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Chapter 18: Erythema Chronicum Migrans

INTRODUCTION

KEY POINTS

  • Erythema chronicum migrans classically presents with a bull’s eye or targetoid appearance consisting of patches and/or plaques.

  • In darker skin, the erythema can appear dusky and violaceous with pallor, particularly at the periphery. In cases where the central bull’s eye is less prominent, the condition could be mistaken for urticaria.

  • In lighter skin, the concentric rings tend to be bright pink to red.

image

FIGURE 18-1.

Targetoid plaque with darker red-brown center and hyperpigmented brown to pink periphery on the lower leg, representing expanding erythema migrans in a patient with darker skin. (Reproduced with permission from Bhate C, Schwartz RA. Lyme disease: Part I. Advances and perspectives. J Am Acad Dermatol. 2011;64(4):619-636.)

The image shows a photograph depicting Erythema chronicum migrans with erythematous bite site surrounded by an expanding red plaque, reminiscent of the bulls eye of a target.
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FIGURE 18-2.

Large targetoid patch with a central ring of dusky erythema and a lighter pink periphery representing erythema migrans in an individual with light skin. (Reproduced with permission from Bhate C, Schwartz RA. Lyme disease: Part I. Advances and perspectives. J Am Acad Dermatol. 2011;64(4):619-636.)

A large, circular lesion with a central red ring followed by darker ring and a pale pink ring at the periphery.
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