TY  - CHAP
M1  - Book, Section
TI  - Erythema Migrans
A1  - Shinkai, Kanade
A1  - Fox, Lindy P.
A2  - Papadakis, Maxine A.
A2  - McPhee, Stephen J.
A2  - Rabow, Michael W.
A2  - McQuaid, Kenneth R.
PY  - 2023
T2  - Current Medical Diagnosis & Treatment 2023
AB  - Erythema  migrans  is  a  unique  cutaneous  eruption  that  characterizes  the  localized  or  generalized  early  stage  of  Lyme  disease  (caused  by  Borrelia  burgdorferi)  (Figure  6–18)  (see  also  Chapter  34).  Three  to  32  days  (median:  7  days)  after  a  tick  bite,  there  is  gradual  expansion  of  redness  around  the  papule  representing  the  bite  site.  The  advancing  border  is  usually  slightly  raised,  warm,  red  to  bluish-red,  and  free  of  any  scale.  Centrally,  the  site  of  the  bite  may  clear,  leaving  only  a  rim  of  peripheral  erythema,  or  it  may  become  indurated,  vesicular,  or  necrotic.  The  annular  erythema  usually  grows  to  a  median  diameter  of  15  cm  (range:  3–68  cm,  but  virtually  always  greater  than  5  cm).  It  is  accompanied  by  a  burning  sensation  in  half  of  patients;  rarely,  it  is  pruritic  or  painful.  Multiple  secondary  annular  lesions  similar  in  appearance  to  the  primary  lesion  but  without  indurated  centers  and  generally  of  smaller  size  will  develop  in  20%  of  patients  but  may  be  even  more  common  in  European  patients.  In  the  southeastern  United  States,  similar  lesions  are  seen  in  patients  who  are  not  as  ill  and  who  tend  to  have  classic  central  clearing  of  their  lesions.  These  patients  have  negative  Lyme  serology  tests.  This  condition  has  been  called  Southern  tick-associated  rash  illness  (STARI).  This  illness  is  transmitted  by  the  lone  star  tick  Amblyomma  americanum  and  some  cases  have  been  shown  to  be  caused  by  Borrelia  lonestari,  for  which  the  white  tail  deer  is  the  animal  reservoir.  Systemic  symptoms  are  uncommon  in  STARI  and  the  skin  lesions  respond  to  the  same  antibiotic  agents  used  for  Lyme  disease,  suggesting  that  a  spirochete  (probably  as  yet  unidentified  Borrelia  species)  is  causative  in  all  these  cases.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/20
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1193628368
ER  -