|
|In Europe, 80% of Lyme rashes look like a '''"bull's eye,"''' but in only 20% of cases in the United States. (20 percent of Lyme infections show no rash.)<ref name=wright_2012>{{cite journal |vauthors=Wright WF, Riedel DJ, Talwani R, Gilliam BL|title=Diagnosis and management of Lyme disease |journal=Am Fam Physician |volume=85 |issue=11 |pages=1086–93 |date=June 2012 |pmid=22962880 |url=http://www.aafp.org/afp/2012/0601/p1086.html |url-status=live |archive-url=https://web.archive.org/web/20130927081243/http://www.aafp.org/afp/2012/0601/p1086.html |archive-date=27 September 2013 |df=dmy-all }}</ref><ref name=tibbles_2007>{{cite journal | vauthors = Tibbles CD, Edlow JA | title = Does This Patient Have Erithema Migrans? | journal = JAMA | volume = 297 | issue = 23 | pages = 2617–27 | date = 20 June 2007 | pmid = 17579230 | doi = 10.1001/jama.297.23.2617 }}</ref><ref name=CDC_Lyme_rashes>{{cite web|title=Lyme disease rashes and look-alikes |url=https://www.cdc.gov/lyme/signs_symptoms/rashes.html |website=Lyme Disease |publisher=Centers for Disease Control and Prevention |access-date=April 18, 2019|date=2018-12-21 }}</ref>
|File:Solid_erythema_migrans_rash_on_the_neck_of_a_woman_with_Lyme_disease.jpg|[[Erythema migrans]] ('''"migrating redness"''') and may have no definite pattern, as in this Lyme rash on a woman's neck.<ref name="boyce">{{cite journal |last1=Boyce |first1=RM |last2=Pretsch |first2=P |last3=Tyrlik |first3=K |last4=Schulz |first4=A |last5=Giandomenico |first5=DA |last6=Barbarin |first6=AM |last7=Williams |first7=C |title=Delayed Diagnosis of Locally Acquired Lyme Disease, Central North Carolina, USA. |journal=Emerging Infectious Diseases |date=March 2024 |volume=30 |issue=3 |pages=564–567 |doi=10.3201/eid3003.231302 |pmid=38407256 |pmc=10902532}}</ref> Rashes from non-Lyme causes may look similar.<ref name=wright_2012/><ref name="annular">{{cite journal |last1=Trayes |first1=KP |last2=Savage |first2=K |last3=Studdiford |first3=JS |title=Annular Lesions: Diagnosis and Treatment. |journal=American Family Physician |date=1 September 2018 |volume=98 |issue=5 |pages=283–291 |pmid=30216021 |url=https://www.aafp.org/pubs/afp/issues/2018/0901/p283.html}}</ref>
|}}
In'''Erythema somemigrans''' partsor of'''erythema chronicum migrans''' is an expanding [[rash]] often seen in the worldearly stage of [[Lyme disease]], EMand can also (but less commonly) be caused by [[southern tick-associated rash illness]] (STARI).<ref name="cdc2015">{{cite web|url=https://www.cdc.gov/stari/disease/|title=Lone star tick a concern, but not for Lyme disease|website=U.S. [[Centers for Disease Control and Prevention]] (CDC)|access-date=2017-10-06}} Page last reviewed: October 22, 2015</ref><ref name="Naktin2017">{{cite journal|last1=Naktin|first1=Jaan Peter|title=Diagnostic Utility of Erythema Migrans|journal=Clinical Infectious Diseases|volume=65|issue=12|pages=2156–2157|year=2017|issn=1058-4838|doi=10.1093/cid/cix544|pmid=28605419|doi-access=free}}</ref> It can appear anywhere from one day to one month after a [[tick bite]]. This [[rash]] does not represent an allergic reaction to the bite, but rather an actual skin infection of one of the Lyme bacteria species [[Lyme disease microbiology|from the genus ''Borrelia'']]. The rash's name comes from [[Neo-Latin]] for "migrating redness."▼'''Erythema migrans''' or '''erythema chronicum migrans''' is an expanding target lesion or lesions, fading in the middle and spreading outwards from the center. E. migrans caused by lyme disease is often seen on the thighs, arms, genitals, nipples, in about 80% of early stage [[Lyme disease]] presentations. The chance of getting infected by a tick bite with lymes disease is very low, 3-12% in Europe.
▲In some parts of the world, EM can also (but less commonly) be caused by [[southern tick-associated rash illness]] (STARI).<ref name="cdc2015">{{cite web|url=https://www.cdc.gov/stari/disease/|title=Lone star tick a concern, but not for Lyme disease|website=U.S. [[Centers for Disease Control and Prevention]] (CDC)|access-date=2017-10-06}} Page last reviewed: October 22, 2015</ref><ref name="Naktin2017">{{cite journal|last1=Naktin|first1=Jaan Peter|title=Diagnostic Utility of Erythema Migrans|journal=Clinical Infectious Diseases|volume=65|issue=12|pages=2156–2157|year=2017|issn=1058-4838|doi=10.1093/cid/cix544|pmid=28605419|doi-access=free}}</ref>
It can appear anywhere from 48 hours to 1 month after a [[chigger]] or [[tick bite]]. This [[rash]] does not represent an allergic reaction to the bite, but rather an actual skin infection of one of the Lyme bacteria species [[Lyme disease microbiology|from the genus ''Borrelia'']].
The rash's name comes from [[Neo-Latin]] for "migrating redness."
==Lyme disease==
"Erythema migrans is the only manifestation of Lyme disease in the United States that is sufficiently distinctive to allow clinical diagnosis in the absence of laboratory confirmation."<ref>{{cite journal |vauthors=Wormser GP, Dattwyler RJ, Shapiro ED, etal |title=The clinical assessment, treatment, and prevention of Lyme disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America |journal=Clin. Infect. Dis. |volume=43 |issue=9 |pages=1089–134 |date=November 2006 |pmid=17029130 |doi=10.1086/508667 |quote="pp. 1101–2 Background and Diagnosis of Erythema Migrans |doi-access=free }}</ref><ref>{{cite journal |vauthors=Ogden NH, Lindsay LR, Morshed M, Sockett PN, Artsob H |title=The rising challenge of Lyme borreliosis in Canada |journal=Can. Commun. Dis. Rep. |volume=34 |issue=1 |pages=1–19 |date=January 2008 |pmid=18290267 |url=http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/08vol34/dr-rm3401a-eng.php}}</ref> TheOften, discoverybut not always, mentions of a [[target lesion]] (bull's-eye lesion) are talking about erythema migrans. isHowever, enoughthe toappearance diagnoseof Lymeserythema diseasemigrans can vary considerably: while some look like a bull's eye, in the clinicU.S. most are evenly red or bluish, without a central or ring-like clearing.<ref name=NEJM2014>{{cite journal | vauthors = Shapiro ED | title = Clinical practice. Lyme disease | journal = The New England Journal of Medicine | volume = 370 | issue = 18 | pages = 1724–1731 | date = May 2014 | pmid = 24785207 | pmc = 4487875 | doi = 10.1056/NEJMcp1314325 | url = http://portal.mah.harvard.edu/templatesnew/departments/MTA/Lyme/uploaded_documents/NEJMcp1314325.pdf | archive-url = https://web.archive.org/web/20161019142422/http://portal.mah.harvard.edu/templatesnew/departments/MTA/Lyme/uploaded_documents/NEJMcp1314325.pdf | archive-date = 19 October 2016 }}</ref><ref name=CDC_Lyme_rashes/><ref name="pmid_24818260">{{Citation |last=Juckett |first=G |year=2014 |title=In reply: Comment on 'Identifying erythema migrans rash in patients with Lyme disease' |journal=Am Fam Physician |volume=89 |issue=6 |pages=424 |url=http://www.aafp.org/afp/2014/0315/p424.html |pmid=24818260 |postscript=.}}</ref> A minority of patients never have any rash. Because Lyme disease can within a few weeks cause long-term neurologic complications, persons with a rash and recent history of outdoor activities where Lyme is common should seek a doctor for diagnosis.<ref name="pmid_24818260"/>
Often, but not always, mentions of a [[target lesion]] (bull's-eye lesion) are talking about erythema migrans. However, the appearance of erythema migrans may vary considerably (in the US) while some look like a bull's eye, in the U.S. most are evenly red or bluish, without a central or ring-like clearing.<ref name="NEJM2014">{{cite journal | vauthors = Shapiro ED | title = Clinical practice. Lyme disease | journal = The New England Journal of Medicine | volume = 370 | issue = 18 | pages = 1724–1731 | date = May 2014 | pmid = 24785207 | pmc = 4487875 | doi = 10.1056/NEJMcp1314325 | url = http://portal.mah.harvard.edu/templatesnew/departments/MTA/Lyme/uploaded_documents/NEJMcp1314325.pdf | archive-url = https://web.archive.org/web/20161019142422/http://portal.mah.harvard.edu/templatesnew/departments/MTA/Lyme/uploaded_documents/NEJMcp1314325.pdf | archive-date = 19 October 2016 }}</ref><ref name="CDC_Lyme_rashes" /><ref name="pmid_24818260">{{Citation |last=Juckett |first=G |year=2014 |title=In reply: Comment on 'Identifying erythema migrans rash in patients with Lyme disease' |journal=Am Fam Physician |volume=89 |issue=6 |pages=424 |url=http://www.aafp.org/afp/2014/0315/p424.html |pmid=24818260 |postscript=.}}</ref>
A minority of patients never have any rash. Because Lyme disease can within a few weeks cause long-term neurologic and middle-ear complications, persons with a rash and recent history of outdoor activities where Lyme is common should seek a doctor for diagnosis.<ref name="pmid_24818260" />
=== Presentation ===
| image2 = Approximately 8 weeks old erythema migrans on the thigh.jpg
| caption2 = After 8 weeks, the rash cleared from the center toward the edges and looked a bit more like a bull's eye.
| width2 = 200}}
The initial sign of about 80% of Lyme infections is an erythema migrans (EM) [[rash]] at the site of a tick bite, often near skin folds, such as the [[armpit]], [[groin]], or [[Popliteal fossa|back of knee]], on the [[Torso|trunk]], under clothing straps, or in children's hair, ear, or neck.<ref name="wright_2012" /><ref name="NEJM2014" /> Most people (less than 75%) who get infected do not remember seeing a tick or the bite. The EM rash appears typically one or two weeks (range 3–32 days) after the bite.
The most distinctive feature of EM is the shape. The speed and extent to which it expands is 2–3cm per day and up to a diameter of 5–70cm (50% attain more than 16cm).<ref name="wright_2012" /><ref name="NEJM2014" /><ref name="tibbles_2007" /> The rash is usually circular or oval, red or bluish, and may be elevated or flat with a central dot.<ref name="NEJM2014" /><ref name="CDC_Lyme_rashes" /> In about 79% of cases in Europe but only 19% of cases in endemic areas of the U.S., the rash gradually clears from the center toward the edges, possibly forming a "bull's eye" pattern.<ref name="tibbles_2007" /><ref name="CDC_Lyme_rashes" /> The rash may feel warm but usually is not itchy, is rarely tender or painful.<ref name="NEJM2014" /><ref>{{cite journal | vauthors=Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, Holman MS, Persing DH, Steere AC | title=Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans | journal=Ann Intern Med | year=2002 | pages=421–8 | volume=136 | issue=6 | pmid=11900494 | doi=10.7326/0003-4819-136-6-200203190-00005}}</ref><ref name="pmid11982300">{{cite journal | author=Edlow JA | title=Erythema migrans | journal=Med Clin North Am | year=2002 | pages=239–60 | volume=86 | issue=2 | pmid=11982300 | doi=10.1016/S0025-7125(03)00085-3}}</ref>[[File:Lyme Disease Rash.jpg|thumb|Visible part of the Lyme disease rash showing its characteristic asymmetrical cross-section]] ▼
▲The mostinitial distinctivesign featureof about 80% of EMLyme infections is an erythema migrans (EM) [[rash]] at the shapesite of a tick bite, often near skin folds, such as the [[armpit]], [[groin]], or [[Popliteal fossa|back of knee]], on the [[Torso|trunk]], under clothing straps, or in children's hair, ear, or neck.<ref name=wright_2012/><ref name=NEJM2014/> Most people who get infected do not remember seeing a tick or the bite. The EM rash appears typically one or two weeks (range 3–32 days) after the bite. The most distinctive features of the EM rash are the speed and extent to which it expands , isrespectively 2–3cm2–3 cm per day and up to a diameter of 5–70cm5–70 cm (50% attain more than 16cm16 cm).<ref name= "wright_2012 " /><ref name= "NEJM2014 " /><ref name= "tibbles_2007 " /> The rash is usually circular or oval, red or bluish, and may behave an elevated or flatdarker with a central dotcenter.<ref name= "NEJM2014 " /><ref name= "CDC_Lyme_rashes " /> In about 79% of cases in Europe but only 19% of cases in endemic areas of the U.S., the rash gradually clears from the center toward the edges, possibly forming a "bull's eye" pattern.<ref name= "tibbles_2007 " /><ref name= "CDC_Lyme_rashes " /> The rash may feel warm but usually is not itchy, is rarely tender or painful , and takes up to four weeks to resolve if untreated.<ref name= "NEJM2014 " /><ref>{{cite journal | vauthors=Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, Holman MS, Persing DH, Steere AC | title=Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans | journal=Ann Intern Med | year=2002 | pages=421–8 | volume=136 | issue=6 | pmid=11900494 | doi=10.7326/0003-4819-136-6-200203190-00005}}</ref><ref name="pmid11982300">{{cite journal | author=Edlow JA | title=Erythema migrans | journal=Med Clin North Am | year=2002 | pages=239–60 | volume=86 | issue=2 | pmid=11982300 | doi=10.1016/S0025-7125(03)00085-3}}</ref>[[File:Lyme Disease Rash.jpg|thumb|Visible part of the Lyme disease rash showing its characteristic asymmetrical cross-section]]
The EM rash is often accompanied by symptoms of a viral-like illness, including fatigue, headache, body aches, fever, and chills, and pain if your right ear. These symptoms may also appear without a rash, or linger after the rash disappears. Lyme can progress to later stages without these symptoms or a rash.<ref name=NEJM2014/> ▼
▲The EM rash is often accompanied by symptoms of a viral-like illness, including fatigue, headache, body aches, fever, and chills, andbut painusually ifnot yournausea rightor earupper-respiratory problems. These symptoms may also appear without a rash, or linger after the rash disappears. Lyme can progress to later stages without these symptoms or a rash.<ref name=NEJM2014/>
A person with an asymptomatic EM rash can easily miss its significance. However, if the initial EM rash is not treated, the infection can become systemic, spreading through the lymphatic system or blood. Within days or weeks, additional EM rashes, usually smaller, can appear at other sites, or the infection can cause more serious complications in the central nervous system, heart, brain (lyme meningitis), or joints, and sometimes (rare) the eye.<ref name=wright_2012/><ref name=NEJM2014/> ▼
▲A person with an asymptomatic EM rash can easily miss its significance. However, if the initial EM rash is not treated, the infection can become systemic, spreadingdisseminate through the lymphatic system or blood. Within days or weeks, additional EM rashes, usually smaller, can appear at other sites, or the infection can cause more serious complications in the central nervous system, heart , brain (lyme meningitis), or joints , and sometimes (rare) the eye.<ref name=wright_2012/><ref name=NEJM2014/>
Lyme meningitis is a serious, life-threatening condition and suspected cases of any meningitis requires intravenous antibiotics immediately.
==Southern tick-associated rash illness==
|
