Diagnosis: Erythema migrans, Lyme disease
This 2007 photograph depicts the pathognomonic erythematous rash in the pattern of a “bull’s-eye”, which manifested at the site of a tick bite on this Maryland woman’s posterior right upper arm, who’d subsequently contracted Lyme disease. Lyme disease patients who are diagnosed early, and receive proper antibiotic treatment, usually recover rapidly and completely. A key component of early diagnosis is recognition of the characteristic Lyme disease rash called erythema migrans. This rash of
This 2007 photograph depicts the pathognomonic erythematous rash in the pattern of a “bull’s-eye”, which manifested at the site of a tick bite on this Maryland woman’s posterior right upper arm, who’d subsequently contracted Lyme disease. Lyme disease patients who are diagnosed early, and receive proper antibiotic treatment, usually recover rapidly and completely. A key component of early diagnosis is recognition of the characteristic Lyme disease rash called erythema migrans. This rash often manifests itself in a “bull s-eye” appearance, and is observed in about 80% of Lyme disease patients. Lyme disease is caused by the bacterium Borrelia burgdorferi, and is transmitted to humans by the bite of infected blacklegged ticks. Typical symptoms include fever, headache, fatigue, and as illustrated here, the characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. Note that there are a number of PHIL images related to this disease and its vectors. Provided by CDC/Dr. James Gathany
Submitted by dermRounds Dermatology Network. Originally posted August 5, 2008.
See case discussion.
• Tinea corporis • Granuloma annulare • Psoriasis (annular) • Erythema chronicum migrans (Lyme) • Subacute cutaneous lupus • Mycosis fungoides • Erythema gyratum repens
• Annular, figurate erythema with a characteristic trailing scale inside the advancing border • "Trailing scale" sign: scale is on inner margin of advancing edge — pathognomonic • Superficial type: scaling, less induration. Deep type: firm, no scale • Often idiopathic, but associated with: infections (dermatophytes, Candida), drugs, and occasionally malignancy • Erythema gyratum repens (parallel wavy bands — "wood grain" pattern): more concerning for malignancy • Chronic, recurring course — lesions expand centrifugally at ~2-5mm/day
Tags: erythema, migrans, lyme, disease, dermrounds dermatology network