Some Visible Signs of Lyme Disease Are Easily Missed or Mistaken


Apr. 22, 2013 — When a person contracts Lyme disease, quick diagnosis and treatment are essential to avoiding long term complications. But the diagnostic process may be delayed if a physician does not recognize a skin rash caused by Lyme disease because it does not have the bull’s-eye appearance that is best known to physicians and the public. In a Research Letter just published in the journal Emerging Infectious Diseases, a prominent research team led by Steven E, Schutzer, MD, Professor of Medicine at the University of Medicine and Dentistry of New Jersey-New Jersey Medical School, confirms findings of Lyme disease in patients with skin lesions that more closely resemble the classic signs of conditions such as contact dermatitis, lupus, common skin infections, or insect or spider bites. Based on these findings they urge doctors to consider Lyme disease as the cause when presented with such lesions, particularly when the patient was in an area where Lyme disease is endemic.

The team describes 14 patients enrolled in an ongoing prospective trial which includes an advanced diagnostic technique that employs a selective “molecular culture-like” amplification of DNA from Borrelia burgdorferi, the bacterium that causes Lyme disease, followed by polymerase chain reaction (PCR) testing, all designed to detect even small numbers of multiple strains of the Lyme agent. The technique was first described in May 2012 in an article published in the journal PLoS One by a team that included several of the same researchers, including Schutzer. Unlike existing methods used to diagnose Lyme disease, the new experimental technique is able to detect evidence of B. burgdorferi early, even in cases where the bacterium is still at low levels in the bloodstream, and sooner than traditional antibody tests, which may require several weeks before becoming positive. It also is able to distinguish between new infections and prior exposure to B. burgdorferi.

Of the patients analyzed, ten found by the experimental technique to have strong microbiologic evidence of Lyme disease had presented with skin lesions that differed markedly from the classic bull’s-eye pattern. The researchers note that multiple textbooks and websites prominently feature the bull’s-eye image as a visual representation of Lyme disease. They write, “This emphasis on target-like lesions may have inadvertently contributed to an underappreciation for atypical skin lesions caused by Lyme disease.”

Not all patients with Lyme disease will have a rash. Schutzer cautioned that “these studies are preliminary and the impetus for further investigation.” However, based on this finding, Schutzer adds, “Doctors who see a rash in a patient who has been in an area where Lyme disease frequently occurs should be alert to the fact that the Lyme disease rash does not have to look like a bull’s-eye, ring-within-a ring. The rash may look different. Doctors should search carefully both for other signs that might suggest Lyme disease, such as flu-like symptoms, and equally for signs that may point towards other conditions. Early diagnosis of most diseases gives the best chance for a cure. This is especially true for Lyme disease.” Schutzer said.

“The ongoing work has the potential to improve clinical research in Lyme disease by objectively defining a group of patients who assuredly were infected with the Lyme disease bacterium,” said Dr. James G. Krueger, Head of the Laboratory for Investigative Dermatology at The Rockefeller University and co-investigator.

In addition to Schutzer and Krueger, investigators are: Bernard W. Berger a prominent dermatologist in private practice in Southampton, N.Y.; Mark W. Eshoo and David J. Ecker of Ibis Biosciences, Inc., Carlsbad, Calif.; and John N. Aucott of Johns Hopkins University.

Funding for the cited study was provided in part by a grant from the National Institute of Allergy and Infectious Diseases, National Institutes of Health.