Lyme disease is a bacterial infection transmitted to humans through tick bites. When a tick infected with the borrelia bacteria manages to transfer it to a person, they may experience symptoms such as fever, chills, muscles and joint aches, headache, fatigue, and swollen lymph nodes. In some cases of Lyme disease, a rash will also develop. The rash most commonly associated with Lyme disease appears as a red bulls-eye shape. In medical terms, it is referred to as erythema migrans.
In as many as 30% of people with Lyme disease, however, a rash may not appear at all, or a different type of rash can develop that resembles that of various other conditions. To help determine if you have become infected with Lyme disease, it’s important to know what the rash looks like, what it could resemble, and at what stage in the disease it appears. Read on to learn how to identify Lyme disease rashes (and how to differentiate between their lookalikes).
When does Lyme rash appear?
There are three distinct stages of Lyme disease, all of which present with various symptoms and signs. During stage 1 of the disease, the bacteria has been most recently contracted and the initial symptoms begin to appear. The typical Lyme disease rash usually appears in stage 1, between a few days or weeks of the initial infection.
There are several different types of Lyme disease rashes that can appear during stage 1 of the infection. The first, a bulls-eye rash, appears circular around the tick bite. It has a central clear ring that expands as well. Other types of rash that could appear include a red lesion that expands and has a crusty center; a red and circular-shaped rash that has a clear center; and a red lesion that is oval-shaped.
The early stages of the rash are typically easiest to see, and people may also notice that there is a small spot or lump that pops up in the center. The rash may also be associated with certain other characteristics, such as being warm to the touch or smooth on the skin. Scaly and crusty edges may also develop. In some rare cases, the Lyme disease rash could also be painful, itchy, and feel as though it is burning. Typically, Lyme rashes are small, but they can gradually grow to up to 12 or more inches.
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
In very rare cases, lymphoma tumors may form on the skin.
What looks like Lyme disease but isn’t?
Sometimes rashes that form due to other health conditions can appear the same as a Lyme disease rash. That’s why it’s important to know the difference between the rashes and symptoms of the condition. Many other symptoms of Lyme disease also present as other conditions, which is why it is aptly nicknamed “The Great Imitator.” In some cases, a typical allergic reaction caused by a bug bite can also be mistaken for Lyme disease.
Other types of rashes that may be confused with a Lyme disease rash include:
Ringworm: Ringworm is a fungal infection that appears as a ring-shaped rash, much like Lyme disease rashes.
Pityriasis rosea rash: Oval, pink, scaly dots appear on the skin with raised borders. They could be mistake for the Lyme disease rashes that appear in stage 2.
Granuloma annulare rash: This type of rash presents as red bumps on the skin that are in a circular pattern, similar to the shape of a Lyme disease rash.
Urticaria multiform: This rash, otherwise known as hives, appears as red welts on the skin that can be separated or form into one larger lesion.
Despite looking similar to the rash that occurs with Lyme disease, the aforementioned lookalikes do not typically present with the other symptoms that are associated with Lyme disease. If you are experiencing any type of rash and believe you may have been bitten by an infected tick, see your doctor. The earlier Lyme disease is treated, the better the potential outcome for recovery.