What is a wandering blush?
The wandering blush is also called erythema migrans. This is a symptom in the form of a skin condition called Lyme disease. This skin phenomenon spreads circularly from the tick’s bite and presents itself as a round redness with a central pallor.
Causes
A wandering blush occurs after a tick bite. If the tick is infected with the bacterium “Borrelia-burgdorferi”, this bacterium can be transmitted to the affected person, which leads to the clinical picture of Lyme disease. In about half of the cases, wandering blush is one of the first symptoms of this disease. The redness is an expression of the infection, as the bacterium spreads throughout the body from the puncture site. This spreading process causes the reddening of the skin to change in position and size and to appear pale in the middle.
Diagnosis
The diagnosis is usually made on the basis of the medical history and the clinical appearance of the flush. If the patient can remember a tick bite, for example because he or she removed the tick himself or herself, this is a decisive indication that a flush is present. The physician should also be asked about the time course.
A flush can occur days to weeks after a tick bite. The appearance of the skin manifestation can also provide information about its origin. Typically, the redness is roundish with a central pallor and not raised.
However, atypical forms may also occur which appear more uniformly reddened or raised. Normally, the above mentioned criteria should be sufficient for diagnosis. In addition, a blood analysis can be carried out, which either detects specific antibodies or directly the pathogen.
However, this test is negative in half of the cases of wandering flush and should only be performed if other symptoms of Lyme disease are present. As mentioned above, a blood analysis can provide information about the presence of Lyme disease. If this blood test is positive, the probability that an unclear reddening of the skin is a wandering flush is higher.
However, the blood test is negative in 50 percent of cases, even though there is a Borrelia infection. The blood analysis consists of the detection of Borrelia-specific antibodies. However, a single positive test result is only groundbreaking in combination with the typical symptoms, as it may also be present in other infectious diseases (e.g. hepatitis). An additional diagnostic possibility is the direct detection of the pathogen. This is very specific because it recognises the DNA of the bacterium, but also very time-consuming.
Symptoms
It is an early symptom of Lyme disease. The name wandering redness is derived from the fact that the rash spreads circularly from a central puncture site. It can sometimes be accompanied by itching and rarely by pain.
Usually the diameter of the flush is 5 cm or more. Usually the redness is flat, but in rare cases it may be raised. Another feature of itinerant redness is the paleness in the centre of the circular redness.
However, in rare cases this may be absent. Other phenomena that can occur with an untypical redness are papules, spots or blisters. It can happen that in addition to the redness of the skin, itching or pain occurs.
Other, rare accompanying symptoms can be nausea, fatigue, muscle pain or fever. In addition, other symptoms of Lyme disease can occur, which can be very variable. It is the local early manifestation of Lyme disease.
If the pathogen reaches other organs in the body, numerous symptoms can occur. If the pathogen reaches the central nervous system, paralysis of the limbs is typical, for example. Headaches can also occur because the bacteria can attack the meninges.
The heart can also be affected in the form of inflammation of the heart muscle. In the late stage of Lyme disease the joints are often affected, especially large joints such as the knee. This clinical picture is called Lyme arthritis.
Since the pathogen can settle in any organ system, a variety of symptoms are possible, which can make diagnosis difficult. Read more about the symptoms of Lyme diseaseThe wandering flush is caused by a reaction of the immune system to the invading pathogen. This can cause itching.
However, this is a rather atypical and very unspecific symptom, as itching can occur in a variety of skin diseases. Various measures can be taken against itching. Non-drug cooling can provide relief.
Creams which alleviate itching can also be applied. Some have a cooling effect, others contain pharmacological agents such as glucocorticoids. In severe cases, antihistamines can be taken as tablets.
Medicinal measures are seldom indicated in cases of itchy flushes, however, as itching rarely occurs and ceases after treatment of the underlying disease. As a rule, flushing is not painful. However, pain may occur in rare cases and does not rule out the presence of erythema migrans. However, as it is a rare symptom, other diagnoses associated with a painful skin manifestation should also be considered.
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