Early Localised Borreliosis
The early stages of disease classically presents with a single, expanding Erythema Migrans (EM or “bull’s-eye”) rash, which may last for weeks. However, the rash may be absent or remain hidden under hair or in an inaccessible place. Epidemiological data from the Health Protection Agency over the last few years has demonstrated that fewer than 50% of laboratory-confirmed cases have reported a rash.

There can be a significant range of rashes beyond the classic, target-like EM, including multiple, flat, raised, or blistering rashes. The rash may also vary in colour from light pink to dark purple. Because of the variations misdiagnoses can occur and allergic reaction, ringworm, cellulitis and other more common skin ailments can be considered the cause. Rashes can also be missed if they are faint or if the patient’s skin is dark.

Recent evidence suggests that B. afzelii can result in more ring-like lesions while B. garinii can result in more irregular lesions, which tend to develop more rapidly.

Other early symptoms tend to be flu-like (mild and without the runny nose, cough and sore throat).

Solid Lesion (source DermAtlas)

Irregular Lesion (source DermAtlas)

Multiple Lesions (source DermAtlas)

Target Lesion (source CDC)

Borrelia lymphocytoma is an uncommon form of early disease. It is normally seen on the earlobe, nipple or scrotum. It appears as a dark, bluish-red, painless patch of skin.

Borrelial Lymphocytoma (©Gerald Stanek)