Tag Archives: bulls-eye rash

Not All Lyme Rashes Are Created Equal

by Jennifer Crystal

Lyme disease: that’s the illness you get when you find a bulls-eye rash, right?

It very well could be, but here’s the catch. The bulls-eye rash isn’t the only sign of Lyme disease. Nor does every Lyme rash (Erythema Migrans or EM) present as a target with red rings around it. To assume that Lyme always comes with a bulls-eye rash is, in fact, to be way off target and—worse—poorly informed when it comes to diagnosing the disease.

In fact, less than 50% of Lyme patients ever find a bulls-eye rash, or any rash at all. But that doesn’t mean they don’t have Lyme. It means they, and their doctors, will need to look a little further.

I found a rash on my forearm in the summer of 1997 while working at a camp in Maine. It wasn’t a bulls-eye shape. It was a series of red dots, sort of stippled, that extended from my wrist almost to my elbow. It wasn’t raised and it didn’t itch.

“It’s probably from your sleeping bag or something,” the camp nurse said. In 1997 Lyme disease was not on the public health radar or mine, which is ironic since I grew up in Connecticut where the disease was first discovered.

That same summer I developed hypoglycemia, which I later learned is a common symptom of the tick-borne disease babesia, a co-infection of Lyme. That fall I was bedridden with flu-like symptoms. Had I presented these symptoms, and my rash, to medical professionals today, they might have seen a pattern and tested me for tick-borne illnesses. Lyme literacy is improving, but not all doctors look at individual symptoms in a big picture way—and that pesky myth of the bulls-eye rash, especially if you don’t have one, still persists, which is why I continue to share my story.

Sample Em-RashEM rashes present in many different ways. Some are small. Some are big and blotchy. Some are spotted. Some are pink and some are bright red. If these sentences are starting to sound like a Dr. Seuss book, it’s because the lesson they contain is simple. If you find any type of rash at all, especially during the summer months, and if you subsequently experience symptoms of tick-borne illness, do not assume your rash is nothing. Show it to a Lyme Literate Medical Doctor (LLMD), who you can find here.

If you, your children, or your pets spend time outdoors, it’s important to do nightly tick checks of everyone exposed. As you are looking for culprits, also keep your eye out for rashes of all kinds. They don’t always appear in obvious places. A rash could be on your back—have someone else look!—in your groin, between your toes, behind your ears, or on your scalp.

And a rash might not be there at all, but you can have Lyme disease without ever getting one. Therefore, in addition to checking yourself for ticks and rashes, it’s important that you keep an eye out for typical Lyme symptoms. If you experience flu-like symptoms such as fatigue, joint aches, headaches, neuropathy, Bell’s palsy, or any other unusual symptom, do not brush it off as a summer flu.

Maybe you’ll get lucky, and that’s all it will be, the summer flu. But it’s better to be safe than sorry; let an LLMD make that call. You will also want to keep an eye out for symptoms of co-infections, like the hypoglycemia which I experienced.

Of course, if you are lucky enough to find a bulls-eye rash, take it as an unequivocal sign: you have Lyme disease. Do not wait to see if you develop symptoms. That can take months. By which time the disease, and possibly co-infections, will have spread further into your system and may cross the blood-brain barrier. Then the disease(s) will be much harder to treat.

In a way, finding a bulls-eye rash is like winning the lottery. If you’re smart, you have a ticket to immediate diagnosis and treatment. Moreover, it’s unlikely that you won’t have to deal with chronic symptoms and long-term treatments. If you aren’t so lucky as to win a bulls-eye, keep looking for ticks, atypical rashes, and symptoms of tick-borne disease.

I wish you all a Lyme-free summer!


Opinions expressed by contributors are their own.

Jennifer Crystal is a writer and educator in Boston. She has written a memoir, One Tick Stopped the Clock, for which she is seeking representation. Contact her at: lymewarriorjennifercrystal@gmail.com

10 Top Myths About Lyme Disease

10 Top Myths About Lyme Disease

Lyme disease has become one of the fastest growing epidemics in the nation. According to the Centers of Disease Control and Prevention, there are more than 329,000 new cases in the U.S. each year. But getting the facts about Lyme disease isn’t always easy.

Here are some of the biggest “myths” about the illness—and the information you need to protect yourself, your family and pets from tick bites so you can safely enjoy the outdoors.

Myth #1:  Lyme always causes a bulls-eye rash.

FACT:  Although most people associate Lyme disease with the bulls-eye-shaped “erythema migrans” (EM) rash, less than 50 percent of patients develop one. Early stage Lyme may manifest as a mild flu-like illness with a headache, a stiff neck, or a rash that’s so pale or oddly positioned that it’s barely noticeable. If you get a rash, it’s just as likely to look like a simple rash that is easily mistaken for a skin infection or spider bite.

Myth #2: Lyme is an East Coast illness only.

FACT: Although it’s more prevalent in the Northeast and Midwest, Lyme disease has been reported in all 50 states and is a problem around the globe. It is endemic in parts of Europe and Asia, Australia and Canada, and is even found in the Amazon region of Brazil.

Myth #3: You’ll know when you’ve been bitten by a tick.

FACT: Ticks have a numbing agent in their saliva so you don’t feel anything when one first bites you. You probably won’t even know a tick is feeding. Most people don’t ever recall seeing a tick latched onto them.

Myth #4: Ticks die in winter.

FACT: Many people believe that ticks die in winter, but that’s not true. Temperatures have to drop below 10 degrees Fahrenheit for a long time in order for ticks to start dying, and thanks to climate change that’s not the reality even in the northern states anymore. Although this past February was the coldest month on record for many Northeast and Midwest areas, the heavy snows paradoxically provided a layer of insulation for blacklegged ticks that are now questing for blood as the weather warms up.

Myth #5: You have to be near deer to be exposed to deer ticks.

FACT: If you don’t see any deer and think the coast is clear, think again. Blacklegged ticks (commonly called deer ticks) carry the bacterium that causes Lyme disease. They feed on small mice, chipmunks, squirrels, rabbits, birds, deer, and even on dogs and cats

Myth #6: Ticks fall from trees.

FACT: Ticks don’t jump, fly, or drop from trees. They crawl up. If you discover a tick on your head or back, it’s probably because it latched onto your foot or leg and crawled up your body and not because it fell off a tree branch. Minimize your exposure by tucking pant legs into socks and shoes, wear long-sleeved shirts, and tuck your shirt into pants to keep ticks on the outside of clothing.

Myth #7: Hiking and camping are the most common ways to catch a tick-borne disease.

FACT:  It’s important to make tick bite prevention an important part of your outdoor plans whether you are gardening, camping, hiking, biking, or just playing outdoors. Although black-legged ticks live in moist and humid environments, particularly in or near grassy or wooded areas, they will cling to brush and shrubs and live in lawns and gardens, especially at the edges of woods and around old stone walls.

Myth #8:  If the blood test is negative, you don’t have Lyme. 

FACT:  Tests for detecting Lyme disease are often inaccurate. At present, your doctor will probably recommend two-tiered blood testing requiring a positive ELISA test result. Doctors commonly order an ELISA first to screen for the disease, then confirm it with a Western Blot. The ELISA measures the total amount of antibodies produced by the body in response to the Lyme bacterium (Borrelia burgdorferi). However, it may miss over half of Lyme cases because antibodies may not be high enough yet to detect, giving a false-negative result. 

Myth #9: Antibiotics cure everyone within two to three weeks.

FACT:  Studies show that as many as 20 percent of patients continue to exhibit symptoms even after they complete antibiotic treatment. What’s more, many of these individuals turn out to have co-infections transmitted by the same ticks that gave them Lyme. These co-infections don’t always respond to treatments for Lyme disease itself.

Myth #10: You can remove a tick with a match or by painting it with nail polish

FACT:   Forget any advice you’ve heard about holding a match to the end of a tick, swabbing it with nail polish or suffocating it with petroleum jelly.  You want to remove an embedded tick from your body. The easiest and safest way is to pull it gently out with tweezers. Grasp the tick close to its head, then slowly lift it away from the skin. Don’t twist or jerk the tick; this can cause the mouth parts to break off and remain in the skin.