Lyme disease is a multisystem infectious disease that is caused by the transmission of Borrelia burgdorferi bacteria into the human body through tick bite. After Borrelia burgdorferi invade the human body, the cellular immune response leads to marked changes in the skin which may manifests early with in a week of bite or over several months to years. Here we will discuss some common early and late Lyme disease rash.

Erythema Chronicum Migrans

Erythema chronicum migrans is an early skin manifestation of Lyme disease. Erythema migrans is usually seen in 70-90% of the patients with Lyme disease. Erythema migrans rash appears after 7-10 days of tick bite and resolves spontaneously after 4-10 weeks, in some cases it may persist for as long as 6 to 12 months. Learn more Click Here

Erythema migrans may sometimes be confused with:

  • Arthropod bite
  • Erythema multiforme
  • Granuloma annulare
  • Urticaria
  • Erysipelas
  • Brown recluse spider bite
  • Fixed drug eruption
Acrodermatitis Chronica Atrophicans

Acrodermatitis chronica atrophicans is late skin manifestation of Lyme disease. It may appear months to year after tick bite. This manifests due to the ongoing active infection cause by Borrelia afzelii. As it occurs after several months of tick bite, one may rarely remember a tick bite. ACA begins with bluish-red discoloration and swelling commonly seen on extensor surface of hands, fingers legs and feet.

Acrodermatitis chronica atrophicans sometimes may be confused with:

  • Venous insufficiency
  • Lichen sclerosus
  • Scleroderma
  • Physiologic age-related atrophy
  • Corticosteroid-induced atrophy

There are several other skin manifestation of Lyme disease but are not commonly seen in every individuals. Some of the uncommon skin manifestations of Lyme disease are given below.

Cutaneous Lesions
Some cutaneous lesion may develop as either early or late skin manifestation of Lyme disease. Some of the common lesions are:

  • Erythema multiforme
  • Panniculitis
  • Syphilis-like papulo-squamous eruption
Cutaneous Scleroborrelioses

Sclerotic skin lesions may also develop as a skin manifestation of Lyme disease and may be seen over several months or years. Some of the common lesions are:

  • Eosinophilic fasciitis
  • Periarticular fibrous nodules
  • Lichen sclerosus et atrophicus
  • Morphea
  • Progressive facial hemiatrophy
Cutaneous Atrophoborrelioses

Cutaneous Atrophic lesions may also been seen in late stage of Lyme disease. These lesions may appear over months to years.

Cutaneous Lymphoborrelioses

Lymphocytic infiltration may also be associated with Lyme disease and may occur in 1% of the cases of Lyme disease.