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Lyme Disease Can Be Diagnosed By ‘bull’s Eye’ Rash Alone

Lyme Disease Rash Revealed

Lyme disease can be diagnosed by the rash alone, new advice for the NHS says.

People with the “bull’s eye” circular rash do not need a blood test and should be treated immediately to avoid complications, the National Institute for Health and Care Excellence says.

Waiting for lab results is unnecessary and can cause delays in patients being prescribed the antibiotics they need.

Lyme disease is spread by tick bites and can be debilitating.

A blood tests can check for it but may not give a positive result until eight weeks after the patient is bitten.

Prof Gillian Leng, deputy chief executive and director of health and social care at the National Institute for Health and Care Excellence , said for most people with Lyme disease, a course of antibiotics would be an effective treatment, “so it is important we diagnose and treat people as soon as possible”.

“A person with Lyme disease may present with a wide range of symptoms, so we have clear advice for professionals about the use of lab tests for diagnosis and the most appropriate antibiotic treatments,” she said.

“If a characteristic bull’s eye rash is present, healthcare professionals should feel confident in diagnosing Lyme disease.”

Lyme disease can be difficult to diagnose. It has similar symptoms to other conditions and there is not always an obvious rash. The rash can also appear in a number of different ways, as these images from the NICE guidance show.

Symptoms can also include:

How You Get Lyme Disease

If a tick bites an animal carrying the bacteria that cause Lyme disease, the tick can become infected. The tick can then transfer the bacteria to a human by biting them.

Ticks can be found in any areas with deep or overgrown plants where they have access to animals to feed on.

Theyre common in woodland and moorland areas, but can also be found in gardens or parks.

Ticks dont jump or fly. They climb on to your clothes or skin if you brush against something theyre on. They then bite into the skin and start to feed on your blood.

Generally, youre more likely to become infected if the tick is attached to your skin for more than 24 hours. Ticks are very small and their bites are not painful, so you may not realise you have one attached to your skin.

How Can Lyme Disease Be Prevented

Unfortunately, there is currently no vaccine for Lyme disease. But you can avoid Lyme disease by avoiding tick bites, checking for ticks, and removing ticks promptly, before they become lodged in the skin. Some tips:

Avoid tick playgrounds: Ticks like low-level shrubs and grasses, particularly at the edges of wooded areas. If youre hiking, try to stay in the center of the trail and avoid bushwhacking. Walk on cleared paths or pavement through wooded areas and fields when possible.

Dress appropriately: Long pants with legs tucked into socks and closed-toed shoes will help keep ticks away from skin. Light-colored clothing helps make ticks visible.

Insect repellant: Products that contain DEET repel ticks but do not kill them and are not 100 percent effective. Use a brand of insect repellent that is designated as child-safe if your child is 1 year or older. For infants, check with your pediatrician about what brands are safe to use. You can also treat clothing with a product that contains permethrin, which is known to kill ticks on contact.

Shower after outdoor activities are done for the day. It may take four to six hours for ticks to attach firmly to skin. Showering will help remove unattached ticks.

  • all parts of the body that bend: behind the knees, between fingers and toes, underarms and groin
  • other areas where ticks are commonly found: belly button, in and behind the ears, neck, hairline, and top of the head
  • anywhere clothing presses on the skin

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Lyme Disease Rash Photos: Early

I recently got Lyme disease for the first time. Luckily, I was able to catch it early and, other than a few days of extreme fatigue, I am doing fine. Since my Lyme rash didnt look like a standard bulls-eye rash right away, I thought Id share some photos of my Lyme rash as well as photos of the standard bulls-eye rash and atypical rashes.

Identifying A Tick Bite

CMAJ features Lyme carditis and other Lyme

Tick bites are often easy to identify. This is because the tick can remain attached to the skin for up to 10 days after it first bites. Most tick bites are harmless and will cause no physical signs or symptoms. Only certain types of ticks transmit disease.

Tick bites are typically singular because ticks dont bite in groups or lines.

Ticks can transmit potentially severe diseases to human hosts. Most signs or symptoms of a tick-borne disease will begin within a few days to a few weeks after a tick bite.

Some diseases that you can contract through a tick bite include:

Also Check: First Signs Of Lyme Disease In Dogs

Where Do Ticks Bite

You can find a tick bite anywhere. However, although they can and do attach to any part of the body, there are certain body parts they more commonly move toward, like the hairline, or in tucked-away places, like the armpits, groin, and behind knees, says Dill. Thats because ticks have heat sensors that allow them to seek out warmer, moist places. Recently, doctors even discovered a tick attached to a 9-year-old boys eardrum.

Symptoms Of Post Treatment Lyme Disease

  • Include severe fatigue, musculoskeletal pain, & cognitive problems
  • Can significantly impact patients health and quality of life
  • Can be debilitating and prolonged

Our research indicates the chronic symptom burden related to PTLD is significant. Although often invisible to others, the negative impact on quality of life and daily functioning is substantial for PTLD sufferers.

The chronic symptom burden related to Lyme disease is considerable, as shown on the left side of the graph above, and statistically significantly greater than the aches and pains of daily living experienced by the control group, on the right.

Also Check: Late Effects Of Lyme Disease

Read Also: Homeopathic Treatment For Lyme Disease In Humans

How To Remove A Tick And Treat A Tick Bite

First, dont panic. If you find one attached to your skin, remove the tick as quickly as possible using a set of fine-tipped tweezers. Grab the tick as closely to the surface of your skin as possible, and pull upward with steady, even pressure. If mouth-parts are left in the skin, try your best to remove them, but if not just let your skin heal normally, says the CDC. Then, make sure to clean the bite area with soap and water or alcohol.

REPEL Plant-Based Lemon Eucalyptus Insect Repellent
REPEL Plant-Based Lemon Eucalyptus Insect Repellent

Dispose of the tick in a sealed bag or container, wrapped up tightly in tape, or by flushing it down the toilet, says the CDC. Never crush it with your fingers, and of course, in the weeks to follow you should keep an eye out for any lingering symptoms, like a rash.

What Are The Complications And Risks Of A Tick Bite

Lyme Disease (Borreliosis) – Rash, Diagnosis, and Treatment (Deer Tick Ixodes Scapularis)

Experiencing a life-threatening illness from a tick bite is pretty uncommon, but it doesn’t hurt to be informed on the possible complications and risks. As you know, certain species of ticks are capable of transmitting infections, the most troubling being tick-borne diseases, explains Keri Peterson, MD, an internal medicine physician based in New York City. “The risk of developing these infections depends on where you live, the type of tick, and how long the tick was attached to the skin,” Dr. Peterson says.

The flu-like symptoms you might feel post-tick bite can mean a number of different things about your medical situation. “The timing of these symptoms vary depending on the type of tick and length of time it was attached to the skin,” says Gina Charles, MD, a family physician based in Pennsylvania. For this reason, no matter what kind of symptoms you’re feeling, the safest bet is always to visit your healthcare provider as soon as possible post-bite to determine if you’ve contracted any of the following.

There are many different species of ticks, but the detail that matters is whether you were bitten by a deer tick or dog tick, which are known to transmit these two major diseases to humans.

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Its better if you go to the doctor right away when you know youve had a tick bite, says Dr. Mudassar. If you go within 36 hours of the bite, you can be treated with a lesser dose of antibiotics .

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Researchers Look To Ai To Detect Lyme Disease Earlier

Long before the COVID-19 pandemic prompted a surge in telemedicine, John Aucott‘s patients would text and email him photos of their rashes. “My kids used to joke: ‘Don’t look at dad’s phone because it’s got pictures of people’s body parts,'” Aucott says. “Every time my phone pinged, it felt like Groundhog Day because it was the same, over and over.”

His phone is still pinging, but Aucott, director of the Johns Hopkins Lyme Disease Research Center, wants to see the photosbecause he knows that untreated Lyme disease can portend debilitating long-term medical consequences, including damage to the heart, joints, and nervous system.

Lyme disease, first identified in the 1970s in Lyme, Connecticuthence the nameis caused by the bacterium Borrelia burgdorferi, transmitted to humans by the bite of a blacklegged tick. Initial symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans, which sometimes looks like a target or bull’s-eye. At this stage, which lasts anywhere from a few days to weeks, treatment with antibiotics can prevent chronic complications.

About 30,000 cases are reported to the Centers for Disease Control and Prevention annually by state health departments, though this is only a fraction of the cases diagnosed and treated around the country, according to the CDC.

Image credit: Johns Hopkins Medicine

“You really have only one chance to diagnose Lyme early, and that’s when you have the rash.”

How Can I Prevent Tick Bites Altogether

If your yard is on the wild side or youve got plans to go hiking, camping, or walking through the forest or mountains, youre in prime tick territory, per the CDC, and you’ll find ticks in highly wooded, humid areas like forests and trails. Headed somewhere you know might be tick-heavy? Spray your clothing, shoes, and camping gear with insecticides that contain 0.5 percent permethrin, Thomas Mather, PhD, director of the Center for Vector-Borne Disease at the University of Rhode Island in Kingston, tells Women’s Health.

You should also try wearing colorful clothing , long-sleeves, and full-length pants, being sure to tuck your hanging sleeves into your gloves and shoes. Reapply your tick repellent throughout your day, and do careful tick checks after you’ve been outside for a significant amount of time. You can also keep tabs on local tick activity in your area by contacting your states health department .

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Stage 2 And 3 Lyme Rashes

During stages 2 and 3 of Lyme disease, rashes may also be present. During stage 2, the rash will take roughly one to six months to appear. It will be markedly different from stage 1 and appear as small oval-shaped rashes, typically appearing on various parts of the body such as the face, legs, and arms. The center of a stage 2 Lyme disease rash may also be darker in the center or appear bluish with a clear center. In contrast with stage 1 rashes, stage 2 skin lesions are not likely to grow as the disease progresses.

Stage 3 Lyme disease does not often encompass rashes however, if skin changes do occur, they will typically appear on the hands and feet. Symptoms of skin changes in stage 3 Lyme disease can include pain, redness, and swelling. If the infection is severe, stage 3 will present with some skin symptoms such as:

  • Hardening, thinning, or tearing of the skin
  • Hair loss around the affected area
  • Sweat gland loss

Recommended Reading: Side Effects Of Lyme Disease In Dogs

When Should You See A Doctor For Your Tick Bite

EM rash

Keep tabs on the bite area after a tick has bitten you. If the area of the bite becomes red or swollen for days or you develop flu-like symptoms, this may be a sign of tick-related disease such as Lyme disease, Dr. Rodney says. You should call your doctor or visit the nearest emergency room. And, if you develop signs of an infection, youll also want to call your doctor for help.

Ticks can be tiny and they can be easily missed, so its important to do thorough body check after youve spent time outdoors. Be sure to look carefully under your arms, around your ears, inside your belly button, behind your knees, between your legs, and in your hair. Checking yourself, kids, and pets can go a long way in minimizing contact with these critters, says Dill.

And as always, stock up on the best tick repellents before your next outdoor adventure.

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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

Antimicrobials That Kill Growing Phase Cysts

Intracellular and Extracellular

Note: I work with the following agents as anti-cyst agents based on the mechanism by which these antibiotics work and some scientific experiments. For the Rifamycins, there are no laboratory experiments showing these agents work against cysts. Clinically, I see great benefit in using the Rifamycins as my anti-cyst agents so I list them here.


  • Rifampin 300 mg 2 pills 1 time a day or 1 pill 2 times a day
  • Rifabutin 150 mg 2 pills 1 time a day


  • Tinidazole 500 mg 1 pill 2 or three times a day usually pulsed for four days on then three days off of each 7 days
  • Metronidazole 500 mg 1 pill 2 or three times a day usually pulsed for four days on then three days off of each 7 days.


  • Grapefruit seed extract 250 mg 1 pill 2 times a day. Note this is an herbal antibiotic that I find as effective as the prescription options in this list.

Read Also: Do Ticks In Florida Carry Lyme Disease

How To Avoid Contracting Lyme Disease

  • Use insect repellant on your clothing and all exposed skin when walking in wooded or grassy areas where ticks thrive.
  • Treat clothing and footwear with permethrin , an insect repellant that remains active through several washings.
  • Walk in the center of trails to avoid high grass when hiking.
  • After walking or hiking, change your clothes and perform a thorough check for ticks, focusing on the groin, scalp, and armpits.
  • Check your pets for ticks.

Contact a doctor if a tick bites you. You should be observed for 30 days for signs of Lyme disease.

Also Check: Top Rated Lyme Disease Doctors

Clinicians Asked What Does A Lyme Disease Rash Look Like

Think the Lyme Disease Rash is Always a Bull’s-eye? Think Again! | Johns Hopkins Rheumatology

Nearly 3 out of 4 investigators were able to identify the Lyme disease rash when presented with 8 types of rash photos.

When asked on a Yes or No basis whether a rash was due to Lyme disease or another condition, the investigators did much better with 94.23% correctly recognizing the EM rash.

The authors were not able to evaluate the ability of doctors in recognizing a Lyme disease rash among other patient populations. Our dataset did not include a significant number of individuals with dark skin.

The study did not look at whether the clinical history might improve the accuracy of the diagnosis. Additionally, the probability of recognizing a Lyme disease rash might improve if the patient has a history of recent exposure to ticks, a tick bite, or symptoms.

The accuracy in identifying what a Lyme disease rash looks like might drop if the patients did not live in an endemic area or if the patient had a confirmation bias. Confirmation bias involves selective gathering of and neglect of contradictory evidence, writes Satya-Murti and colleagues.²

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