3. Erythema Chronicum Migrans

Erythema Chronicum Migrans

This PatientPlus article is written for healthcare professionals so the language may be more technical than the condition leaflets. You may find the abbreviations list helpful.

This is a characteristic clinical feature of Lyme borreliosis, occurring in approximately 90% of patients infected with Borrelia burgdorferi transmitted to humans by the bite of ticks from the genus Ixodes.

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  • Lyme disease occurs in temperate regions of North America, Europe and Asia.
  • In some countries of Europe the incidence of Lyme disease has been estimated to be over 100 per 100,000 people a year.
  • The characteristic manifestation of early Lyme disease (stage 1) is erythema migrans: a circular rash at the site of the infectious tick attachment, which radiates from the bite, within 2-40 days.
  • It starts as a red macule or papule at the site of the tick bite after a 7- to 10-day delay.
  • Common areas include the popliteal fossa, groin, the axilla, the thorax and the trunk The hairline and scalp are especially common in children.
  • It is associated with other symptoms of infection, including fatigue, myalgia, arthralgia, headache, fever, chills, stiff neck, and regional lymphadenopathy.
  • It is also associated with carditis, neurological disease, arthritis, and acrodermatitis chronica atrophicans (a swollen, bluish-red skin lesion on a distal extremity).
LYME DISEASE
  • Culture, serology and skin biopsy may be necessary for diagnosis.

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.[2]
  • Amoxicillin or cefuroxime are alternatives if doxycycline is contra-indicated.
  • Macrolides such as azithromycin or clarithromycin should be reserved as third-line treatment as they are not as effective as the aforementioned antibiotics.[3]
  • The duration of treatment recommended is 2-4 weeks.
  • Avoid exposure to tick bites.
  • Antibiotic prophylaxis can be offered in endemic areas under certain circumstances if the tick bite can be positively identified.[3]
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Further reading & references

  1. Edlow J; Erythema Chronicum Migrans, eMedicine, May 2010
  2. British National Formulary
  3. Wormser GP, Dattwyler RJ, Shapiro ED et al.; The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1;43(9):1089-134. Epub 2006 Oct 2.
Original Author: Dr Laurence Knott Current Version:
Last Checked: 20/12/2010 Document ID: 957  Version: 23 © EMIS

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.