Erythema migrans generally refers to Erythema chronicum migrans and is nothing but a rash that is often (though not always) observed in the beginning stage of the Lyme disease. It can show its presence any time from one day to one month after a tick bite. This rash doesn’t represent any allergic reactions to the bite, but rather it is the virtual skin infection that shows that something has had happened due to the Lyme bacteria, Borrelia burgdorferi sensu lato.

It is a path-gnomonic sign: a physician-named rash warrants an instant diagnosing of Lyme disease and prompt treatment without foster testing, even by the strict criteria of the CDS (Centers for Disease Control). There has been no other disease capable of causing such type of rash. The condition is also sometimes named as Erythema migrans (without the "chronicum") or just EM. Nevertheless, this phrase is also used to depict the geographic tongue.

In the year of 1909, there was a meeting of the Swedish Society of Dermatology; Arvid Afzelius who first confronted research about an expanding, ring like lesion that he had detected. Afzelius issued this in his work about twelve years later and speculated that the rashes came from the bite of an Ixodes tick, meningitic symptoms and signs in plenty of cases and those both genders were affected. These rashes are now known as Erythema migrans, the skin rashes found in beginning stage Lyme disease.

It was in the years of 1920s, French physicians Garin and Bujadoux narrated a patient who had had meningoencephalitis, painful sensory radiculitis, and Erythema migrans that followed tick bite, and they then showed the symptoms that were because of a spirochetal infection.

The rashes of this disease are classically 5 to 6.8 cm in diameter appearing as an annular homogenous erythematic, central erythematic, central clearing, or central purpura. Sometimes, Erythema migrans might be less than 5cm in diameter. Multiple painless EM rashes might occur that indicates disseminated infection.

The precautions for Erythema migrans

Since it is a skin disease, hygiene comes as the first as ‘must-follow’ factor. One should clean the skin thoroughly while bathing. One should not use any sort of chemically made cosmetics, especially the bath or toilet bar or soap. Instead, one should go for natural herbal soap particularly that that is made up of Neem or Turmeric or Aloe. They all are milder and skin-friendly. They help cleansing the areas (local) and also remove the bad dead cells from the skin.

One should avoid taking excessive alcohol, spicy, oily and fermented foods. Sour tested foods such as curds, buttermilk and foods like jaggery is contraindicated. One should include fresh fruits juices and dark green leafy vegetables that not only help in digestion but they are also natural cleanser of the body.

The treatment

Oral antibiotics generally doxycycline for adults and children older than 8, or penicillin group (such as amoxicillin) or cephalosporin group for adults, younger children and pregnant or breastfeeding women are considered to be standard and well adopted remedies for early-stage Lyme disease. These drugs often terminate the infection and prevent ramifications. Generally, a 14- to 21-day course of antibiotics is preferred to clear off infection entirely but some studies reveal that courses lasting 10 to 14 days are equally effectual. In some cases, long duration of treatment has been associated to serious complications.

If the condition has progressed, a doctor might recommend treatment with intravenous antibiotics for 14 to 28 days. This is generally effective, although it might take some time to recover. However, IV antibiotics might cause various side effects, including decreasing the white blood cell count, producing gallstones and mild to severe loose motions. The Food and Drug Administration (FDA) warns consumers and healthcare providers that they must restrict taking bismacine, an injection compound advised by some alternative therapy practicians for treating Lyme disease. Bismacine, also known as chromacine, has high levels of the metal called bismuth.

Though bismuth is safely used in certain oral medicines for stomach ulcers, it is not approved to use in injectable form or as any kind of therapy for Lyme disease. Bismacine causes bismuth poisoning, which can lead to heart and kidney failure.

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