Erythema chronicum migrans is the so-called “wandering redness,” a reddish circular rash that appears several days to weeks after a tick bite in the area of the bite site, spreads centrifugally outward, fading centrally, and is considered the first stage of Lyme disease.
What is erythema chronicum migrans?
Tick bites are among the few dangers still lurking in nature in this country. Lyme disease as a secondary disease occurs in Germany of the Öfteren, a vaccination does not yet exist. However, if detected in time, it can be treated excellently. The first stage of Lyme disease, erythema chronicum migrans, should therefore be known to everyone who is occasionally out and about in the German forest and to all parents whose children still play outside in the summer.
Causes
Lyme disease is caused by bacteria, which are also conveniently called Borrelia. These borrelia are transmitted by ticks, which are at home in German forests and, contrary to widespread popular belief, do not swoop down from trees but wait in bushes about waist high for human contact and then settle into the skin of the person passing by. Depending on the region (south more than north), between 10 and 50 percent of domestic ticks are infested with Borrelia. Only about 3 percent of all persons bitten by ticks become infected with the bacteria via the saliva of the tick, which is probably mainly related to the sucking period: If the tick is discovered and professionally removed within 6-12 hours, the risk of transmission is very low. Again, only about 10 percent of those infected then actually contract Lyme disease, which is probably due to our excellent immune system. Nevertheless, tick bites are frequent and therefore cases of Lyme disease also occur frequently in Germany. It is important to recognize the symptoms in time.
Symptoms, complaints and signs
Erythema chronicum migrans is a very serious disease that must be treated by a doctor in any case, because in the worst case it can also lead to the death of the affected person. First and foremost, patients suffer from a reddening of the skin and the formation of papules and pustules at the affected site. The site may also be painful or affected by itching. Likewise, the usual symptoms of flu or a cold appear, so that patients suffer from fatigue, exhaustion and chills. As a rule, the fatigue cannot be compensated by sleep. Furthermore, erythema chronicum migrans also leads to severe headaches and a significant reduction in the patient’s quality of life. Significant pain in the back or in the joints can also occur and make everyday life more difficult. If no treatment of the disease takes place, the disease also spreads to and damages the heart and nervous system of the affected person. In the worst case, the patient may die from this damage. For this reason, erythema chronicum migrans often also significantly reduces the life expectancy of the affected person.
Diagnosis and course
About 5 to 29 days after the tick bite, a small papule usually develops where the tick sat. A circular redness then forms around it, which spreads centrifugally, i.e., from the inside to the outside, within days, fading in the center. The result is the appearance of a ring that grows larger and moves outward. The rash owes its name “wandering redness”, or in medical terms erythema chronicum migrans, to this behavior. Since the disease does not hurt, migratory rash is often not even discovered. Only sometimes fever, poor general condition, fatigue or headache appear, but they disappear after a few days and are too unspecific to be associated with an incipient Lyme disease. Muscle aches and flu-like symptoms may also occur. The erythema itself may disappear after days without the Lyme disease being cured. However, it can also persist for months. If Lyme disease is not detected and treated in this first stage, the pathogens spread in the body, can cause further symptoms and in the end become a severe, life-threatening disease: In the second stage after four weeks at the earliest, the heart and the peripheral nervous system are affected, which becomes noticeable through rhythm disturbances, paralysis and pain.In the late stage, often after months, skin, individual joints and the central nervous system are affected. Encephalitis can lead to death. Erythema chronicum migrans as a skin manifestation is typical enough to diagnose it as incipient Lyme disease after a tick bite. In addition, a physician will perform a blood test for Borrelia antibodies, but these are often not even detectable in the early stages of the disease.
Complications
Due to erythema chronicum migrans, the complications of a tick bite occur. These do not have to occur immediately and lead directly to symptoms, in most cases these spread only in the course of the disease. The patient suffers from severe fatigue and also n headache. Papules form on the body and there is a relatively high fever. The joints and extremities also ache and the affected person suffers from a general feeling of illness. In most cases, these symptoms do not appear until several weeks after the bite of the tick. In the worst case, other organs are also affected, so that there may be discomfort in the heart or lungs. If the central nervous system is damaged, paralysis of various parts of the body can occur. This results in a restriction of movement. In most cases, antibiotics are used for treatment, which leads to a positive course of the disease. Usually, the affected person is dependent on bed rest for a few days before the body can be exposed to stress again. Life expectancy is not affected by erythema chronicum migrans in most cases.
When should you see a doctor?
A tick bite requires a visit to the doctor if the tick cannot be completely removed from the wound by its own means. Special care should be taken if the torso has detached from the tick and the head is still in the wound. A doctor should always be consulted in these situations. If the affected person complains of various complaints, a visit to the doctor should be made even if the tick has been professionally removed. If fever occurs or there is chills, there is reason for concern. Symptoms such as headache, back or joint pain should be clarified by a doctor. If pain occurs directly in the region of the tick bite, a visit to the doctor is necessary. If there is inflammation of the wound or if the wound enlarges, a visit to the doctor should be made. If poplars or redness of the skin form, these are considered unusual and should be clarified by a doctor. If fatigue, nausea, dizziness or vomiting occur, the affected person must be examined and treated. If the site of entry does not heal within a few days after the tick bite, it should be presented to a physician. If the general well-being, the usual level of performance drops or weakness sets in, a visit to the doctor is advisable. Medical attention must be given to the discomfort to prevent serious illness from developing.
Treatment and therapy
In the first stage, Lyme disease can be treated very well with antibiotics, doxycycline as a tablet for a few days lets the majority of infections heal without consequences. A blood test controls the success. In later stages, tougher measures must be taken, cephalosporins are then the drug of choice, sometimes also by infusion over a longer period of time. By the way, not every tick bite is treated, as is often assumed: The probability of actually contracting Lyme disease is simply too low to expose oneself to the possible risks and side effects of antibiotic treatment. However, the appearance of wandering redness is an urgent reason for therapy, and every day earlier that one receives antibiotic therapy reduces the risk of chronic infection.
Outlook and prognosis
The prognosis for erythema chronicum migrans is positive if the disease is completely cured. This is possible with antibiotic therapy. Despite adequately treated erythema chronicum migrans, about 5 percent of patients subsequently suffer from “post-treatment Lyme disease symptoms.” The symptoms are similar to those of Lyme borreliosis. The resulting occurrence of joint and muscle pain, constant fatigue and difficulty concentrating reduces the quality of life. However, since erythema chronicum migrans is considered a precursor to Lyme disease, the occurrence of such sequelae is not entirely surprising. The migratory redness triggered by tick bites can be treated well in most cases.It is rather unlikely that Lyme disease will develop in those affected after antibiotic treatment. This prognosis obviously also applies to those 5 percent of sufferers who develop Lyme disease-like symptoms despite treatment. Untreated, however, the prognosis is different. Erythema chronicum migrans, which remains untreated, can lead to a diminished quality of life due to severe pain. If left untreated, erythema chronicum migrans can reduce the life expectancy of those affected. If treatment continues to be omitted, the heart can be affected. The nervous system may also be affected by damage. In the worst case, erythema chronicum migrans left untreated results in the patient’s death.
Prevention
For prevention, children should also be extensively checked for ticks after playing outdoors, and adults need to remember this as well. Defense sprays and wide-ranging clothing can also minimize the attack surface for ticks. Ticks should be removed professionally and completely; if this is done within twelve hours, the risk of Lyme disease is very low. Medicinal measures are then initially necessary. However, the appearance of a wandering redness within the next four weeks should be specifically watched for.
Aftercare
In most cases of erythema chronicum migrans, no special or direct measures and options for aftercare are possible. The affected person must first undergo a comprehensive examination and treatment for this disease to prevent further complications. The earlier the disease is detected, the better is usually the further course. In general, it is recommended to protect oneself against ticks and to avoid the infested areas as much as possible. Likewise, vaccination against ticks is very useful to prevent the occurrence of erythema chronicum migrans. In most cases, this infection is treated with the help of antibiotics. The affected person is dependent on a regular intake and also on a correct dosage. If there are any questions or uncertainties, a doctor should be contacted first. Even after the symptoms have subsided, the antibiotics usually have to be taken for a few more days. Alcohol should also be avoided during the course of treatment. However, the further course of erythema chronicum migrans depends on the exact stage of the disease. In general, the affected person should also take it easy with this disease and not expose himself to exertion or other stressful activities.
What you can do yourself
In everyday life, special caution against tick bites is important. Particularly in the months of spring or summer, care should be taken during walks and stays outdoors to avoid getting tick bites. For this purpose, insect sprays can be applied to the skin for protection. These keep ticks away and at the same time protect against further insect bites. Before spending time in meadows or forests, it is advisable to gather information about the current regional tick distribution. Long clothing and closed shoes make it more difficult for ticks to gain access to the human body. Seat pads should be used in meadows. Large blankets or cloths are sufficient to avoid direct contact with the ground. Immediately after a walk in the forest or a stay in a meadow, the skin should be checked thoroughly for tick bites. The tick should be removed with a steady hand and tick forceps. Care should be taken to ensure that the entire body of the tick is removed. If this is not successful or if the tick is located in a difficult to reach area on the body, it is necessary to consult a doctor. It should be avoided to remove the head of the tick on one’s own responsibility with tweezers or similar tools.
