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
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
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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
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