Lyme disease rash: Symptoms, stages, and identification

Lyme disease can result from the bite of a black-legged tick that is carrying the bacterium.

In the early stages of the disease, around 70–80 percent of people develop a rash that resembles a bull’s-eye. The medical term for this distinctive rash is erythema migrans.

Other people with Lyme disease may have a different type of rash or no rash at all.

In this article, we describe Lyme disease rashes, other symptoms, and the stages of the illness. We also look at treatment options.

Symptoms and stages of Lyme disease rashes

There are three stages of Lyme disease.

After exposure to the disease bacterium, a person may notice some of the following skin changes:

Stage 1

In the first stage of Lyme disease, a quick-spreading rash often develops at or near the site of the bite.

The rash tends to appear within a few days or weeks of infection.

According to the Centers for Disease Control and Prevention (CDC) in the United States, there are several types of Lyme disease rash. These include:

• a distinctive bull’s-eye rash with a central clear ring that slowly expands — this is the “classic” type
• an expanding red lesion with a crusty center
• a red, circular rash with a clear center
• a red, oval-shaped rash

Ticks can bite any area of the body, but they usually target the:

• armpit
• back
• groin
• lower leg

Individuals may notice a small spot or lump on the skin in the center of a rash. In the early stages, the rash may be:

• warm to the touch
• smooth
• scaly or crusty at the outer edges
• itchy, burning, or painful, in rare cases
• small, but it may gradually expand to 12 or more inches

Stage 2

If a person does not receive treatment, the bacterium that causes Lyme disease spreads in the body. This is stage 2 of the disease.

Stage 2 rashes generally appear 1–6 months (or more) after infection.

When the disease is in the second stage, a person may develop several small oval-shaped rashes on the face, legs, and arms. These may have a dusky center. Other people develop a bluish rash without a clear center.

Stage 1 rashes grow quickly, but stage 2 rashes tend to remain the same size.

Not everyone with Lyme disease develops a rash. Other symptoms in the first 3–30 days can include:

• chills
• fever
• a headache
• muscle and joint pain
• swollen lymph nodes

In the later stages, Lyme disease can cause:

• numbness or tingling in the hands and feet
• shortness of breath
• neck stiffness
• dizziness
• arthritis
• severe fatigue
• nerve-related pain
• pain in the bones, muscles, and joints
• a loss of muscle tone in one or both sides of the face that results in drooping (facial palsy)
• intense headaches
• chest pain
• short-term memory loss (dementia)
• an irregular heart rhythm
• inflammation of the brain and spinal cord
• heart failure

Anyone who suspects that they have Lyme disease should see a doctor for a diagnosis.

The doctor will ask about a person’s medical history and perform a physical examination. They may also order blood tests to help with diagnosis.

If a person may have been bitten by a tick, and they notice a rash or other Lyme disease symptoms, they should seek treatment without delay.

The longer a tick with the bacterium remains on the skin, the higher the risk of contracting Lyme disease.

Even if symptoms disappear, it is best to seek medical attention. Untreated Lyme disease can damage the nervous system, and cause arthritis and other serious conditions.

Early detection and treatment are key in preventing complications and supporting a good outlook for a person with Lyme disease.

Treatment

A doctor will prescribe antibiotics. People typically need to take oral antibiotics for up to 21 days.

Examples of antibiotics for Lyme disease include:

• amoxicillin
• cefuroxime
• doxycycline

Always finish a course of antibiotics to ensure that the infection is completely eradicated.

If the disease is affecting the central nervous system, a doctor may recommend intravenous (IV) antibiotics. In this case, the drugs enter the body through a vein. A person may need this treatment for up to 1 month.

Although effective, IV antibiotics can have adverse effects, such as:

• diarrhea, which can also occur with oral antibiotics
• a decreased white blood cell count
• an increased vulnerability to other infections

Antibiotic treatments are effective for most people with Lyme disease. However, even after treatment, some people still experience symptoms, including fatigue. If this occurs, a specialist can investigate further.

Outlook

There are several types of Lyme disease rashes, and they can change over time.

It is important to recognize the symptoms, as untreated Lyme disease can cause complications that affect the nerves, the joints, and short-term memory.

If a person receives treatment when the disease is at an early stage, there is a good chance of recovery. Full recovery can take several months.

For some people, symptoms can last for years. The medical community is not sure why this happens, but further antibiotic treatment does not appear to resolve the issue.

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