Erythema migrans

Erythema migrans also called as Erythema chronicum migrans. Description: A raised erythematous ring with advancing indurated borders and central clearing, radiating from the site of a tick bite and persisting for 2-16 weeks; the characteristic skin lesion of Lyme disease, due to the spirochete Borrelia burgdorferi, which may be identified by PCR in biopsies. The characteristic manifestation of early Lyme disease (stage 1) is erythema migrans: a circular rash at the site of the infectious tick attachment that radiates from the bite, within 2 - 40 days. Starts as a red macule or papule at the site of the tick bite after a 7-10 day delay. It expands over a period of days to weeks in 80-90% of people with Lyme disease. Central clearing may or may not occur. Associated with other symptoms of infection including fatigue, myalgia, arthralgia, headache, fever, chills, stiff neck, regional lymphadenopathy. Also associated with carditis, neurological disease, arthritis, acrodermatitis chronica atrophicans (swollen, bluish-red skin lesion on a distal extremity). Erythema migransThe EM rash occurs, according to sources, in 80% to 90% of those infected with Borrelia. A systematic review of the medical literature shows that 80% of patients have an expanding EM rash, at the site of the tick bite, although some patients with EM do not recall a tick bite. In endemic areas of the United States homogeneously red rashes are more frequent. Within a month of being infected with Lyme disease this condition will appear. The rash typically starts out small and red around the site of the tick bite before expanding. Individuals may develop more than one rash area in some cases. It may look like a bull's-eye sometimes. The rash will not be developed by all patients with Lyme disease. In approximately eighty percent of the individuals with Lyme disease the rash will occur. An allergic reaction to one of many factors can cause some skin rashes, blemishes and growths. A virus or exposure to environmental elements can also be a cause. If you notice any change in the color or consistency of your skin it is important to check with your doctor to get a proper diagnosis. Erythema migrans can occur in anyone who has been bitten by a tick and those who develop Lyme disease. All races and sexes are affected the same. Both adults and children can get the disorder. It is associated with Lyme disease. Anytime from one day to a month after being infected it will start as a circular rash. The rash will appear slightly raised as it begins to grow. The center of the rash can appear clear which makes it resemble a bull's-eye. It is not painful for an individual but it may be warm to the touch. They can happen anywhere on the body. The thighs, groin, buttocks, trunk, armpits, waist and knees are common areas. Symptoms: Within a month of being bitten by the tick that carries Lyme disease a red rash will develop. The rash typically starts out small and then grows. It can grow to as much as one foot across. It is not itchy or painful, but the rash may be warm to the touch. After three to four weeks the rash usually fades. Individuals may also experience a fever, headaches, body aches and a sense of fatigue. Many feel like they have common flu symptoms. Causes and Risk factors: Erythema migrans can occur in anyone who has been bitten by a tick and those who develop Lyme disease. All races and sexes are affected the same. Both adults and children can get the disorder. An allergic reaction to one of many factors can cause some skin rashes, blemishes and growths. A virus or exposure to environmental elements can also be a cause. If you notice any change in the color or consistency of your skin it is important to check with your doctor to get a proper diagnosis. Diagnosis: A doctor will first have to diagnose the individual with Lyme disease in order to diagnose erythema migrans. To confirm the presence of Lyme disease it is done with a gathering of medical symptoms from the individual, their history and a blood test. The rash is easy to identify as being associated with Lyme disease once it is diagnosed. If the rash is in areas that are not easy to view it can sometime be missed such as the buttocks. If in this area tick bites are also harder to discover. Culture and serology may be necessary for diagnosis. Microscopic features: Histologically, there is a superficial and deep perivascular and interstitial infiltrate of lymphocytes. In some cases plasma cells and eosinophils are present. Eosinophils may be present at the site of tick bite. A few neutrophils may also be noted. Special stain: Warthin-Starry silver stain - In some specimens spirochetes are identified in the papillary dermis at the dermoepidermal junction. Diagnosis may be confirmed by using an indirect immunofluorescence or immunoperoxidase techniques. B. burgdorferi may also be identified in formalin-fixed paraffin-embedded lesions by polymerase chain reaction method. Treatment: The rash will fade on its own if it is left alone and eventually go away. Oral antibiotics are often prescribed to treat Lyme disease. Individuals will have to take these antibiotics for at least three weeks. If an individual is allergic to antibiotics it is important to tell their physician since this is the main course of treatment. The rash will usually fade within three to four weeks once Lyme disease is treated. To keep the rash from getting irritated a cream or ointment may be recommended by a doctor. The rash can recur in some individuals. The body's reaction to a virus can cause erythema migrans. It is important to have the underlying cause of the disorder treated in these cases since this will usually allow the rash to begin to heal and go away on its own. It is important to determine if Lyme disease is the cause since erythema migrans can be confused with other rashes that look similar. Although the rash will resolve spontaneously, antibiotics hasten resolution and help prevent progression to Lyme disease:
  • Doxycycline is the antibacterial of choice for early Lyme disease.
  • Amoxicillin, cefuroxime or azithromycin are alternatives if doxycycline is contra-indicated.
The duration of treatment recommended is 2-4 weeks. Medicine and medications: Doxycycline, Amoxicillin, cefuroxime, or azithromycin. Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.  

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