Lyme disease and the Skin (For Professionals)

• Some of the infections which affect the body can manifest itself with some skin changes. This is what happens in Lyme disease (also called Borreliosis). Lyme disease is a bacterial illness caused by a spiral shaped bacteria (spirochete) named Borrelia burgdorferi. These are bacteria which are often found in deer. What happens is that the sick deer carry these bacteria. In turn, ticks bite deer and and then bite human skin. Along with their human skin bite, they also spread bacteria into the bloodstream.  The condition is typically caught while being in the woods of contaminated areas.
• The interesting thing is the fact that a person with Lyme disease cannot bring to the disease to another human. He or she bears the consequences alone and does not share them (not contagious). The consequences are skin, joint, heart and nervous system disorders causing discomfort and can be serious if not treated.
• Lyme disease has been reported most often in the northeastern part of the United States, but it has been reported in all 50 states, as well as in China, Europe, Japan, Australia, and parts of the former Soviet Union. In the United States, the disease has been reported:

1. in the North-East from the states of Maine to Maryland
2. in the Midwest in Minnesota and Wisconsin
3. in the West in Oregon and Northern California.

So, how do we know if we have Lyme disease?

• The first reaction would take place in the skin, because it the point of entry. After a person gets bitten by the infected tick, there is a certain reddish rash that spreads (erythema chronicum migrans). The person also feels body malaise and joint and muscle pains, after which the bacteria spreads into other organs.

So now you see that Lyme disease is also a disease of the skin !

• Lyme disease is not just a skin disease but a systemic disease. It can present with inflamed skin outside, but inside, it involves the heart and nervous system. The person may also have nerve damage and cannot feel (anesthesia), cannot move well and can have painful joints and have altered consciousness. So if you see a person with exposure to deer developing a skin rash, flu like symptoms and with pain on movement and have difficulty feeling and thinking, then he or she is a suspect for Lyme disease.
• Another thing you can see is how the rash appears. Usually, the site where the skin was bitten by the insect appears as an expanding ring of flat redness, which may have an outer ring of brighter redness and a central area of clearing, like e “bull’s eye”. Doctors call this “erythema chronicum migrans”. The redness spreads and often disappears in about a month. However, weeks to months after the said redness, the person feels joint, heart and nervous system disturbances. The person can have heart failure because of inflammation in the heart. The person can also develop Bell’s palsy, wherein he or she cannot move a certain part of the face due to disease of the nerves. It can also affect the brain, causing stiffness of the neck and confusion. These are signs that meningitis is taking place. In addition, there is also arthritis or swelling of the joints, stiffness and pain.

So, what do you do if you suspect a case of Lyme disease?

• You should bring the person to the doctor. The doctor may then order some blood tests to confirm the diagnosis. Blood testing is done to check for complete blood count and note the presence of antibodies in the blood against Lyme bacteria. These antibodies can be detected using a laboratory method called an enzyme-linked immunosorbent assay [ELISA].) However, there are some tests which can have false positive and false negative results. Currently, the confirmatory test that is most reliable is the Western Blot assay antibody test. More accurate tests are being developed.
• Once the diagnosis is confirmed by the doctor, then antibiotics will be given. If early, Lyme disease is usually treated with medicines taken by mouth, for example, doxycycline (Vibramycin), amoxicillin (Amoxil), or cefuroxime axetil (Ceftin). Of note, doxycycline should not be used in pregnancy.
• Generally, antibiotic treatment resolves the rash within one or two weeks. Later illness such as nervous-system disease might require intravenous drugs; examples are ceftriaxone (Rocephin) and penicillin G.
• Your doctor may also give you pain relievers. Swollen joints can be reduced by the doctor removing fluid from them (arthrocentesis). An arthrocentesis is a procedure whereby fluid is removed from a joint using a needle and syringe under sterile conditions. It is usually performed in a doctor’s office.
• For those being exposed to ticks which harbor the disease, it is best that you protect yourself from Lyme disease. When walking in the forest, you should use spray insect repellant containing DEET (Diethyltoluamide) onto exposed skin. Wear long pants tucked into boots and long sleeves. Clothing, children, and pets should be examined for ticks. Ticks can be removed gently with tweezers and saved in a jar for later identification. Bathing the skin and scalp and washing clothing upon returning home might prevent the bite and transmission of the disease.
• If you see that someone has been bitten by a tick which has attached itself to the skin for at least 36 hours, you can consult your doctor who may give the person doxycycline (200 mg) to prevent Lyme disease. This therapy is not recommended if the tick is acquired in an area where these ticks are not commonly infested (infection rate less than 20%) with the bacterium (Borrelia) that causes Lyme disease. Also, doxycycline should not be used in pregnancy.

Contributors: Dr Christophe HSU – dermatologist. Geneva, Switzerland