Myth: Bullseye Rash is Always Present in Lyme Disease
Many people believe that the bullseye rash, also known as erythema migrans (EM), is necessary for a Lyme disease diagnosis. While a bullseye rash is indeed clinically diagnostic, its absence cannot rule out either acute or chronic Lyme disease. However, a non-bullseye rash is more common...
Non-Bullseye Rashes Are More Common:
- The most common type of rash from a tick bite is a non-specific, solid-colored pink rash, occurring more frequently than the bullseye rash. Still, this may occur in as little as 50% of cases of Lyme. [1].
- Only about 33% of patients with Chronic Lyme Disease recalled having a bullseye rash, and 42% remembered a tick bite [2].
- EM rash is only present in about 70% of early cases of Lyme disease [3]. Approximately 20-30% of patients with Early Lyme Disease will not present with EM.
Beware of Co-Infections:
- There are several other infections that ticks can transmit. These are known as “co-infections”, such as anaplasmosis and babesiosis. These infections can mimic Lyme disease symptoms but won't cause a bullseye rash.
- Relying solely on the absence of a bullseye rash to rule out Lyme disease can result in missed diagnoses of co-infections.
Diagnosing Without a Bullseye Rash:
- If a bullseye rash isn't present, consider other factors:
- Exposure to tick-endemic areas. Remember that cases of tick borne illness have been reported in all 50 states.
- Hobbies or work that involves the outdoors or risk for exposure, such as farming, landscaping, gardening, Veterinary, horseback riding, hunting, hiking, etc.
- Owning pets such as dogs, cats, horses
- Presence of common Lyme disease symptoms such as fatigue, fevers, chills, joint pain, muscle aches, abnormal sweats, swollen lymph nodes, headache
- Use positive laboratory findings as additional supportive evidence
Don't solely rely on the presence or absence of a bullseye rash for a Lyme disease diagnosis. Consider other factors and symptoms to ensure accurate diagnosis and treatment.
Resources:
1 Smith RP, Schoen RT, Rahn DW, et al. Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans. Ann Intern Med 2002;136:421-8.
2 Johnson, L., Shapiro, M., Stricker, R. B., Vendrow, J., Haddock, J., & Needell, D. (2020, October). Antibiotic treatment response in chronic lyme disease: why do some patients improve while others do not?. In Healthcare (Vol. 8, No. 4, p. 383). MDPI.
3 Schwartz, A. M., Hinckley, A. F., Mead, P. S., Hook, S. A., & Kugeler, K. J. (2017). Surveillance for lyme disease—United States, 2008–2015. MMWR Surveillance Summaries, 66(22), 1
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