Clinical Characteristics Of Patients
During the 13-year period in which we have been at MGH, 30 patients were referred to us for evaluation of presumed LA in whom we diagnosed a systemic autoimmune joint disorder. Of the 30 patients, 15 had new-onset RA, 13 had new-onset PsA, and 2 had new-onset peripheral SpA. The median duration from the onset of Lyme disease to the start of joint symptoms was 4 months , which is similar to the time frame in which LA may occur after EM .
Duration from Lyme disease to onset of rheumatoid arthritis , psoriatic arthritis or peripheral spondyloarthropathy . For comparison, the duration from erythema migrans, the initial skin lesion of the infection, to onset of Lyme arthritis is shown for historical patients seen in the late 1970s who were not treated with antibiotic therapy . Thus, the duration from erythema migrans to the development of arthritis was known.
The number of patients referred for presumptive Lyme arthritis over a 13-year period, according to the year of referral. The patients were stratified into 3 groups according to our diagnoses of post-Lyme systemic autoimmune joint diseases, antibiotic-refractory Lyme arthritis, or antibiotic-responsive Lyme arthritis.
An Illness Of The Immune System
Scleroderma is classified as an autoimmune disease. This means that a persons immune system works against itself. The normal immune system protects the body by fighting off foreign invaders such as viruses and infections. In an autoimmune disease, the immune system mistakes a persons own tissues as foreign invaders and sets up a protective attack that backfires to cause problems.
In scleroderma, cells start making collagen as if there were an injury that needs repairing. The cells do not turn off as they should and end up making too much collagen. The extra collagen in the tissues can prevent the bodys organs from functioning normally.
Signs Of Lyme Disease That Appear On Your Skin
Signs of Lyme disease
If you see a rash or another sign of Lyme disease on your skin, see your primary doctor right away. When caught early and treated, Lyme disease can be cured with antibiotics and most people recover fully.
Lyme disease is caused by a bite from a black-legged tick. If you are bitten by this tick and develop Lyme disease, you may see a bulls-eye rash. Its a common sign of Lyme disease, but its not the only sign.
Lyme disease occurs in stages. Heres what you may see on your skin during each stage.
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Other Kinds Of Erythema
There are numerous types of erythema in addition to those described. They include erythema induratum secondary to TB, erythema elevatum diutinum, and erythema gyratum repens:
- Erythema induratum secondary to TB results from a tuberculid skin eruption, a group of skin conditions linked to underlying or silent tuberculosis.
- Erythema elevatum diutinum is a rare necrotizing vasculitis that causes red, purple, brown, or yellow papules, plaques, or nodules. These usually appear on the back of the hands and extensor surfaces , and on the buttocks.
- Erythema gyratum repens is rapidly moving and a marker of underlying cancer. It is common in people with lung cancer.
Stage : Quickly Expanding Rash
After being bitten by a black-legged tick, a quickly growing rash can appear. This is the earliest stage of Lyme disease, known as stage 1.
Most people who develop a rash, get it within days or weeks of being bitten by a tick.
Where you see the rash: If you develop a rash, it appears near the tick bit you. For most people, that means the back, groin, armpit, or a lower leg. However, a tick can bite you anywhere.
What the rash can look like: You may see a spot or bump on the skin, which is the bite mark. Around or near the bite mark, a rash develops. Some people see the bulls-eye rash . You can also have one of the other rashes shown here.
Early rash caused by Lyme disease
Notice the bite mark in the center of this early rash, which will expand quickly.
Bull’s-eye rash on woman’s upper arm
This is another early sign of Lyme disease.
Lyme disease rash with lighter color on the outside
This rash has expanded, but you can still see the bite mark in the center.
Rash from Lyme disease has begun to clear
As the rash begins to clear, the redness fades.
If you develop a rash during this stage, you may notice that it:
Feels smooth and warm to the touch
Causes a burning sensation
Itches or feels painful
Has an outer edge that feels scaly or crusty
When the rash and symptoms begin: According to the Centers for Disease Control and Prevention , the rash begins 3 to 30 days after the tick bites you.
About 50% of people who have Lyme disease develop flu-like symptoms , which include:
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An Illness That Does Not Go Away
Scleroderma is chronic. This means that it lasts for your lifetime. However, like diabetes, high blood pressure, heart disease, and psoriasis, scleroderma can be treated and the symptoms managed. The cause of scleroderma is unknown and there is currently no cure, but there are treatments that can effectively prevent or limit the damage caused by this chronic disease.
What Can I Do Right Now
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The Look Of Lyme: How Your Dermatologist Can Help Identify This Common Disease
- Written by:Ashley Stephens
According to the CDC, roughly 300,000 Americans are diagnosed with Lyme Disease each year. Of those 300,000 cases, 96% are reported in just 14 states.
We often think about bites and rashes with Lyme Disease. However, its impact is more than skin-deep. Lyme disease affects the central nervous system, musculoskeletal system, and cardiovascular system. Rapidly seeking treatment when the visual cues of Lyme appear is key to positive outcomes. Most patients who address the disease early on have a good prognosis following a three-week course of antibiotics.
A bullseye rash is the hallmark of Lyme Disease. It’s large , flat, and rarely itches. Generally, the rash will form within 72 hours of a tick bite but it can take up to 30 days. When you see this rash, it is a sign of spreading bacterial infection. It will expand and resolve without treatment however, that does not mean the infection has resolved gone away.
Ick! You may have missed your tick.
You can develop Lyme without this classic rash. Roughly 30% of patients with Lyme report that they did not have or do not remember having a rash. Nearly 50% of all patients don’t recall being bitten by a tick in the first place. Thats understandable. Ticks are tiny, about the size of a poppyseed, and can embed in your scalp, between toes, and inside skin folds. Ticks also thrive in warm, moist areas with high blood flow.
Multiple, smaller bullseye-like rashes
What Are The Signs And Symptoms Of Lyme Disease
The signs and symptoms of Lyme disease usually appear one to 30 days after a tick bite, but most commonly between seven to 14 days. The first sign is usually a skinrash and flu-like symptoms.
There are three stages of Lyme disease:
Stage 1: Early localized disease
- Occurs one to 30 days after a tick bite
Stage 3: Late disease
- If untreated, Lyme disease can progress to chronic Lyme disease or stage 3 of Lyme disease. Stage 3 Lyme disease occurs months to years after the initial infection or a period of latency. Most patients presenting with late disease do not have erythema migrans because the rash urges the patient to seek treatment earlier.
- Skin manifestation:
- Acrodermatitis chronica atrophicans: Found almost exclusively in patients of European descent. It commonly affects older women and is characterized by bluish-red discoloration on the back of the hands, feet, knees and elbows.
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Erythemic Skin Caused By Psoriasis
Psoriasis is an inflammatory skin disease that causes skin cells to multiply quicker than normal, leading to skin cell buildup in the form of bumpy red patches covered with white scales . Different types of psoriasis lead to erythemic skin, including plaque psoriasis and a rare type called erythrodermic psoriasis.
Plaque psoriasis is the most common type of psoriasis. It is known for causing raised, inflamed, and scaly patches of skin that can be itchy and painful. Plaque psoriasis can appear on any body area, but is most often seen on the elbows, knees, lower back, and scalp.
In people with fair skin, the plaques will often appear as raised, red, and patchy with silvery-white scales. In people of color, those plaques might appear darker, thicker, and purplish, grayish, or darker brown.
Erythrodermic psoriasis is the least common type of psoriasis and the most severe. It affects the skin across the entire body and can be life-threatening.
It most often affects people living with severe and unstable plaque psoriasis. It has also been linked to another rare psoriasis type called pustular psoriasis.
Symptoms of pustular psoriasis include white, pus-filled, painful bumps , along with redness and discoloration of the skin. The pustules are not contagious and are the result of inflammation.
Stage : Small Oval Rashes Or A Reddish Lump
When a tick that causes Lyme disease bites you, it infects you with bacteria. Without treatment, the bacteria can spread to other areas of your body. Stage 2 begins when the bacteria spread to other parts of your body.
During this stage, you may see small, oval rashes on your skin. Some people develop a bluish-red lump.
Where you see these signs: Because the infection has spread, small rashes can appear anywhere on your skin, except for your palms and soles. Most rashes appear on the arms, legs, and face.
Some people develop a lump, which your doctor may refer to as borrelial lymphocytoma. In children, this lump tends to appear on an earlobe. Adults often see a raised growth form around a nipple.
Borrelial lymphocytoma on a childs ear
This can appear in stage 2 of Lyme disease.
What you may see on your skin: The rashes that appear during stage 2 differ from the rash that can appear in stage 1. In stage 2, the rashes stay the same size rather than grow larger.
When the rashes, lump, and symptoms begin: About 30 to 45 days after the tick bites you, you may notice rashes or a lump. These can also take longer to appear, sometimes six months or more.
Some people develop symptoms, which make them feel ill, including:
Shortness of breath and dizzy spells
Bells palsy, which causes one half of the face to droop
Heart problems, such as chest pains or an irregular heartbeat
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Autoimmune Diseases And Lyme Disease: Misdiagnosis Or Complication Of Lyme
As mentioned above, there are documented correlations between Lyme and autoimmune diseases. The evidence shows that Lyme disease may trigger an autoimmune disease, or it may mimic an autoimmune disease.
What does this mean for patients and physicians? It comes down to the importance of getting an accurate and timely diagnosis if you suspect Lyme or another tick-borne disease. The longer Lyme disease goes untreated, the stronger the chance that it will spread to multiple body systems and possibly trigger an autoimmune response.
Because Lyme disease symptoms mimic symptoms of so many other conditions, including autoimmune diseases, it is notoriously tricky to diagnose. One of the most common Lyme disease misdiagnoses is the autoimmune disease rheumatoid arthritis , characterized by chronic joint pain.
If a patient with Lyme is diagnosed with RA without the Lyme being detected and treated, not only can the arthritic symptoms of Lyme persist and worsen, but the Lyme can also go on to affect more systems, causing neurological and psychiatric symptoms, heart problems, and more. In rare cases, untreated Lyme can even be fatal.
Symptoms Of Lyme Disease
People with Lyme disease may react to it differently, and the symptoms can vary in severity.
Although Lyme disease is commonly divided into three stages early localized, early disseminated, and late disseminated symptoms can overlap. Some people will also present in a later stage of disease without having symptoms of earlier disease.
These are some of the more common symptoms of Lyme disease:
- a flat, circular rash that looks like a red oval or bulls-eye anywhere on your body
- other flu-like symptoms
These symptoms may occur soon after the infection, or months or years later.
Your child may have Lyme disease and not have the bulls-eye rash. According to an early study, results showed roughly 89 percent of children had a rash.
Lyme disease is best treated in the early stages. Treatment for early localized disease is a simple 10- to 14-day course of oral antibiotics to eliminate the infection.
Medications used to treat Lyme disease include:
- doxycycline, amoxicillin, or cefuroxime, which are first-line treatments in adults and children
- cefuroxime and amoxicillin, which are used to treat women who are nursing or breastfeeding
Intravenous antibiotics are used for some forms of Lyme disease, including those with cardiac or central nervous system involvement.
After improvement and to finish the course of treatment, healthcare providers will typically switch to an oral regimen. The complete course of treatment usually takes 1428 days.
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Stage : Early Disseminated Lyme Disease
Early disseminated Lyme disease occurs several weeks to months after the tick bite.
Youll have a general feeling of being unwell, and a rash may appear in areas other than the tick bite.
This stage of the disease is primarily characterized by evidence of systemic infection, which means infection has spread throughout the body, including to other organs.
Symptoms can include:
- disturbances in heart rhythm, which can be caused by Lyme carditis
- neurologic conditions, such as numbness, tingling, facial and cranial nerve palsies, and meningitis
The symptoms of stages 1 and 2 can overlap.
Rash And Skin Disorders
A rash is an area of swollen, irritated skin that manifests in different patterns and varying shades of red, purple or brown. Some rashes are caused by allergic reactions to the environment, food or medications, while others appear because of a skin disorder or underlying disease or infection. Some clear up on their own, but others are chronic and require treatment to control symptoms.
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Most rashes are not life threatening, according to the American Academy of Dermatology. They may be treated with over-the-counter antihistamines, lotions or cortisone creams that relieve itching and swelling. These may go away on their own after a few days or weeks.
For example, a common type of rash is contact dermatitis. It causes redness and itching in reaction to an environmental irritant that touches the skin such as poison ivy, soap, cosmetics or household chemicals. Its usually treated by over-the-counter medicines and staying away from the irritant that triggered the rash. It is uncomfortable but isnt serious or contagious.
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Stage : Changing Skin
In stage 3, few signs of Lyme disease appear on the skin. Most problems occur in the heart and nervous system, and these can be serious.
Where you see signs on your skin: If you were in Europe when bit by a tick, you may see changes to your skin in this late stage. These changes usually appear on a hand or foot. Some people develop this change on both of their hands or feet. It can also occur on a knee, elbow, or elsewhere.
What the skin looks like: The skin begins to swell, and you may notice some redness. These signs are caused by having a bacterial infection for a long time. The affected skin may also feel sore.
In time, the skin starts to harden and shrink, causing deep lines to form. If you have hair in the area, it tends to fall out. The sweat glands can die, and the skin often becomes so thin that it tears easily. The medical name for this condition is acrodermatitischronical atrophicans.
In stage 3, you may also see tumors on your skin. It is believed that the long-term infection and swelling in the lymph nodes can lead to a cancer known as cutaneous B-cell lymphoma.
Skin starts to harden and shrink, causing deep lines to form
The medical name for this condition is acrodermatitis chronical atrophicans. Swelling, hardened skin, and deep lines on the foot of someone who has had Lyme disease for years.
When you see signs of changing skin and symptoms: These tend to occur months or years after you are bitten by a tick.