The various displays of the Lyme disease rash

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Most people, in addition to training clinicians typically imagine that the rash indicative of Lyme disease at all times presents in a bull’s-eye sample. This isn’t appropriate. On this examine, investigators sought to characterize varied displays of the rash in Lyme disease sufferers, in an effort to help clinicians in recognizing the broad spectrum of EM lesions.


Within the examine “The Spectrum of Erythema Migrans in Early Lyme Disease: Can We Improve Its Recognition?,” investigators examined photos of lesions from 69 contributors, together with 43 males and 26 girls, suspected to have early Lyme disease.  Nearly all of contributors (83%) offered with a single lesion.¹

The photographs have been retrospectively evaluated by a dermatologist and a household practitioner with experience in early Lyme disease.

The authors discovered that 35 lesions (51%) have been erythema migrans (EM); 23 lesions (30%) have been thought of to be potential early EM or tick chew reactions, and 11 (16%) have been thought to not be EM, however fairly different diagnoses, together with ringworm, allergic contact dermatitis, and mosquito bites.

“Solely two lesions (6%) have been noticed with a traditional bull’s eye or ring-within-a-ring sample.”

EM rashes have been reported most ceaselessly to seem on the stomach, thigh, again and hip.

Individuals with an EM rash reported the next signs: chills, fever, night time sweats, headache, fatigue, physique aches, nausea and neuralgia.

Most EM lesions appeared:

  • Uniform (51%)
  • Pink (74%)
  • With an oval form (63%)
  • Properly-defined borders (92%)

What did early EM or tick chew reactions appear to be? They “have been sometimes <5 cm in measurement (74%), crimson (52%), spherical lesions (61%), with a punctum current (100%),” based on the authors.

Lesions that weren’t EM rashes appeared: pink or crimson (64%), spherical (55%), or uniform (45%) lesions, but additionally had raised (25%) or irregular borders (33%).

“EM generally happens in kinds that aren’t the traditional bull’s eye.”

“Solely 14 (20%) contributors general had constructive laboratory proof for LD; these included 13 (37%) of the contributors with EM-classified lesions,” the authors wrote.


The authors counsel that “training ought to deemphasize the bull’s eye kind and stress the broad variability in EM as an alternative and the truth that a lot of them current as a uniform, homogeneous lesion.”

The authors conclude:

  • “Sufferers typically current with lesions that will symbolize the very early stage of EM or tick chew reactions, and most sufferers will take a look at damaging on presently obtainable laboratory exams…”
  • “Clinicians might not be conscious of all current variations, such that some LD sufferers with EM might not be instantly acknowledged and promptly identified and handled. Therefore, additional enhancements by way of clinician consciousness and recognition of EM are wanted.”


  1. Schotthoefer A M, Inexperienced C B, Dempsey G, et al. (October 25, 2022) The Spectrum of Erythema Migrans in Early Lyme Illness: Can We Enhance Its Recognition? Cureus 14(10): e30673. doi:10.7759/cureus.30673

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