What are the other Names for this Condition? (Also known as/Synonyms)

• Erythema Migrans

What is Erythema Chronicum Migrans? (Definition/Background Information)

• Erythema Chronicum Migrans is described as a skin rash that that occurs in the early stages of Lyme disease. It can be also found with other tick-borne illnesses
• Lyme disease is a non-contagious bacterial infection caused by Borrelia burgdorferi. The disease is transmitted through the bites of infected blacklegged ticks and is mostly reported in parts of Europe and North America
• Erythema Chronicum Migrans is caused by the infection and is not a reaction to tick bite. It may appear within the first few days of tick bite, or after many weeks
• Individuals of any age may be affected. The red skin rash is present as a characteristic bull’s eye rash that gradually increases in size. The symptoms of Lyme disease that may be noted include fever, fatigue, and joint pain
• Adequate treatment of the underlying Lyme disease through the administration of antibiotics can help resolve Erythema Chronicum Migrans. The prognosis is good in a majority of cases with early treatment

Who gets Erythema Chronicum Migrans? (Age and Sex Distribution)

• Erythema Chronicum Migrans may occur at any age; both children and adults may be affected
• Both males and females may be affected
• Individuals of all racial and ethnic background can be affected. However, Lyme disease is prevalent in certain regions of North America and Europe, called the endemic regions

What are the Risk Factors for Erythema Chronicum Migrans? (Predisposing Factors)

• Individuals with Lyme disease are at an increased risk for developing Erythema Chronicum Migrans
• The skin rash may also develop due to other infections caused by tick bites

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Erythema Chronicum Migrans? (Etiology)

• The Borrelia bacteria are found growing in the skin of Erythema Migrans. Research scientists believe that Erythema Chronicum Migrans is caused by an immunological response of the body to Lyme disease. The skin rashes do not form as a reaction to tick bites, but due to the underlying infection. The bacterium then spreads to affect the numerous organs affected by Lyme disease
• Lyme disease is caused due to infection by Borrelia burgdorferi; a spiral shaped  bacterial species. The bacterium is transmitted to humans by bites of infected blacklegged ticks; the bacteria enter into the body through the broken skin

It is important to note that Erythema Chronicum Migrans and Lyme disease are non-contagious and they cannot be transmitted from one individual to another.

What are the Signs and Symptoms of Erythema Chronicum Migrans?

Erythema Chronicum Migrans is a classical sign of Lyme disease. It is present in approximately three-fourth of the individuals with Lyme disease. It appears within a few days to 30 days after the tick bite (average period, approximately 1 week).

The signs and symptoms of Erythema Chronicum Migrans include:

• A red bump at the site of tick bite
• The skin rash is small to begin with, but slowly expands
• It is usually single with an average size of 4-6 cm
• The reddish rash could get as large as 30 cm across, and might have a clearing in the center, giving a characteristic appearance of a bull’s eye
• It can be itchy and warm to touch, but is not usually painful
• The associated symptoms of early Lyme disease, such as fever and chills, muscle ache, headache, and tiredness, may be noted
• The rash may be localized to one spot or could appear on multiple spots
• During the later stages, Erythema Migrans is observed in several areas of the body, along-with other signs and symptoms of Lyme disease that include severe joint pain, neurological symptoms, and involvement of body organs

How is Erythema Chronicum Migrans Diagnosed?

A diagnosis of Erythema Chronicum Migrans may involve the following:

• A thorough medical history assessment and complete physical examination, including evaluating for recent outdoor activities
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Lab tests, such as enzyme-linked immunosorbent assay (ELISA), to check for Lyme disease
• Western blot test to check for the presence of Borrelia burgdorferi with antibodies
• Skin biopsy, if necessary: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. PCR testing is available to detect Borrelia burgdorferi in skin biopsies of Erythema Chronicum Migrans

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Erythema Chronicum Migrans?

The complications of Erythema Chronicum Migrans are typically from the presence of the underlying infection i.e., Lyme disease. In general, the complications may include:

• Cosmetic issues that result in emotional stress
• Secondary bacterial and fungal infection due to scratching and bleeding
• Complications of Lyme disease that include chronic joint pain, irregular heartbeat, hepatitis, meningitis, and facial palsy

How is Erythema Chronicum Migrans Treated?

The treatment of Erythema Chronicum Migrans (ECM) depends on the underlying condition. Treating the underlying Lyme disease successfully can result in the disappearance of ECM. The treatment measures may include:

• Early-stage Lyme disease is treated through a course of oral antibiotics
• Late-stage Lyme disease is treated through intravenous antibiotics

Additionally, the following skin care tips may be considered:

• Keeping the skin moist may help in reducing the signs and symptoms
• If any of the prescribed treatment causes new stinging or burning symptoms, then it is important to stop using them immediately and inform the physician’s office
• Taking care of oneself, being clean and hygienic, avoiding oily make-ups and creams, drinking lots of water, etc. are all simple practices that may help ensure a faster recovery from the condition
• Avoid excessive washing and scrubbing of the skin; also limit time spent in water (during the skin condition period)
• Completely avoid scratching the affected areas

How can Erythema Chronicum Migrans be Prevented?

Erythema Chronicum Migrans may be avoided by taking the following preventative methods for Lyme disease and other tick-borne illnesses:

• Avoid visiting tick-infested areas when possible; taking adequate protection while doing so
• Use insect repellents (such as DEET) and permethrin-treated clothes
• Protect pets from tick bites with medications available through a veterinarian
• Checking self and pets for ticks on skin immediately after any outdoor activity
• Shower immediately after any outdoor activity
• Wash clothes worn outdoors separately and dry them in high heat

What is the Prognosis of Erythema Chronicum Migrans? (Outcomes/Resolutions)

• The prognosis for Erythema Chronicum Migrans is usually good, in many cases, since it is a benign skin condition. The skin rashes usually disappear within 4 weeks, often without treatment
• However, the overall prognosis is dependent on the underlying cause (Lyme disease), the severity of the symptoms presented, and appropriate and prompt treatment availed

Additional and Relevant Useful Information for Erythema Chronicum Migrans:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse