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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

Erythema Chronicum Migrans (C0014740)

Definition (MSH)A deep type of gyrate erythema that follows a bite by an ixodid tick; it is a stage-1 manifestation of LYME DISEASE. The site of the bite is characterized by a red papule that expands peripherally as a nonscaling, palpable band that clears centrally. This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck.
ConceptsDisease or Syndrome (T047)
ICD9088.81
MSHD015787
EnglishECM - Erythema chronicum migrans, Erythema chronica migrans, Erythema Chronicum Migrans
Spanisheritema migratorio cronico
Parent ConceptsSkin finding (C0455205), Lyme Disease (C0024198), Erythema (C0041834), Skin Diseases, Bacterial (C0162627), Disease due to Arthropod (C0277343), Non-pyogenic bacterial infection of skin (C0406142), Duplicate concept (C1274013)
SourcesAIR, MSH, MTHICD9, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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