Erythema Migrans Information - erythema chronicum migrans

Erythema Migrans Information

Erythema migrans is a unique cutaneous eruption that characterizes the localized or generalized early stage of Lyme disease. Three to 32 days (median: 7 days) after a tick bite, there is gradual expansion of redness around the papule representing the bite site. The advancing border is usually slightly raised, warm, red to bluish-red, and free of any scale. Centrally, the site of the bite may clear, leaving only a rim of peripheral erythema, or it may become indurated, vesicular, or necrotic. The annular erythema usually grows to a median diameter of 15 cm (range: 3–68 cm, but virtually always > 5 cm). It is accompanied by a burning sensation in half of patients; rarely, it is pruritic or painful. Twenty percent of patients will develop multiple secondary annular lesions similar in appearance to the primary lesion but without indurated centers and generally of smaller size. In the southeastern United States, similar lesions are seen in patients without evidence of Lyme borreliosis. The etiology of these cases is unclear, but they are not due to borrelia.

Without treatment, erythema migrans and the secondary lesions fade in a median of 28 days, though some may persist for months. Ten percent of untreated patients experience recurrences over the ensuing months. Treatment with systemic antibiotics is necessary to prevent systemic involvement. However, only 60–70% of those with systemic involvement experience erythema migrans.

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