Quiz Answers

Q1   No! This is not Lyme disease. This is just a typical skin reaction to

a tick bite. It is normal for a small, dime sized or less, area of

redness to remain after a tick bite, this is a reaction to the tick

proteins in the skin and does not indicate infection. However if

the rash begins to expand in size (usually greater than 2-3 inches

in size) you may be at risk for Lyme disease and should consult

your physician.



Q2   Yes! This is Lyme disease. 1% of Lyme disease rashes have a

central blistering or pustular appearance that is commonly

mistaken for a spider bite. Why does this occur? It is a more

severe reaction to B. burgdorferi. These rashes are often

referred to as vesiculopustular.



Q3 Yes! This is Lyme disease. A uniformly red rash is the most

common form of a Lyme disease rash. These rashes can be

distinguished from other skin rashes by their sharply demarcated

border and round or oval shape. While the Lyme rash may be

mildly itchy or sensitive, it is not usually described as painful or

extremely itchy like poison ivy.



Q4   No! This is not Lyme disease. This rash is caused by

a skin infection from the bacteria Staphylococcus aureus

The secretion of puss from the  center of the skin lesion 

distinguishes this rash from Lyme disease.



Q5   No! This is not Lyme disease. This rash is caused by

hand -- foot -- mouth disease. Like many viral

infections, the rash is made up of multiple, blotchy

red areas throughout the skin surface.




Q6  Yes! This is Lyme disease. This is the classic

“bull’s eye” target lesion of Lyme disease that we always

think of with Lyme disease, but actually rarely

occurs. The majority of Lyme skin lesions lack the

hallmark rings. Only about 10-20% of Lyme disease

lesions have a bull’s eye appearance


Q7  No! This is not Lyme disease. This is just a normal immediate skin reaction

to a tick bite. Ticks stay attached and feeding on the skin for 2-3 days before

they drop off and leave. Lyme disease and it’s tell-tale rash take

approximately 7-10 to develop. Therefore the appearance of a tick can be a

good indication it is not Lyme disease, yet. The risk of developing Lyme

disease is approximately 2% for any given tick bite. Most people who get

Lyme disease never remember seeing a tick because they are so small and

often in hidden areas.



Q8  No! This is not Lyme disease. This rash is called contact dermatitis

caused by poison ivy. This differs from a Lyme disease rash due

to its linear, non-circular shape.



Q9  Yes! This is Lyme disease. These are not multiple tick bites. The

original skin infection of Lyme disease can spread through the

bloodstream to other areas of the skin. This results in multiple skin

lesions that often have variable shapes and appear throughout

different areas of the skin. This form of Lyme disease are often referred

to as disseminated cutaneous lesions.




Q10  Yes! This is Lyme disease. Some Lyme rashes have a blue-purple color and

can be mistaken for a bruise. What distinguishes this from a bruise? The

perfectly uniform circle and the lack of the yellowish discoloration often seen with bruises.



Q11  No! This is not Lyme disease.  This is the rash of shingles. 

It is made up of several red areas that align along one band on one side

of the body. The rash is unusually sensitive or painful.



Q12  No! This is not Lyme disease.  This is the rash of cellulitis which

is an infection by common bacteria such as strep and staph. It has an irregular 

shape and lacks the distinct border and oval/round shape of Lyme disease. 

The redness of the skin is more random and does not have a target appearance.

It is more tender than the rash of Lyme disease and often spreads more rapidly than Lyme disease.

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What other clues are there to Lyme disease besides the characteristic round

or oval appearance of the skin lesion?

1. Patients with Lyme disease often, but not always, have symptoms such

as fever, chills, flu-like achiness, neck and headache and other signs of a

systemic illness

2. Patients with Lyme disease lack symptoms and signs of typical viral

respiratory illness such as running nose and prominent cough.

3. Lyme disease has a highly seasonal pattern. The majority of acute cases

occur in the late spring and early summer, the exact opposite of the

seasonal pattern for respiratory viral illnesses