Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis

M. Feder, Henry; Abeles, Micha; Bernstein, Megan; Whitaker-Worth, Diane; Grant-Kels, Jane M.

doi:10.1016/j.clindermatol.2006.07.012

« Previous Next »Clinics in Dermatology
Volume 24, Issue 6 , Pages 509-520, November 2006

Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis

Henry M. Feder Jr, MD
- Division of Infectious Diseases, University of Connecticut Health Center, Farmington, CT 06030, USA
- Department of Pediatrics, Connecticut Children's Medical Center, USA
- Tel.: +1 860 679 2928; fax: +1 860 679 1350.
Micha Abeles, MD
- Division of Rheumatology, University of Connecticut Health Center, Farmington, CT 06030, USA
- Tel.: +1 860 679 2160; fax: +1 860 679 1287.
Megan Bernstein, MD
- University of Connecticut Health Center, Farmington, CT 06030, USA
Diane Whitaker-Worth, MD
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT 06030, USA
- Tel.: +1 860 679 3474; fax: +1 860 679 1267.
Jane M. Grant-Kels, MD
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT 06030, USA
- Corresponding author. Tel.: +1 860 679 3474; fax: +1 860 679 1267.

Abstract

Most patients with erythema migrans, the pathognomonic rash of Lyme disease, do not recall a deer tick bite. The rash is classically 5 to 68 cm of annular homogenous erythema (59%), central erythema (30%), central clearing (9%), or central purpura (2%). Serologic testing is not indicated for patients with erythema migrans, because initially, the result is usually negative. Successful treatment of a patient with erythema migrans can be accomplished with 20 days of oral doxycycline, amoxicillin, or cefuroxime axetil. Patients with Lyme arthritis usually present with a mildly painful swollen knee. Patients with Lyme arthritis have markedly positive serology and can usually be successfully treated with 28 days of oral doxycycline or amoxicillin. Some patients may have persistent effusion despite 4 to 8 weeks of antibiotics and may need synovectomy. Persistent effusion is not due to persistent infection. Antibiotic therapy for more than 8 weeks for patients with Lyme disease is not indicated. Chronic Lyme disease due to antibiotic resistant infection has not been demonstrated.