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The Truth About Erythema Migrans

The Truth About Erythema Migrans Abstract LYME DISEASE in Europe and the United States is caused by different strains of the spirochete Borrelia burgdorferi. Therefore, the clinical manifestations of Lyme disease may be different in these 2 locations.1-3 For example, in the United States, the pathognomonic rash erythema migrans (EM) will persist for 1 to 4 weeks without treatment, whereas in Europe the rash will persist for 2 to 16 weeks if left untreated. In Europe, the rash is termed erythema chronicum migrans (ECM). Multiple EM and arthritis occur more frequently in the United States than in Europe. Borrelia lymphocytoma, acrodermatitis chronica atrophicans, and focal neuralgias occur commonly in Europe but are unusual in the United States. Because of these differences, conclusions based on European studies cannot be generalized to the United States. In this issue of the Archives, Hulshof and colleagues4 from the Netherlands report on the excellent outcome of 44 European patients References 1. Steere AC. Lyme disease . N Engl J Med. 1989;321:586-596.Crossref 2. Krause PJ, Feder HM Jr. Lyme disease and babesiosis . Adv Pediatr Infect Dis. 1994;9:183-209. 3. Malane MS, Grant-Kels JM, Feder HM Jr, Luger SW. Diagnosis of Lyme disease based on dermatologic manifestations . Ann Intern Med. 1991;114:490-498.Crossref 4. Hulshof MM, Vandenbroucke JP, Nohlmans MKE, Spanjaard L, Bavinck JNB, Dijkmans BAC. Long-term prognosis in patients treated for erythema chronicum migrans and acrodermatitis chronica atrophicans . Arch Dermatol. 1997; 133:33-37.Crossref 5. Feder HM Jr, Whitaker DL. Misdiagnosis of erythema migrans . Am J Med. 1995:99:412-419.Crossref 6. Luger SW, Krauss E. Serologic tests for Lyme disease: interlaboratory variability . Arch Intern Med. 1990;150:761-763.Crossref 7. Stobierski MG, Hall WN, Robinson-Dunn B, Stiefel H, Shiflett S, Carlson V. Isolation of Borrelia burgdorferifrom two patients in Michigan . Clin Infect Dis. 1994;19:944-946.Crossref 8. Steere AC, Malawista SE, Newman JH, Spieler PN, Bartenhagan NH. Antibiotic therapy in Lyme disease . Ann Intern Med. 1980;93:1-8.Crossref 9. Steere AC, Hutchinson GJ, Rahn DW, et al. Treatment of the early manifestations of Lyme disease . Ann Intern Med. 1983;99:22-26.Crossref 10. Dattwyler RJ, Volkman DJ, Conary SM, et al. Amoxicillin plus probenecid versus doxyclycline for treatment of erythema migrans borreliosis . Lancet . 1990; 336:1404-1406.Crossref 11. Nadelman RB, Luger SW, Frank E, et al. Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease . Ann Intern Med. 1992; 117:273-280.Crossref 12. Luft BJ, Dattwyler RJ, Johnson RC, et al. Azithromycin compared with amoxicillin in the treatment of erythema migrans . Ann Intern Med. 1996;124:785-791.Crossref 13. Salazar JC, Gerber MA, Goff CW. Long-term outcome of Lyme disease in children given early treatment . J Pediatr. 1993;122:591-593.Crossref 14. Gerber MA, Sharpiro ED. Lyme disease in children in southeastern Connecticut . N Engl J Med. 1996;335:1270-1274.Crossref 15. Feder HM Jr, Hunt MS. Pitfalls in the diagnosis and treatment of Lyme disease in children . JAMA . 1995;474:66-68.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

The Truth About Erythema Migrans

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References (19)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1997.03890370099015
Publisher site
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Abstract

Abstract LYME DISEASE in Europe and the United States is caused by different strains of the spirochete Borrelia burgdorferi. Therefore, the clinical manifestations of Lyme disease may be different in these 2 locations.1-3 For example, in the United States, the pathognomonic rash erythema migrans (EM) will persist for 1 to 4 weeks without treatment, whereas in Europe the rash will persist for 2 to 16 weeks if left untreated. In Europe, the rash is termed erythema chronicum migrans (ECM). Multiple EM and arthritis occur more frequently in the United States than in Europe. Borrelia lymphocytoma, acrodermatitis chronica atrophicans, and focal neuralgias occur commonly in Europe but are unusual in the United States. Because of these differences, conclusions based on European studies cannot be generalized to the United States. In this issue of the Archives, Hulshof and colleagues4 from the Netherlands report on the excellent outcome of 44 European patients References 1. Steere AC. Lyme disease . N Engl J Med. 1989;321:586-596.Crossref 2. Krause PJ, Feder HM Jr. Lyme disease and babesiosis . Adv Pediatr Infect Dis. 1994;9:183-209. 3. Malane MS, Grant-Kels JM, Feder HM Jr, Luger SW. Diagnosis of Lyme disease based on dermatologic manifestations . Ann Intern Med. 1991;114:490-498.Crossref 4. Hulshof MM, Vandenbroucke JP, Nohlmans MKE, Spanjaard L, Bavinck JNB, Dijkmans BAC. Long-term prognosis in patients treated for erythema chronicum migrans and acrodermatitis chronica atrophicans . Arch Dermatol. 1997; 133:33-37.Crossref 5. Feder HM Jr, Whitaker DL. Misdiagnosis of erythema migrans . Am J Med. 1995:99:412-419.Crossref 6. Luger SW, Krauss E. Serologic tests for Lyme disease: interlaboratory variability . Arch Intern Med. 1990;150:761-763.Crossref 7. Stobierski MG, Hall WN, Robinson-Dunn B, Stiefel H, Shiflett S, Carlson V. Isolation of Borrelia burgdorferifrom two patients in Michigan . Clin Infect Dis. 1994;19:944-946.Crossref 8. Steere AC, Malawista SE, Newman JH, Spieler PN, Bartenhagan NH. Antibiotic therapy in Lyme disease . Ann Intern Med. 1980;93:1-8.Crossref 9. Steere AC, Hutchinson GJ, Rahn DW, et al. Treatment of the early manifestations of Lyme disease . Ann Intern Med. 1983;99:22-26.Crossref 10. Dattwyler RJ, Volkman DJ, Conary SM, et al. Amoxicillin plus probenecid versus doxyclycline for treatment of erythema migrans borreliosis . Lancet . 1990; 336:1404-1406.Crossref 11. Nadelman RB, Luger SW, Frank E, et al. Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease . Ann Intern Med. 1992; 117:273-280.Crossref 12. Luft BJ, Dattwyler RJ, Johnson RC, et al. Azithromycin compared with amoxicillin in the treatment of erythema migrans . Ann Intern Med. 1996;124:785-791.Crossref 13. Salazar JC, Gerber MA, Goff CW. Long-term outcome of Lyme disease in children given early treatment . J Pediatr. 1993;122:591-593.Crossref 14. Gerber MA, Sharpiro ED. Lyme disease in children in southeastern Connecticut . N Engl J Med. 1996;335:1270-1274.Crossref 15. Feder HM Jr, Hunt MS. Pitfalls in the diagnosis and treatment of Lyme disease in children . JAMA . 1995;474:66-68.Crossref

Journal

Archives of Dermatology – American Medical Association

Published: Jan 1, 1997

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