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  • Erythema Chronicum Migrans

Viral Infection

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Erythema Chronicum MigransAka: Erythema Migrans

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  1. See Also
    1. Lyme Disease
  2. Definition
    1. Pathognomonic bullseye rash of early Lyme Disease
  3. Epidemiology
    1. Now thought to occur in 90% of Lyme Disease cases
      1. Previously thought to be seen in only 50-60%
      2. Lower detection due to ECM rash that is missed
      3. Reinforces need for very careful skin exam
    2. Appears in 86-100% of symptomatic Lyme Disease cases
  4. Timing
    1. Occurs 3-30 days (median 7 days) after Deer Tick bite
  5. Distribution
    1. Localized rash at Deer Tick bite site
  6. Appearance
    1. Initial
      1. Small red painless Papule at tick bite site
      2. Rash does not itch
      3. Expands centrifugally over days or weeks
    2. Later: Annular Lesion
      1. Circular, oval or triangular
      2. Central clearing or darkening with induration
        1. Occurs in only 33% of cases
      3. Macular, papular or vesicular
      4. Expands to >5 cm diameter
        1. Typically 20-30 cm (up to 70 cm) diameter
    3. Resolution
      1. Rash resolves in weeks if not treated
    4. Variations
      1. Multiple lesions (hematogenous spread of infection)
      2. Central vessicle or Pustules (5% of cases)
      3. May appear purpuric on legs
  7. Symptoms
    1. No Pruritus
  8. Differential Diagnosis
    1. See Annular Lesion
    2. Localized hypersensivity reaction to Insect Bite
      1. Typically <5 cm in size
      2. Course
        1. Onset while tick still attached
        2. Starts to resolve within 48 hours
      3. Distinguish from Erythema migrans
        1. Mark margins
        2. Observe for 48 hours off antibiotics
        3. Improvement suggests not a Lyme Disease rash
    3. Contact Dermatitis
      1. Pruritus (does not occur in Erythema migrans)
    4. Cellulitis
      1. Distribution may help distinguish from EM rash
      2. Cellulitis rare in axilla, popliteal fossa, abdomen
  9. Interpretation: Classic Erythema migrans rash
    1. Erythema migrans is diagnostic for Lyme Disease
      1. Allows diagnosis without confirmatory testing
  10. References
    1. Nadelman (1995) Am J Med 98:15S
    2. Stanek (2003) Lancet 362:1639
    3. Wormser [AU] AND 2006 [DP] AND Clin Infect Dis [TA] " class="LinkRef">Wormser (2006) Clin Infect Dis 43:1089

Glossitis, Benign Migratory (C0017677)

Definition (MSH)An idiopathic disorder characterized by the loss of filiform papillae leaving reddened areas of circinate macules bound by a white band. The lesions heal, then others erupt.
ConceptsDisease or Syndrome (T047)
ICD9529.1
EnglishBenign migratory glossitis, Denuded islands on tongue, Erythema migrans, Geographic Tongue, Geographical tongue, Glossitis Areata Exfoliativa, Glossitis areata migrans, Lingual erythema migrans, Lingual geographica, Pityriasis linguae, TONGUE GEOGRAPHIC
Spanishglositis areata exfoliativa, glositis areata migratoria, glositis migratoria benigna, lengua geográfica, lengua geografica
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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