Rash Decisions: 5 Common Misconceptions about Lyme Rashes
By Jennifer Halpern
After a 26-mile run through the Grand Canyon, I returned home with sore legs, memories of beautiful scenery, and a big insect bite on my left arm. The first two faded, but the bite stuck around for a few more weeks. I questioned it but never had it checked out—I thought to myself, “If it were a tick bite, I’d have the classic bulls-eye rash, right?” I had no other symptoms until a year later, which pointed me back to that bug bite and the missing telltale red rash: a sign it might be Lyme disease.
Lyme disease is a prevalent tick-borne illness that affects hundreds of thousands of Americans each year. When it comes to Lyme, the focus often falls on the notorious bull's-eye rash, erythema migrans (EM), that can accompany the infection. However, misconceptions surrounding this rash persist, leading to confusion and misdiagnosis.
Get ready to unravel these myths and discover the real story behind this enigmatic rash. We shed light on what it looks like, how long it lasts, what it feels like, whether a rash must be present to indicate Lyme after a tick bite, and more.
5 Misconceptions about Lyme Rash
Misconception 1. A Lyme Rash Always Looks Like a Bull's-Eye Target.
Contrary to popular belief, many Lyme rashes do not resemble a bull's-eye target.
The Reality
The range for people infected with Lyme disease who develop a rash is broad: anywhere from 30% to 80%. While a bull’s-eye rash is a classic Lyme symptom, many people will develop other types of rashes.
When a bull’s-eye rash is present, it will often appear uniform in surface color and shape, with or without central darkness or clearing. But there are also some familiar rashes that are well-known impersonators of a Lyme rash, such as shingles and ringworm. With the variations in rashes, contrary to popular belief, a rash is not always a prerequisite for a Lyme disease diagnosis.
If you develop a rash after a known or suspected tick bite, take photos to share with a Lyme specialist or dermatologist to help facilitate prompt treatment or additional testing, if necessary.
Misconception 2. A Lyme Rash Feels The Same For Everyone.
The sensations associated with the Lyme rash can vary from person to person.
The Reality
While some individuals may have rashes that feel itchy or painful, other people may experience only mild itching or tenderness. Some may not experience any discomfort at all. Besides Lyme rashes, let your healthcare professional know about any other symptoms you may be experiencing, including fatigue, fever, muscle and joint pain, problems with cognition, and more. They’ll need to factor in all of your symptoms to get the whole picture and make an accurate diagnosis.
Misconception 3. The Rash Occurs at the Site of the Bite.
A Lyme rash can occur at the site of the tick bite, but it can also appear in other areas of the body, regardless of where the bite occurred.
The Reality
Because a Lyme rash can sometimes develop in hard-to-see places, such as behind the knee, on the back, or in the armpit, it is crucial to thoroughly check your entire body for ticks and be aware of any unusual rashes.
Misconception 4. A Lyme Rash Looks the Same On Each Person
One common misconception is that a Lyme rash looks the same on everyone, regardless of skin tone.
The Reality
A Lyme rash can appear differently on different skin tones, according to the American Academy of Dermatology Association (AAD), which may make a rash more challenging to identify as being associated with Lyme disease. Additionally, Lyme rashes on darker skin tones may not exhibit the classic bull's-eye pattern, making it crucial for healthcare providers to be aware of the variations in appearance rashes can have on each individual.
Typically, Lyme rashes last a week or less. If you notice a suspicious rash, regardless of its duration, consult with your doctor as soon as possible.
Misconception 5. A Negative Test Result Rules Out Lyme Disease—With or Without a Rash
Many people believe a negative test result for Lyme disease means they have not been infected with the tick-borne disease.
The Reality
The accuracy of Lyme disease tests during the early stages of infection varies. One 2022 study found that only 37% of participants with diagnostic Lyme rashes tested positive for Lyme disease during the acute phase. The study used the standard two-tier testing (STTT) approach, which included ELISAs as the first-tier and immunoblot testing for IgM and IgG antibodies as the second-tier.
What does this mean for those who may be infected with Lyme disease? Ultimately, a negative Lyme test result should not be the sole determining factor for diagnosis. Clinical evaluation, symptoms, and history of tick exposure should also be considered.
Facing the Truth about Lyme Rashes
Although Lyme rashes might look different from one person to the next, if you happen to get a bull's-eye rash, that is the telltale sign you've been infected with Lyme disease. Be sure to see a healthcare professional so that you can get the correct diagnosis and begin treatment.
Keep in mind that not everyone who gets infected with Lyme will develop a bull's-eye rash. So if you discover a rash or believe a tick may have bitten you, those are both reasons enough to reach out to your healthcare professional for their recommendations as well.
References:
Lyme Disease Surveillance and Data. Centers for Disease Control and Prevention website. https://www.cdc.gov/lyme/data-research/facts-stats/index.html#:~:text=Recent%20estimates%20using%20other%20methods,not%20actually%20have%20Lyme%20disease.
Lyme Disease Symptoms. Lymedisease.org website. https://www.lymedisease.org/lyme-basics/lyme-disease/symptoms/
Schotthoefer AM, Green CB, Dempsey G, Horn EJ. The Spectrum of Erythema Migrans in Early Lyme Disease: Can We Improve Its Recognition? Cureus. 2022 Oct 25;14(10):e30673. doi: 10.7759/cureus.30673
Signs of Lyme Disease that Appear on Your Skin. American Academy of Dermatology Association website. https://www.aad.org/public/diseases/a-z/lyme-disease-signs
