Featured Test Can You Test For Lyme Disease Years Later By Peter E February 15, 2022 0 0 Can Lyme Disease Be Detected By A Blood Test I have lyme diseaseand was misdiagnosed for 9 years In a word: yes! Removing a tick can prevent Lyme disease. Thoracic Outlet Syndrome-How long does a Flare-up Last? These generally center on my kiddos. In dogs, the most common signs include fever, loss of appetite, painful or swollen joints, lameness that comes and goes, swollen lymph nodes, and lethargy. This is a reaction of a patient being treated for another infection with antibiotics. Is COVID-19 overshadowing Lyme disease diagnoses? Natalie tried many acne products without success. Image 1: Centers for Disease Control and Prevention, Public Health Image Library, Last accessed May 11, 2017. Its not always possible to find a tick, so its important to pay close attention to your skin. When a tick that causes Lyme disease bites you, it infects you with bacteria. October 23, 2022 0 0 Advanced Family Dentistry Of Old Lyme Diagnosing Lyme Disease In Dogs Do you know the signs of Lyme disease? In time, the skin starts to harden and shrink, causing deep lines to form.