Lyme disease is a tick-borne infection caused by Borrelia burgdorferi, a spirochetal bacterial pathogen [1] [2]. In approximately 80% of cases, cutaneous manifestations of this infection appear, predominantly in the form of erythema chronicum migrans (or erythema migrans), a pathognomonic finding of Lyme disease. It is described as an erythematous papule or macule at the site of the tick bite [3] [4] [5] [6]. The incubation period is variable (3-30 days), but in the majority of cases, erythema chronicum migrans is seen after 1-2 weeks and can occur on virtually any site of the body [1] [2] [5]. However, the waist, the extremities, the groins, the back, and the head and neck in the pediatric population are most frequent sites [4]. The progression of the erythematous macule, which may be asymptomatic, painful, or pruritic, eventually leads to a "target" or "bull's eye" lesion (as a central clearing around the center of the erythematous lesion is observed), with a diameter of > 5 cm, although a diameter as large as 60 cm has been reported [7] [8]. Numerous reports have confirmed that up to 30% of lesions exhibit significant variations [3] [5] [6] [7]. Firstly, multiple lesions can develop, the reason being the dissemination of the infection [3]. Secondly, an increasing number of cases present only with profound erythema and the absence of central clearing, thus the typical "target" lesion is not a mandatory finding in Lyme disease [5] [6]. Moreover, necrosis of the lesion, central hemorrhage, and formation of bullae are less common, but still possible variants of erythema chronicum migrans [1] [8]. It must be noted that numerous symptoms of Lyme disease can accompany erythema chronicum migrans, such as neurological deficits, fever, neck stiffness (suggesting meningitis), cardiac conduction abnormalities and arthritis (a sign of disseminated disease) [1] [2] [5].

• Fatigue

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. synonyms Erythema Chronicum Migrans UMLS ECM - Erythema chronic migrans, ECM - Erythema chronicum [dermis.net]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. [profiles.umassmed.edu]

  Nausea, vomiting, and diarrhea are sometimes observed along with headache and fatigue. The rash fades with time and the patient can start to develop joint problems, susceptibility to infection, extreme fatigue, and a host of other symptoms. [wisegeek.com]

• Nausea

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. synonyms Erythema Chronicum Migrans UMLS ECM - Erythema chronic migrans, ECM - Erythema chronicum [dermis.net]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. [profiles.umassmed.edu]

• Abnormal Pulse

  Erythema chronicum migrans is also associated with flu-like symptoms including fever, headache, fatigue, headache, sore throat, abnormal pulse, neck stiffness and pain, pain and swelling of one or more large joints, numbness or tingling sensation of hands [dermatalk.com]

• Erythema

  In approximately 80% of cases, cutaneous manifestations of this infection appear, predominantly in the form of erythema chronicum migrans (or erythema migrans), a pathognomonic finding of Lyme disease. [symptoma.com]

  Only two of the erythema chronicum migrans patients had IgG or IgM antibodies to flagellin. However, all seven morphea lesions as well as the other lesions were polymerase chain reaction negative. [ncbi.nlm.nih.gov]

  "Erythema migrans". Med Clin North Am. 86 (2): 239–60. doi : 10.1016/S0025-7125(03)00085-3. PMID 11982300. ^ Goddard J (2017) Not all erythema migrans lesions are Lyme disease. [en.wikipedia.org]

  […] migrans, Erythema chronica migrans, Erythema Chronicum Migrans, Erythema, chronicum migrans, Erythema, migrans, chronicum [dermis.net]

• Skin Rash

  Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. If left untreated, infection can spread to joints, the heart, and the nervous system. [microbiologyinpictures.com]

  BostonGlobe.com, "Lyme disease: How we discovered it and where we go from here," 22 Aug. 2019 Early in the infection people may experience fever, headache, fatigue, swollen glands or a skin rash called erythema migrans, or a bull’s eye. — Andrea K. [merriam-webster.com]

  Synonym: toasted skin syndrome. ERYTHEMA ANNULARE erythema annulare A red, ring-shaped rash. [medical-dictionary.thefreedictionary.com]

• Erythema Annulare

  Erythema Annulare Centrifugum (Overview) Erythema Annulare Centrifugum: Background, Pathophysiology, Etiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. [tripdatabase.com]

  It is very similar to erythema annulare centrifugum, except that the advancing edge is frequently broader, up to a centimeter of raised erythema. It is associated with an arthritis known as Lyme arthritis. [skincareguide.ca]

  Weiterer Beitrag zur Kenntnis des Erythema chronicum migrans. Arch Dermatol Syph. 1923; 143: 365–374 View in Article | Google Scholar 7.Balban, W. Erythema annulare entstanden durch Insektenstiche. [jaad.org]

  […] i-them'at-us), adjective erythema ab igne Localized erythema due to exposure to heat. Synonym: toasted skin syndrome. ERYTHEMA ANNULARE erythema annulare A red, ring-shaped rash. [medical-dictionary.thefreedictionary.com]

• Skin Lesions with Central Clearing

  A Skin lesion with central clearing, in right lower quadrant of abdomen. Raised lesion marks indicate from which area the attached tick was removed. [doi.org]

• Ecthyma

  […] this gene will be send to {{ username }} {{geneWatchAttr}} Parent Terms Term With Siblings Child Terms Actinomycosis, Cervicofacial Annular Erythema bacillary angiomatosis cutaneous anthrax Cutaneous Syphilis Cutaneous Tuberculosis + Digital Dermatitis ecthyma [rgd.mcw.edu]

• Headache

  General symptoms such as headache, fever, myalgia and/or arthralgia were found in about half of the patients with a disease duration of less than or equal to 3 weeks. Three patients had coexisting lymphadenosis benigna cutis. [ncbi.nlm.nih.gov]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. synonyms Erythema Chronicum Migrans UMLS ECM - Erythema chronic migrans, ECM - Erythema chronicum [dermis.net]

  This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck. [profiles.umassmed.edu]

The importance of recognizing erythema chronicum migrans lies in the fact that up to 60% of patients have negative serology tests for B. burgdorferi in the first several weeks of the infection [5]. For this reason, a meticulous physical examination supported by data obtained during patient history is the pivotal step in confirming Lyme disease and observing its hallmark lesion [6]. Physicians must inquire whether patients reside in or have recently visited at-risk areas, and note the signs and symptoms that possibly suggest an infectious etiology, while the course and progression of the skin lesion should also be discussed with the patient (if the patient had noticed the lesion etc.). The entire body should be examined in order to exclude multiple erythema chronicum migrans, and a close inspection, as well as palpation of the lesion, is vital for raising clinical suspicion of Lyme disease as a potential diagnosis [1] [2] [4] [7] [8]. Physicians must be aware of the incubation period of erythema chronicum migrans, its variable presentation, and the broad differential diagnosis [4]. In all patients in whom this lesion is suspected, microbiological investigation to confirm Lyme disease is mandatory. As serologic testing may be initially negative, blood cultures, biopsy samples of the lesion and polymerase chain reaction (PCR) testing can be implemented [1] [2] [5] [6]. But because of their limited use and sensitivity/specificity in the absence of erythema chronicum migrans, clinical assessment remains the most important part of Lyme disease workup.

[…] received a recommended treatment and in 1 of the 3 patients who received other treatments. [ncbi.nlm.nih.gov]

Treatment: The treatment of choice is the use of penicillin or another antibiotic to which Borrelia is sensitive. Such treatment should be continued for 2-4 weeks. Back to Dermatology Glossary - E Index | Back to Dermatology Glossary Index [skincareguide.ca]

Antibiotic Treatment of Multiple Erythema Migrans migrans Lyme borreliosis ceftriaxone treatment doxycycline treatment outcome subjective symptoms Additional relevant MeSH terms: Layout table for MeSH terms Erythema Erythema Chronicum Migrans Glossitis [tripdatabase.com]

Annals of the New York Academy of Sciences 1988 Between June 1981 and July 1987 the efficacy of antibiotic treatment of 215 patients with erythema chronicum migrans of Lyme… (More) Bernard W. [semanticscholar.org]

The prognosis in most patients with Lyme borreliosis is excellent. [ncbi.nlm.nih.gov]

Babesia microti Prognosis the rash typically self-resolves without treatment untreated Lyme disease can result in arthritis excellent prognosis with early antibiotic treatment Presentation Symptoms early localized stage erythema migrans (7-14 days post-tick [step2.medbullets.com]

Prognosis Usually bad, often associated with residual or progressive neurocognitive deficits. Differential diagnosis Encephalitis of any cause. Kozhevnikov-Rasmussen syndrome. Management options* Seizures are resistant to AEDs. [epilepsy.com]

"Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis". Clin. Dermatol. 24 (6): 509–20. doi : 10.1016/j.clindermatol.2006.07.012. PMID 17113969. ↑ Weber K, Wilske B (2006). [ipfs.io]

These results suggest an etiologic role for the Ixodes ricinus spriochete in European erythema chronicum migrans disease. [ncbi.nlm.nih.gov]

BACKGROUND: The study of histopathological alterations in relation to Erythema chronicum migrans (Lyme disease) and the demonstration of its etiological agent in tissues have been little divulged in our Country and region. [scielo.br]

Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire, 62 (‎51-52)‎, 386 - 387. http://www.who.int/iris/handle/10665/226543 Journal Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire, 62 (‎51-52)‎: 386 - 387 Collections [apps.who.int]

Abstract Epidemiology and clinical presentation of Erythema chronicum migrans disease are not well known yet. [ncbi.nlm.nih.gov]

Erythema chronicum migrans and Lyme arthritis: epidemiologic evidence for a tick vector. American Journal of Epidemiology 108 :312–321. PubMed Google Scholar 10. Steere, A. C., Malawista, S. E., Hardin, J. A., Ruddy, S., Askenase, P. W., Andiman, W. [link.springer.com]

[…] erythema chronicum migrans Member Rated 0 Patient case no. 4085 Date added 27 July 2003 Patient details Age Elderly patient Localisation Trunk / abdomen Primary Lesions Excoriation Papule / erythematous Plaque / erythematous Pathophysiology infectious [dermquest.com]

Erythema Annulare Centrifugum (Overview) Erythema Annulare Centrifugum: Background, Pathophysiology, Etiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. [tripdatabase.com]

The symptoms of EPC have been interpreted to be due to cortical hyperexcitability, but the exact pathophysiology is poorly understood due to a high degree of variability. [ncbi.nlm.nih.gov]

Prevention Avoid exposure to tick bites. Remove ticks as soon as possible. Ticks take some time to transmit infection, so this may be prevented if removed quickly. [patient.info]

Abstract The efficacy of antibiotic treatment of 117 patients with erythema chronicum migrans of Lyme disease was evaluated in terms of the necessity for retreatment and the prevention of the late manifestations of Lyme disease. [ncbi.nlm.nih.gov]

The Centers for Disease Control and Prevention (CDC) definition is “erythema migrans (EM), the initial skin lesion that occurs in 60%–80% of patients. [doi.org]

1. Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Seventh edition. Philadelphia: Elsevier/Saunders; 2013.
2. Mandell GL, Bennett JE, Dolin R. Mandel, Douglas and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, Pennsylvania: Churchill Livingstone; 2015.
3. Eriksson P, Schröder MT, Niiranen K, Nevanlinna A, Panelius J, Ranki A. The many faces of solitary and multiple erythema migrans. Acta Derm Venereol. 2013;93(6):693-700.
4. Juckett G. Arthropod bites. Am Fam Physician. 2013;88(12):841-847.
5. Shapiro ED. Lyme Disease. N Engl J Med. 2014;370(18):1724-1731.
6. Aucott J, Morrison C, Munoz B, Rowe PC, Schwarzwalder A, West SK. Diagnostic challenges of early Lyme disease: Lessons from a community case series. BMC Infect Dis. 2009;9:79.
7. Schutzer SE, Berger BW, Krueger JG, Eshoo MW, Ecker DJ, Aucott JN. Atypical Erythema Migrans in Patients with PCR-Positive Lyme Disease. Emerg Infect Dis. 2013;19(5):815-817.
8. Wetter DA, Ruff CA. Erythema migrans in Lyme disease. CMAJ. 2011;183(11):1281.