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How Many Get A Rash?

How Many People Get A Rash?

Typically less than 50% of people with Lyme have a rash.  In children it is reported to be less than 10% (Dr. Charles R. Jones, CT.).  The EM rash is diagnostic for Lyme and so it is frequently reported at high levels (sample bias).  Some papers that may not have this bias are:

In 1977 Steere said 25% of patients had an EM rash.

Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, Ross MR, et al. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities. Arthritis Rheum. 1977;20: 7–17. 

Available: http://www.ncbi.nlm.nih.gov/pubmed/836338


Here are some other papers

EM rash 22% mean of 2 samples   Ljøstad U, Skogvoll E, Eikeland R, Midgard R, Skarpaas T, Berg A, et al. oral doxycycline versus intravenous ceftriaxone for European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blind, randomised trial. In: The Lancet [Internet]. Aug 2008 [cited 3 Dec 2014] pp. 1–4. doi:10.1016/S1474-4422(08)70119-4         


EM rash  26.6% Guerrero A, Escudero R, Martí-Belda P, Quereda C. Frequency of the clinical manifestations of Lyme borreliosis in Spain. Enferm Infecc Microbiol Clin. 1996;14: 72–9. Available: http://www.ncbi.nlm.nih.gov/pubmed/8714152


EM rash 9% Djukic M, Schmidt-Samoa C, Nau R, von Steinbüchel N, Eiffert H, Schmidt H. The diagnostic spectrum in patients with suspected chronic Lyme neuroborreliosis - the experience from one year of a university hospital’s Lyme neuroborreliosis outpatients clinic. Eur J Neurol. 2011;18: 547–55. doi:10.1111/j.1468-1331.2010.03229.x


Average of studies is 43%, but as mentioned it is probably biased.

Information kindly provided by Michael Cook.

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