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
Myth: Bullseye Rash is Always Present in Lyme Disease Related Blog Posts
Myth: Bullseye Rash is Always Present in Lyme Disease Related Services
Lyme Disease
Lyme Disease Diagnosis and Treatment in Delmar NY and Burlington VT offices At the Stram Center we vow to continue our education on Lyme Disease research, stay up to date on the most effective testing and all the safe available therapies. Moreover, our years of experience in treating patients according to the whole person-integrative medicine approach allows us the most effective way to care…Lyme Disease
