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How To Identify the Lyme Disease Bullseye Rash On Different Skin Types

Lyme disease is often called ‘The Great Imitator’, as it has an uncanny ability to mimic other disorders. Misdiagnosis is extremely common in the field of Lyme treatment, a situation which is compounded by a base lack of understanding regarding the chronic form of the disease. The two stages of Lyme disease, acute and chronic, are very different; they produce vastly different symptoms, which also may vary depending on the individual patient. However, the acute stage is much more uniform, and a lot easier to treat. It is recommended that the disease is caught at this early stage to stop the spread and eventual mutation into chronic Lyme. Although acute Lyme symptoms often appear a lot like the flu, there is a smoking gun symptom that is 100% indicative of the disorder. This is the distinctive Lyme disease bullseye rash, a red ring encircling a smaller red dot. But how prevalent is this symptom, and how does it affect people with different skin types? 

The official name of the rash is ‘erythema migrans’ and though it would be helpful if everyone infected with Lyme presented with it, sadly they do not. However, it is common enough that it can be considered a decent indicator, and something to watch out for if you fear you may have been exposed to ticks. It occurs in about 70% to 80% of people infected with Lyme disease, and forms on the site of the tick bite. It’s important to keep in mind that ticks won’t necessarily bite where they land – they will often seek out the most sheltered or protected area of the body before biting, making the rash harder to find if it is present.

BCA-clinic - tick
Ticks will often bite in hard-to-reach places on the body, making the distinctive Lyme disease bullseye rash difficult to spot at times.

On top of that, there is evidence that the Lyme disease bullseye rash might not be consistent for all skin types. A study from 2000 which examined the racial discrepancies in Lyme disease concluded that African Americans may not realise they have the disease as readily as Caucasians, due in part to the higher presence of erythema migrans in the latter. Caucasians were six times as likely to detect the bullseye rash than African Americans, leading to higher instances of treatment. The variance in skin colour would make perfect sense with these results; the bullseye rashes were likely present in the African American patients, but were rendered harder to detect because of the darker skin tone.

So we can reasonably conclude that the darker the skin tone, the harder it is to detect the presence of a bullseye rash. However, it is also important to be aware that Lyme-associated rashes are not always bullseye-shaped. In fact, they can come in a variety of shapes and sizes, and it’s important to be aware of all of them. Not only is the acute phase the best chance the patient has of being treated successfully, it is also the stage of the disease where doctors are most literate. You can almost chart a graph: the longer Lyme stays in the system, the less most doctors will know what to do about it. BCA-clinic have been investigating and supporting the treatment of chronic Lyme disease for many years. They understand how the disease works long-term, and how chronic Lyme differentiates itself from acute Lyme. It is an undeniable fact that the longer the disease stays in the system, the harder it is to eradicate it.

How easy it is to identify a Lyme bullseye rash depends on the type of skin you have.

In addition to the bullseye shape, it’s important to be aware of what forms a Lyme rash can take. An expanding red lesion with a central crust or blistering is one possibility. The edges of the rash will likely be irregular and quite large. Disseminated Lyme disease can produce multiple rashes in the early stages; fortunately, these will be quite easy to see, so the chances of getting prompt treatment is high, as long as the patient is observant. A red, oval-shaped plaque on the trunk is also quite an easy one to identify, as it will often cover much of the skin. There are additionally two variations on the traditional bullseye shape, which might be a little harder to spot due to them being less distinctive. The first is an expanding red ring without anything in the centre, while the second has a bluish hue with no clearing in the centre. Visual examples of all of these rashes are available at the CDC (Centres for Disease Control and Prevention) website.

As the bullseye rash is such a key component of identifying Lyme disease, it’s important to be aware of it, no matter your skin type. People with darker skin might have to look that extra bit harder for the rash, since it doesn’t show up as easily as it does on lighter skin. Regardless, any rash that suddenly appears or seems to be expanding should be looked at by a medical professional as soon as possible.