Various Skin Manifestations Related to Lyme Disease*

There are various rashes and skin manifestations associated with Lyme and tick borne diseases. Approximately 50% of reported cases of Lyme disease indicated the patient did not have an EM (bulls-eye) rash.  Nationally, less than 10% of children report a rash (Dr. Jones, CT). Later and chronic stages of Lyme tend to bring on more skin-related changes in some people.

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Chronic Lyme Disease- Rashes & Manifestations  

Acrodermat
itis chronica atrophicans (ACA) represents the persistent late stage of borreliosis in which Borrelia species may survive for decades. Occasionally, B-cell lymphoma may develop and additional neoplastic complications such as basal cell carcinoma or squamous cell carcinoma (SCC) have been reported along with ACA.
  
Patients with ACA manifestat
ions can also experience acral pain, paresthesia, dysesthesia, cognitive dysfunction, peripheral neuropathy, lymphadenopathy, musculoskeletal pains, destruction of small joints, atrophy of the epidermis, morphea, lichen sclerosus atrophicus, facial edema, paresis of the brachial plexus and fibrotic nodules or bands (most often elbows and  knees).  Edema with or without a bluish discoloration of the skin may occur. 

Chronically ill Lyme patients have been misdiagnosed with scleroderma, livedo, venous insufficiency, Reynaud’s syndrome, edema or an ongoing aging process.


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Chronic Lyme Disease- Rashes & Manifestations Acrodermatitis chronica atrophicans (ACA) Acrodermatitis chronica atrophicans (ACA) represents the persistent late stage of borreliosis in which Borrelia species may survive for decades. Occasionally, B-cell lymphoma may develop and additional neoplastic complications such as basal cell carcinoma or squamous cell carcinoma (SCC) have been reported. Patients with ACA manifestations can also experience acral pain, paresthesia, dysesthesia, cognitive dysfunction, peripheral neuropathy, lymphadenopathy, musculoskeletal pains, destruction of small joints, atrophy of the epidermis, morphea, lichen sclerosus atrophicus, facial edema, paresis of the brachial plexus and fibrotic nodules or bands (most often elbows and knees). Edema with or without a bluish discoloration of the skin may occur. Many chronically ill Lyme patients have been misdiagnosed with scleroderma, livedo, venous insufficiency, Reynaud’s syndrome, edema or an ongoing aging process.
Rashes shortly after tick bite- multiple EM's.
Multiple EM rashes after a tick bite. Less than 10 percent of children are reported to have an EM rash.
Multiple EM rashes after a tick bite- child's leg.
Tick bite site with expanding EM rash- 4 days after the bite. Inner circle around tick bite is approximately 3 inches in diameter.
Swelling in feet, toes and ankles prior to ACA development. Swelling usually precedes the formation of the ACA rash. Once swelling subsides, the fat layers appear to have diminished and the rash begins to form. The skin can become red/purple color and turn paper-thin in the area above the rash.
Bright red areas, with or without white patches, are sometimes noted in chronically ill Lyme patients. The condition can be aggravated by cold temperatures. It can occur on the hands, feet, ears, breasts, knees or elbows.
Close up of Raynaud's-like presentation along with some minor swelling and redness.
ACA- Loss of fatty layer, linear pattern, discoloration, ankle swelling
Foot with ACA rash developing. Rash subsided with antibiotic treatment. When treatment was stopped the swelling returned, subsided, and then the rash returned. USA patient.
ACA rash reforming when antibiotic treatment is discontinued in a chronically ill Lyme patient. Note purple and red colors and hard nodule on ankle bone.
Swollen foot, with what appears to be blood spots on ankle slightly under the skin. ACA of chronic Lyme is forming- see lines across foot and the discoloration of skin.
ACA, nodules, swelling, color changes- active stage
Ankle swelling and ACA rash forming on foot.
ACA rash with lines forming along the top of the foot. Fat layer disappeared after periods of on/off swelling.
Bright red and purple colored feet in Lyme and multiple tick borne disease patient. Note the loss of fat occurring under the skin layer and wrinkles forming.
Ankle swelling, pocket swelling (below ankle bone), loss of fatty layer
ACA early rash forming on foot. Note toe/foot joints and comb-like lines along top of foot where fat layer is disappearing.
Right foot with ACA, ankle swelling, discoloration, loss of fatty layer on bottom and side of foot.
Low blood flow to areas of the foot in chronic Lyme patient.
Skin on hands lost underlying fat layer resulting in protruding veins and tendons, paper thin skin, leathery texture, lines due to chronic Lyme ACA
Very fragile paper-thin skin on the hand as a result of the ACA presentation of chronic Lyme disease.
ACA in active stage
Swelling and lump forming below joint on outer side of wrist.
Nodule on finger joint- hard, slightly red, slightly tender
Blister-like bumps with red discoloration of skin.
Small blister-like bumps on skin- some red, some white. Also discoloration caused by chronic Lyme, ACA stage.
ACA stage of chronic Lyme. The paper-thin skin is peeling from the knees due to pants legs rubbing across knees while patient walks or sits.
ACA rash on knee. Note red and purple discoloration, lines through skin, swelling and lacy (livedo) patterns along legs. Also thin skin on top of feet and red/purple discoloration.
Lacy livedo rash across upper and lower leg. ACA and slight swelling around knee. Purple/pink discoloration.
Faded ACA patches on thighs above the knees. Fluid on knees. This condition developed after the standard recommended treatment failed to cure Lyme disease.
Livedo in chronic Lyme patient with ACA late stage Lyme. Condition worsens with cold temperatures and stress. For more information: http://www.dermis.net/dermisroot/en/42784/diagnose.htm
Lacy rash of Livedo in chronic Lyme patient. For more information: http://www.dermis.net/dermisroot/en/42784/diagnose.htm
Livedo lacy rash- red and purple discolorations. More prominent when patient is cold or overly stressed.
Swelling on knee, ACA on thigh and mild livedo (lacy rash).
Livedo and knee swelling in chronic Lyme patient. For more information: http://www.dermis.net/dermisroot/en/42784/diagnose.htm
ACA rash on leg, around and above knee, with paper-thin skin peeling and slow to heal wounds. Also discoloration and some livedo.
ACA, Livedo and knee swelling.
ACA rash on knee. Discoloration and livedo present in chronically ill Lyme patient.
ACA, Livedo, knee swelling, discoloration.
Livedo on leg- chronic Lyme patient. For more information: http://www.dermis.net/dermisroot/en/42784/diagnose.htm
ACA, Close-up view.
Acrodermatitis chronica atrophicans (ACA) Acrodermatitis chronica atrophicans (ACA) represents the persistent late stage of borreliosis (chronic Lyme disease) in which Borrelia species may survive and multiply for decades. ACA Rash and late stage Lyme symptoms developed in this U.S. patient (ACA often reported to not be in the Lyme strains found in the USA) even though patient was treated according to the IDSA's Lyme Treatment Guidelines.
ACA rash on legs slowly fading after patient was treated with antibiotics.
ACA rash in U.S. patient is returning after antibiotic treatment has been stopped.
Skin peeling on elbow due to ACA chronic Lyme disease manifestations. Note red nodule several inches below peeling skin.
Skin peeling after ACA rash appeared on elbow. Clothes rubbing against the elbow while wearing long sleeves caused the skin to peel.
ACA skin peeling on elbow after swelling subsided. Note bright red nodule.
Clumps and patches of hair coming out in patient with chronic Lyme disease.
ACA developed around eye and eye socket in patient with chronic Lyme disease. Nodule on skin along inner eye. Purple/red/black discoloration.
ACA rash surrounding eye. In this patient, inadequate treatment caused the ACA to form on hands, feet, chest and around the eyes.
ACA due to chronic Lyme disease- discoloration around eye and eye socket
ACA Chronic Lyme- discoloration- red, purple, yellow.
Purpura: This disorder usually presents with red or purple colored patches and is often accompanied by aching in the joints and fever.
Morgellons Rashes. Many Morgellons patient test positive for Lyme disease. For more information: http://www.cherokeechas.com/AJCDerm1.pdf
Morgellons rash. Close up of open lesion. For more information: http://www.cherokeechas.com/AJCDerm1.pdf