Erythema chronicum migrans - wikipedia Erythema chronicum migrans `` Erythema migrans '' redirects here. For the tongue condition, see Geographic tongue. Erythema chronicum migrans An erythema migrans rash. Classification and external resources Specialty infectious disease ICD - 10 A69. 2 ( ILDS A69. 22 ) ICD - 9 - CM 088.81, 529.1 DiseasesDB 4439 MeSH D015787 ( edit on Wikidata ) Erythema chronicum migrans ( New Latin, literally, `` chronic migrating redness '' ) refers to the rash often ( though not always ) seen in the early stage of Lyme disease. It can appear anywhere from one day to one month after a tick bite. This rash does not represent an allergic reaction to the bite, but rather an actual skin infection of one of the Lyme bacteria species from the genus Borrelia. `` Erythema migrans is the only manifestation of Lyme disease in the United States that is sufficiently distinctive to allow clinical diagnosis in the absence of laboratory confirmation. '' It is a pathognomonic sign : a physician - identified rash warrants an instant diagnosis of Lyme disease and immediate treatment without further testing, even by the strict criteria of the Centers for Disease Control and Prevention. Such target lesions ( bull 's - eye rashes ) are characteristic of Borrelia infections, and no other pathogens are known that cause this form of rash. It is also true, though, that the rash in Lyme disease may also be solid rather than bullseye - shaped, so self - diagnosis can not rule out Lyme disease, and a doctor visit is advisable. `` Not all erythema migrans lesions are Lyme disease '' : A similar condition called Southern Tick Associated Rash Illness ( STARI ) produces a similar rash pattern although it develops more quickly and is smaller. The associated infectious agent has not been determined. Antibiotic treatment resolves the illness quickly. This erythema is also sometimes called erythema migrans or EM. However, a less common meaning of the term `` erythema migrans '' is a mucosal condition of the tongue, also called geographic tongue. Contents 1 Presentation 1.1 Oral erythema migrans 2 Cause 3 Diagnosis 4 Treatment 5 History 6 See also 7 References 8 External links Presentation The erythema migrans rash is classically 5 to 6.8 cm in diameter, appearing as an annular homogenous erythema ( 59 % ), central erythema ( 30 % ), central clearing ( 9 % ), or central purpura ( 2 % ). Because of the `` bull 's - eye '' description to describe the Lyme disease rash, the condition commonly called ringworm is sometimes confused with Lyme disease. Uncommonly, EM may be less than 5 cm in diameter. Multiple painless EM rashes may occur, indicating disseminated infection. The EM rash occurs in 80 % to 90 % of those infected with Borrelia. A systematic review of the medical literature showed 80 % of patients have an expanding EM rash, at the site of the tick bite, although some patients with EM do not recall a tick bite. In endemic areas of the United States, homogeneously red rashes are more frequent. Advocates of a diagnosis called `` chronic lyme disease '' dispute the generally accepted incidence of the rash, claiming it occurs in less than 50 % of infections. Oral erythema migrans Oral erythema migrans also called migratory stomatitis when extensive areas in the oral cavity mucosa are affected, or geographic tongue when confined to the dorsal and lateral aspects of the tongue mucosa, is a very common entity of unknown cause and pathogenesis that affects 1 % to 2.5 % of the general population. Cause This section is empty. You can help by adding to it. ( March 2017 ) Diagnosis This section is empty. You can help by adding to it. ( March 2017 ) p - 66 antibody detection by Western blot ( non specific ) Treatment This section is empty. You can help by adding to it. ( March 2017 ) doxycycline or amoxicillin for initial stages, for late stage penicillin G or ceftriaxone History In a 1909 meeting of the Swedish Society of Dermatology, Arvid Afzelius first presented research about an expanding, ring - like lesion he had observed. Afzelius published his work 12 years later and speculated the rash came from the bite of an Ixodes tick, meningitic symptoms and signs in a number of cases and that both sexes were affected. This rash is now known as erythema chronicum migrans, the skin rash found in early - stage Lyme disease. In the 1920s, French physicians Garin and Bujadoux described a patient with meningoencephalitis, painful sensory radiculitis, and erythema migrans following a tick bite, and they postulated the symptoms were due to a spirochetal infection. In the 1940s, German neurologist Alfred Bannwarth described several cases of chronic lymphocytic meningitis and polyradiculoneuritis, some of which were accompanied by erythematous skin lesions. See also Acrodermatitis chronica atrophicans References Jump up ^ Wormser GP, Dattwyler RJ, Shapiro ED, et al. ( November 2006 ). `` The clinical assessment, treatment, and prevention of Lyme disease, Human Granulocytic Anaplasmosis, and Babesiosis : Clinical Practice Guidelines by the Infectious Diseases Society of America ''. Clin. Infect. Dis. 43 ( 9 ) : 1089 -- 134. PMID 17029130. doi : 10.1086 / 508667. `` pp. 1101 -- 2 Background and Diagnosis of Erythema Migrans Jump up ^ Ogden NH, Lindsay LR, Morshed M, Sockett PN, Artsob H ( January 2008 ). `` The rising challenge of Lyme borreliosis in Canada ''. Can. Commun. Dis. Rep. 34 ( 1 ) : 1 -- 19. PMID 18290267. ^ Jump up to : Juckett, G ( 2014 ), `` In reply : Comment on ' Identifying erythema migrans rash in patients with Lyme disease ' '', Am Fam Physician, 89 ( 6 ) : 424, PMID 24818260. Jump up ^ Goddard J ( 2017 ) Not all erythema migrans lesions are Lyme disease. The American journal of medicine, 130 ( 2 ), 231 - 233. Jump up ^ Lone Star Tick a Concern @ CDC Jump up ^ Naktin J.P ( 2017 ). Diagnostic Utility of Erythema Migrans. Clinical Infectious Diseases. Jump up ^ Rapini, Ronald P. ; Bolognia, Jean L. ; Jorizzo, Joseph L. ( 2007 ). Dermatology. St. Louis : Mosby. ISBN 1 - 4160 - 2999 - 0. ^ Jump up to : Feder HM, Abeles M, Bernstein M, Whitaker - Worth D, Grant - Kels JM ( 2006 ). `` Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis ''. Clin. Dermatol. 24 ( 6 ) : 509 -- 20. PMID 17113969. doi : 10.1016 / j. clindermatol. 2006.07. 012. Jump up ^ Weber K, Wilske B ( 2006 ). `` Mini erythema migrans -- a sign of early Lyme borreliosis ''. Dermatology ( Basel ). 212 ( 2 ) : 113 -- 6. PMID 16484816. doi : 10.1159 / 000090650. Jump up ^ CDC Lyme Disease Erythema Migrans Disease Retrieved May 13 2007 Jump up ^ Dandache P, Nadelman RB ( 2008 ). `` Erythema migrans ? ''. Infect Dis Clin North Am. 22 ( 2 ) : 235 -- 60. PMID 18452799. doi : 10.1016 / j. idc. 2007.12. 012. Jump up ^ Rational Clinical Examination Jump up ^ Tibbles CD, Edlow JA ( 2007 ). `` Does this patient have erythema migrans ? ''. JAMA. 297 ( 23 ) : 2617 -- 27. PMID 17579230. doi : 10.1001 / jama. 297.23. 2617. Jump up ^ Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, Holman MS, Persing DH, Steere AC ( 2002 ). `` Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans '' ( PDF ). Ann Intern Med. 136 ( 6 ) : 421 -- 8. PMID 11900494. doi : 10.7326 / 0003 - 4819 - 136 - 6 - 200203190 - 00005. Jump up ^ Edlow JA ( 2002 ). `` Erythema migrans ''. Med Clin North Am. 86 ( 2 ) : 239 -- 60. PMID 11982300. doi : 10.1016 / S0025 - 7125 ( 03 ) 00085 - 3. Jump up ^ Donta ST ( 2002 ). `` Late and chronic Lyme disease ''. Med Clin North Am. 86 ( 2 ) : 341 -- 9, vii. PMID 11982305. doi : 10.1016 / S0025 - 7125 ( 03 ) 00090 - 7. Jump up ^ Cameron D, Gaito A, Narris N, Bach G, Bellovin S, Bock K, Bock S, Burrascano J, Dickey C, Horowitz R, Phillips S, Meer - Scherrer L, Raxlen B, Sherr V, Smith H, Smith P, Stricker R, ILADS Working Group ( 2004 ). `` Evidence - based guidelines for the management of Lyme disease '' ( PDF ). Expert Rev Anti Infect Ther. 2 ( 1 Suppl ) : S1 -- 13. PMID 15581390. doi : 10.1586 / 14789072.2. 1. S1. Jump up ^ Zadik Y, Drucker S, Pallmon S ( Aug 2011 ). `` Migratory stomatitis ( ectopic geographic tongue ) on the floor of the mouth '' ( PDF ). J Am Acad Dermatol. 65 ( 2 ) : 459 -- 60. PMID 21763590. doi : 10.1016 / j. jaad. 2010.04. 016. Jump up ^ Lipschütz, B. ( 1931 ). `` Zur Kenntnis der `` Erythema chronicum migrans '' ``. Acta dermato - venereologica. Stockholm. 12 : 100 -- 2. External links Wikimedia Commons has media related to Erythema migrans. DermAtlas 208 Diseases of the skin and appendages by morphology Growths Epidermal wart callus seborrheic keratosis acrochordon molluscum contagiosum actinic keratosis squamous - cell carcinoma basal - cell carcinoma Merkel - cell carcinoma nevus sebaceous trichoepithelioma Pigmented Freckles lentigo melasma nevus melanoma Dermal and subcutaneous epidermal inclusion cyst hemangioma dermatofibroma ( benign fibrous histiocytoma ) keloid lipoma neurofibroma xanthoma Kaposi 's sarcoma infantile digital fibromatosis granular cell tumor leiomyoma lymphangioma circumscriptum myxoid cyst Rashes With epidermal involvement Eczematous contact dermatitis atopic dermatitis seborrheic dermatitis stasis dermatitis lichen simplex chronicus Darier 's disease glucagonoma syndrome langerhans cell histiocytosis lichen sclerosus pemphigus foliaceus Wiskott -- Aldrich syndrome Zinc deficiency Scaling psoriasis tinea ( corporis cruris pedis manuum faciei ) pityriasis rosea secondary syphilis mycosis fungoides systemic lupus erythematosus pityriasis rubra pilaris parapsoriasis ichthyosis Blistering herpes simplex herpes zoster varicella bullous impetigo acute contact dermatitis pemphigus vulgaris bullous pemphigoid dermatitis herpetiformis porphyria cutanea tarda epidermolysis bullosa simplex Papular scabies insect bite reactions lichen planus miliaria keratosis pilaris lichen spinulosus transient acantholytic dermatosis lichen nitidus pityriasis lichenoides et varioliformis acuta Pustular acne vulgaris acne rosacea folliculitis impetigo candidiasis gonococcemia dermatophyte coccidioidomycosis subcorneal pustular dermatosis Hypopigmented tinea versicolor vitiligo pityriasis alba postinflammatory hyperpigmentation tuberous sclerosis idiopathic guttate hypomelanosis leprosy hypopigmented mycosis fungoides Without epidermal involvement Red Blanchable Erythema Generalized drug eruptions viral exanthems toxic erythema systemic lupus erythematosus Localized cellulitis abscess boil erythema nodosum carcinoid syndrome fixed drug eruption Specialized urticaria erythema ( multiforme migrans gyratum repens annulare centrifugum ab igne ) Nonblanchable Purpura Macular thrombocytopenic purpura actinic / solar purpura Papular disseminated intravascular coagulation vasculitis Indurated scleroderma / morphea granuloma annulare lichen sclerosis et atrophicus necrobiosis lipoidica Miscellaneous disorders Ulcers Hair telogen effluvium androgenic alopecia alopecia areata systemic lupus erythematosus tinea capitis loose anagen syndrome lichen planopilaris folliculitis decalvans acne keloidalis nuchae Nail onychomycosis psoriasis paronychia ingrown nail Mucous membrane Aphthous stomatitis oral candidiasis lichen planus leukoplakia pemphigus vulgaris mucous membrane pemphigoid cicatricial pemphigoid herpesvirus coxsackievirus syphilis systemic histoplasmosis squamous - cell carcinoma Infectious diseases Bacterial diseases : BV4 non-proteobacterial G - ( primarily A00 -- A79, 001 -- 041, 080 -- 109 ) Spirochaete Spirochaetaceae Treponema Treponema pallidum Syphilis / bejel Yaws Treponema carateum ( Pinta ) Treponema denticola Borrelia Borrelia burgdorferi / Borrelia afzelii Lyme disease Erythema chronicum migrans Neuroborreliosis Borrelia recurrentis ( Louse borne relapsing fever ) Borrelia hermsii / Borrelia duttoni / Borrelia parkeri ( Tick borne relapsing fever ) Leptospiraceae Leptospira Leptospira interrogans ( Leptospirosis ) Spirillaceae Spirillum Spirillum minus ( Rat - bite fever / Sodoku ) Chlamydiaceae Chlamydophila Chlamydophila psittaci ( Psittacosis ) Chlamydophila pneumoniae Chlamydia Chlamydia trachomatis Chlamydia Lymphogranuloma venereum Trachoma Bacteroidetes Bacteroides fragilis Tannerella forsythia Capnocytophaga canimorsus Porphyromonas gingivalis Prevotella intermedia Fusobacteria Fusobacterium necrophorum ( Lemierre 's syndrome ) Fusobacterium nucleatum Fusobacterium polymorphum Streptobacillus moniliformis ( Rat - bite fever / Haverhill fever ) Urticaria and erythema ( L50 -- L54, 695, 708 ) Urticaria ( acute / chronic ) Allergic urticaria Urticarial allergic eruption Physical urticaria Cold urticaria Familial Primary cold contact urticaria Secondary cold contact urticaria Reflex cold urticaria Heat urticaria Localized heat contact urticaria Solar urticaria Dermatographic urticaria Vibratory angioedema Pressure urticaria Cholinergic urticaria Aquagenic urticaria Other urticaria Acquired C1 esterase inhibitor deficiency Adrenergic urticaria Exercise urticaria Galvanic urticaria Schnitzler syndrome Urticaria - like follicular mucinosis Angioedema Episodic angioedema with eosinophilia Hereditary angioedema Erythema Erythema multiforme / drug eruption Erythema multiforme minor Erythema multiforme major Stevens -- Johnson syndrome, Toxic epidermal necrolysis panniculitis ( Erythema nodosum ) Acute generalized exanthematous pustulosis Figurate erythema Erythema annulare centrifugum Erythema marginatum Erythema migrans Erythema gyratum repens Other erythema Necrolytic migratory erythema Erythema toxicum Erythroderma Palmar erythema Generalized erythema Retrieved from `` https://en.wikipedia.org/w/index.php?title=Erythema_chronicum_migrans&oldid=800697508 '' Categories : Bacterium - related cutaneous conditions Lyme disease Spirochaetes Hidden categories : Articles to be expanded from March 2017 All articles to be expanded Articles with empty sections from March 2017 All articles with empty sections Articles using small message boxes All articles with unsourced statements Articles with unsourced statements from March 2017 Talk Contents About Wikipedia Deutsch Français Italiano Polski Português Русский Edit links This page was last edited on 15 September 2017, at 03 : 39. 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Question: erythema migrans a bullseye rash at the portal of entry is associated with
Answer: Lyme disease