Lyme Disease Rashes

Key points

Erythema migrans rash is a common symptom that occurs in over 70 percent of people with Lyme disease. Erythema migrans rashes have certain characteristics that help differentiate them from other types of skin lesions. Review the images below to learn what erythema migrans rashes look like versus other skin conditions.

Illustration of different forms of erythema migrans on dark skin and light skin.

Erythema migrans rashes

Resource‎

The Many Forms of Lyme Disease Rashes (Erythema Migrans) [PDF – 1 page]

“Bull's-eye” or target lesion

Close-up image of a circular, reddish, skin rash.
Circular, expanding rash with target-like appearance.

Expanding rash with central crust

Close up image of a red rash on the skin with hair next to it.
Expanding lesion with central crust on chest. Photo credit: Bernard Cohen

Expanding erythema migrans

Close up image of a small, light, circular rash on dark skin.
Early, expanding erythema migrans with nodule. Photo credit: Reprinted from Bhate C, Schwartz RA. Lyme disease: Part I. Advances and perspectives. J Am Acad Dermatol 2011;64:619-36, with permission from Elsevier.
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Multiple rashes, disseminated infection

Close up image of a human's back, with multiple red rashes in the shape of ovals across their lower back.
Early disseminated Lyme disease; multiple lesions with dusky centers. Photo credit: Bernard Cohen

Red, oval plaque

Close up image of someone's skin with a large red flush in the skin next to sparse hair.
Red, expanding oval-shaped plaque on trunk. Photo credit: Alison Young

Expanding rash with central clearing

Image of a human's limb with a red circular ring flushed in the skin.
Circular, expanding rash with central clearing. Photo credit: Taryn Holman

Bluish hued rash, no central clearing

Close up image of a human's skin with a large red and blue colored rash and raised texture in the center.
Bluish hued without central clearing. Photo credit: Yevgeniy Balagula

Expanding lesion, no central clearing

Image of a black person's back of knee showing a light colored circular rash taking up the majority of the back of the calf.
Expanding lesion without central clearing on back of knee. Photo credit: Gary Wormser

Red blue lesion with central clearing

Close up image of a person's back of knees, with a purple hued rash developing on the back of the right knee.
Red-blue lesion with some central clearing on back of knee. Photo credit: Robin Stevenson

Skin conditions that are NOT erythema migrans

Insect bite hyper-sensitivity

Close up image of a person's light-colored skin with a red circular-shaped flush spreading across the skin.
Large itchy rash caused by an allergic reaction to an insect bite. Photo Credit: Chris Ha

Fixed drug reaction

Close up image of a person's limb with a dark hyperpigmented circular shape appearing right next to a growth of hair.
A skin condition that occurs up to two weeks after a person takes a medication. The condition reappears at the same location everytime a person takes that particular medication. Photo credit: Shahbaz A. Janjua
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Ringworm (tinea corporis)

Close up image of a person's torso from the side, with multiple raised, redish skin lesions in circular shapes going down their side.
Ringworm is a common skin infection that is caused by a fungus. It's called "ringworm" because it can cause a ring-shaped rash that is usually red and itchy with raised edges. Photo credit: Bernard Cohen
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Pityriasis rosea rash

Image of a person's torso with small, raised, reddish-brownish rashes spotted throughout their entire stomach surface.
A rash without a known cause that can be a round or oval, pink, and scaly with a raised border. It can sometimes itch. Larger patches than the one shown here are also common. Photo credit: Bernard Cohen
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Granuloma annulare rash

Image of a person's legs taken from the top. They have multiple circular rashes sparsely
Reddish bumps on the skin arranged in a circle or ring. Photo credit: Bernard Cohen

Urticaria multiforme

Close up image of a white infant's chest and arms. They have multiple defined spots of red color flushed in their skin.
Also known as hives. Often caused by an allergic reaction to food, an infection, or a medicine. May burn or itch. Photo credit: Bernard Cohen
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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)