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].

• Fever

  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 acute disease is often associated with fever, malaise, and arthralgias. [medical-dictionary.thefreedictionary.com]

  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]

• Fatigue

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

  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]

  […] syndrome: severe and debilitating fatigue Multiple sclerosis: leading to problems with muscle control and strength, vision, balance, sensation, and mental functioning Lupus: joint pain, swelling, may affect kidneys, brain and other organs If you suspect [bayarealyme.org]

• Chills

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

  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]

• Malaise

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

  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]

  The syndrome may include advancing erythematous rash stemming from an apparent insect bite, hyperesthesias, myalgias, malaise, fever, lymphadenopathy, and, rarely, meningitis. [ncbi.nlm.nih.gov]

• Weakness

  Symptoms may include: Twitching of the muscles in the face or hands Muscle weakness after the seizure Jerky or rhythmic movements Altered senses In some cases other areas of the body, such as the legs, may be affected. [cedars-sinai.edu]

  Symptoms include severe fatigue, fever, pain, intermittent weakness and achiness of the muscles and joints, numbness in arms and legs, vision changes, and cognitive dysfunction such as short-term memory difficulties and problems multitasking. [hopkinsarthritis.org]

  There was no history of any prior drug intake, oral ulceration, cough, rhinitis, joint pain, weakness of limbs, palpitation, travel, unprotected sexual intercourse or blood transfusion. [ijdvl.com]

  The localized nature of the seizures along with preserved consciousness and postictal confusion and weakness (Todd paralysis) are understood to be characteristic of the disorder but may not be considered pathognomonic due to recorded exceptions. [ncbi.nlm.nih.gov]

• Cough

  Drugs for the Management of Allergy, Cough, and Cold Symptoms Appendix BB.: Systemic Anti-Infectives Appendix CC.: Antibiotic Dosing by Weight for Liquid Forms Appendix CC.1.: Acyclovir (Zovirax Suspension) Appendix CC.2.: Amantadine (Symmetrel Syrup [connect.springerpub.com]

  Acute Lyme disease is not associated with typical cold-like symptoms of runny nose, prominent cough, or prominent diarrhea. [hopkinsarthritis.org]

  There was no history of any prior drug intake, oral ulceration, cough, rhinitis, joint pain, weakness of limbs, palpitation, travel, unprotected sexual intercourse or blood transfusion. [ijdvl.com]

  […] reaction (PCR), culture, and serologic tests Case Report A 74-year-old African American man was evaluated on 24 May 1999 at New York Medical College (NYMC; Valhalla) because of an abdominal skin rash that had been present for ∼4 days, as well as fatigue, cough [doi.org]

• Dyspnea

  […] within one to two months after infection (range of less than one week to seven months). 17 – 19 Lyme carditis is a less common complication of systemic disease, occurring in approximately 4 to 10 percent of patients. 19 It may present as chest pain, dyspnea [web.archive.org]

  Musculoskeletal and neurologic symptoms are the most common; less common are symptoms from cardiac disturbances, such as dizziness, syncope, dyspnea, chest pain, and palpitations. [emedicine.medscape.com]

• Nausea

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

  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]

• Vomiting

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

  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]

• Arthritis

  […] the onset of the arthritis. [ncbi.nlm.nih.gov]

  STEEREMALAWISTASNYDMAN ASD: Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum 20:7-17, 1977 CrossrefMedlineGoogle Scholar 3. AFZELIUS A: Erythema chronicum migrans. [acpjournals.org]

  Lyme arthritis--and in some patients with a characteristic skin lesion--erythema chronicum migrans--that sometimes precedes the onset of the arthritis. [science.sciencemag.org]

• Photophobia

  In stage 1 Lyme disease, the ocular manifestations are conjunctivitis and photophobia. These are mild and transient, and ophthalmologists usually need not be consulted. [emedicine.medscape.com]

• Erythema

  This graph shows the total number of publications written about "Erythema Chronicum Migrans" by people in this website by year, and whether "Erythema Chronicum Migrans" was a major or minor topic of these publications. [profiles.umassmed.edu]

  PMID: 6465906 Erythema chronicum migrans of Lyme disease B W Berger. Arch Dermatol. 1984 Aug. Abstract Erythema chronicum migrans (ECM) is the distinctive cutaneous lesion of the multisystem tick-borne spirochetosis, Lyme disease. [pubmed.ncbi.nlm.nih.gov]

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

• Skin Rash

  The red skin rash is present as a characteristic bull’s eye rash that gradually increases in size. [dovemed.com]

  —Carrie Arnold, Popular Science, 28 June 2020 Typical symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans. [merriam-webster.com]

  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]

  Without a telltale skin rash, it can be very hard to diagnose Lyme disease. Many people never recall being bitten. [bayarealyme.org]

• Dermatitis

  […] hypersensivity reaction to Insect Bite Typically Course Onset while tick still attached Starts to resolve within 48 hours Distinguish from Erythema Migrans Mark margins Observe for 48 hours off antibiotics Improvement suggests not a Lyme Disease rash Contact Dermatitis [fpnotebook.com]

  Page Excerpt: Images 10.9.1A: Perivascular and interstitial dermatitis + 10.9.1B: Lymphocytes, plasma cells, and eosinophils = Borreliosis In the United States, the findings pictured here are termed “erythema chronicum migrans” and are considered to be [derm101.com]

  Página 516 - Werner Y, Lindberg M: Transepidermal water loss in dry and clinically normal skin in patients with atopic dermatitis. Acta Derm Venereol (Stockh) 1985;65:102-105. ‎ [books.google.es]

• Blister

  On examination, there was an erythematous annular plaque on the back of the left lower leg approximately 6 × 5 cm in size, with a central brownish fluid filled blister [Figure 1]. [journals.lww.com]

  Acrodermatitis causes children to form itchy red or purple blisters on... Read more Weight Loss Coach A weight loss coach is a life coach who uses personal coaching methods to bring about weight loss that is long term. [allpathy.com]

  See: illustration necrolytic migratory erythema Abbreviation: NME Red, blistering or crusting patches that appear on the skin of the buttocks, groin, lower extremities, or perineum. The lesions are itchy and painful. [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]

  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]

  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]

  […] 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]

• Headache

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

  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]

  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]

• Meningism

  HELLERSTRÖM S: Erythema chronicum migrans Afzelius with meningitis. Acta Derm Venereol (Stockh) 31:227-234, 1951 MedlineGoogle Scholar 7. GELBJERG-HANSEN G: Erythema chronicum migrans Afzelii and meningitis after a tick bite. [acpjournals.org]

  […] due to lyme disease Meningitis in Lyme disease Meningoencephalitis due to lyme disease Myopericarditis due to lyme disease Polyneuropathy due to lyme disease Clinical Information Recurrent multisystemic infectious disease caused by a spirochete, borrelia [icd9data.com]

  Two untreated patients developed meningitis/meningoradiculitis and one untreated patient arthritis. The importance of a sufficient antibiotic therapy to prevent late manifestations is stressed. [ncbi.nlm.nih.gov]

• Stroke

  Stroke, Hemorrhagic Temporal Arteritis Thoracic Aortic Dissection Upper Gastrointestinal Bleed Urinary Incontinence, Women Urinary Tract Infection, Child Urinary Tract Infection, Women Vaginitis Vertigo The e-chapter logo indicates a chapter that is [jamaevidence.mhmedical.com]

  EPC in adults is sometimes linked to damage in the brain tissue from a stroke. [cedars-sinai.edu]

  University Medical Center Michael J Schneck, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neuroimaging, Neurocritical Care Society, and Stroke Council of the American Heart Association Disclosure [medscape.com]

  Stroke[edit] Central facial palsy can be caused by a lacunar infarct affecting fibers in the internal capsule going to the nucleus. The facial nucleus itself can be affected by infarcts of the pontine arteries. [en.wikipedia.org]

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]

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]

These patients had uneventful recoveries following treatment with systemic antibiotics. Thirty-four skin biopsy specimens were obtained from the ECM lesions of 30 patients. [pubmed.ncbi.nlm.nih.gov]

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]

Similar articles Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis. Feder HM Jr, Abeles M, Bernstein M, Whitaker-Worth D, Grant-Kels JM. Feder HM Jr, et al. [pubmed.ncbi.nlm.nih.gov]

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

ELISA 38 1986 [Etiology of acrodermatitis chronica atrophicans and erythema chronicum migrans]. [allie.dbcls.jp]

ELISA, IFA, Ig 33 1987 Epidemiology of borrelia infections in Austria. [allie.dbcls.jp]

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

Lyme disease can present with neurologic abnormalities without diagnostic extraneural features, can be suspected on clinical and epidemiologic grounds, and can be diagnosed serologically. [ncbi.nlm.nih.gov]

[…] 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.