Erythema Chronicum Migrans

A deep type of gyrate erythema that follows a bite by an ixodid tick; it is a stage-1 manifestation of LYME DISEASE. The site of the bite is characterized by a red papule that expands peripherally as a nonscaling, palpable band that clears centrally. This condition is often associated with systemic symptoms such as chills, fever, headache, malaise, nausea, vomiting, fatigue, backache, and stiff neck.

Also Known As:

Networked: 58 relevant articles (3 outcomes, 4 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Lyme Disease (Disease, Lyme)
2.	Meningitis
3.	Reactive Arthritis (Reiter Disease)
4.	Acrodermatitis (Gianotti Crosti Syndrome)
5.	Disease Progression

Experts

1.	Consensus group: 1 article (01/2017)
2.	Fingerle, Volker: 1 article (01/2017)
3.	Hofmann, Heidelore: 1 article (01/2017)
4.	Hunfeld, Klaus-Peter: 1 article (01/2017)
5.	Huppertz, Hans-Iko: 1 article (01/2017)
6.	Krause, Andreas: 1 article (01/2017)
7.	Rauer, Sebastian: 1 article (01/2017)
8.	Ruf, Bernhard: 1 article (01/2017)
9.	Atiq, Nasirah: 1 article (01/2013)
10.	van Meurs, Tim: 1 article (01/2013)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Erythema Chronicum Migrans:

1.	Anti-Bacterial Agents (Antibiotics)IBA 01/01/1989 - "Antibiotic therapy given during erythema chronicum migrans is often protective with regard to late joint manifestations. " 12/01/1989 - "The clinical course of six patients with erythema migrans of Lyme disease was viewed in the context of antibiotic susceptibility studies of their own Borrelia burgdorferi isolates. " 12/01/1993 - "Years before the spirochetal etiology of Lyme disease was determined, the effectiveness of antibiotic treatment for erythema chronicum migrans had been established. " 07/01/1980 - "We studied antibiotic efficacy in 113 patients with erythema chronicum migrans, the first manifestation of Lyme disease. " 01/01/1988 - "Between June 1981 and July 1987 the efficacy of antibiotic treatment of 215 patients with erythema chronicum migrans of Lyme disease was evaluated in terms of the necessity for retreatment and the prevention of the late manifestations of Lyme disease. "
2.	Penicillins (Penicillin)FDA Link 07/01/1958 - "Part B: penicillin therapy; lymphadenosis benigna cutis & erythema chronicum migrans, connections & etiology; summary]." 11/01/1989 - "Furthermore, two cases of erythema chronicum migrans, which is considered pathognomonic for Borrelia infection, were treated with penicillin perorally. " 01/01/1985 - "The antibody response to one of the spirochetal strains isolated from Swedish I. ricinus was studied in 37 patients with the typical clinical picture of erythema chronicum migrans (ECM), in 45 patients with chronic meningitis (CMe) cured by high-dose intravenous penicillin, in 298 patients with post-infectious arthritis, and in controls. " 03/01/1991 - "The skin diseases Erythema (chronicum) migrans (ECM, EM), Lymphadenosis benigna cutis (LABC), and Acrodermatitis chronica atrophicans (ACA) have long been described in northern Europe, and dermatologists are very familiar with these manifestations, which have been successfully treated with penicillin for about 40 years without the causative agent being known. " 01/01/1985 - "Eight cases of meningoradiculitis (Garin-Bujadoux-Bannwarth's syndrome) are presented; the first case followed an "unidentified insect" bite and erythema chronicum migrans, whereas the second and third cases were not preceded by any documented insect bite or erythema; they occurred during summer in 1984 and 1985 and were characterized by cranial or radicular neuritis, lymphocytic meningitis, positive serology by immunofluorescence against Borrelia Burgdorferi and a good response to Penicillin (20 000 000 U during 14 days I.V.). "
3.	EnzymesIBA 10/01/1988 - "We used an antibody-capture enzyme immunoassay (EIA) to evaluate the early antibody responses to Borrelia burgdorferi in paired sera from 30 patients with erythema chronicum migrans. " 01/01/1985 - "Serologic studies of erythema chronicum migrans Afzelius and acrodermatitis chronica atrophicans with indirect immunofluorescence and enzyme-linked immunosorbent assays." 09/01/1991 - "Often, for families and physicians, the clinical dilemma is whether fatigue, arthritis/arthralgias, a positive enzyme-linked immunosorbent assay (ELISA), and tick exposure, but no evidence of erythema chronicum migrans, are sufficient to diagnose and treat Lyme disease. " 01/01/1986 - "Erythema chronicum migrans in Sweden: clinical manifestations and antibodies to Ixodes ricinus spirochete measured by indirect immunofluorescence and enzyme-linked immunosorbent assay." 01/01/1985 - "To determine whether antibodies to Borrelia spirochetes were present, sera from 88 patients with uncomplicated erythema chronicum migrans Afzelius (ECMA), from 9 patients with ECMA-related extracutaneous complications and from 26 patients with acrodermatitis chronica atrophicans (ACA) were submitted to an enzyme-linked immunosorbent assay (ELISA) and an indirect immunofluorescence (IF) assay. "
4.	AntigensIBA 01/01/1981 - "Serological study with rickettsial antigens in erythema chronicum migrans." 10/01/2000 - "To determine whether antigen-presenting Langerhans cells (LCs), which reportedly show signs of injury in erythema chronicum migrans (ECM), the early stage of disease, are altered in ACA. " 04/01/1990 - "The diagnosis was confirmed serologically by the finding of increased levels of antiborrelial antibodies assessed by the ELISA method, using antigen from Borrelia recurrentis, in a total of 87% patients with erythema chronicum migrans and in all patients with lymphadenosis benigna cutis. " 01/01/1981 - "21 sera of 13 patients with erythema chronicum migrans (ECM) and related diseases were examined for the presence of antibodies against 14 rickettsial antigens by using 3 serological techniques in 2 laboratories. " 08/01/1995 - "One hundred patients, aged 6-15 years and presented to El-Shatby University Children's Hospital with chronic/recurrent arthritis and skin lesions suggestive of erythema chronicum migrans (ECM), were investigated for presence of IgG antibodies against Borrelia burgdorferi flagellum antigen ELISA test. "
5.	ImmunosorbentsIBA 01/01/1985 - "Serologic studies of erythema chronicum migrans Afzelius and acrodermatitis chronica atrophicans with indirect immunofluorescence and enzyme-linked immunosorbent assays." 09/01/1991 - "Often, for families and physicians, the clinical dilemma is whether fatigue, arthritis/arthralgias, a positive enzyme-linked immunosorbent assay (ELISA), and tick exposure, but no evidence of erythema chronicum migrans, are sufficient to diagnose and treat Lyme disease. " 01/01/1986 - "Erythema chronicum migrans in Sweden: clinical manifestations and antibodies to Ixodes ricinus spirochete measured by indirect immunofluorescence and enzyme-linked immunosorbent assay." 01/01/1985 - "To determine whether antibodies to Borrelia spirochetes were present, sera from 88 patients with uncomplicated erythema chronicum migrans Afzelius (ECMA), from 9 patients with ECMA-related extracutaneous complications and from 26 patients with acrodermatitis chronica atrophicans (ACA) were submitted to an enzyme-linked immunosorbent assay (ELISA) and an indirect immunofluorescence (IF) assay. "
6.	Adrenal Cortex Hormones (Corticosteroids)IBA 04/04/1985 - "As compared with nonresponders, penicillin-responsive patients in both studies were more likely to have previously received antibiotics for erythema chronicum migrans (P less than 0.02) and less likely to have been given intraarticular corticosteroids during or at the conclusion of parenteral therapy (P less than 0.1). "
7.	AntibodiesIBA 01/01/1986 - "26 Swedish patients with erythema chronicum migrans (ECM) were studied regarding associated clinical symptoms and antibodies to Swedish Ixodes ricinus spirochete. " 04/15/1983 - "Antibodies against Borrelia duttoni using indirect immunofluorescence could be demonstrated in 6 patients with erythema chronicum migrans and in 8 persons with tick-borne meningopolyneuritis. " 07/01/1994 - "For two children with facial palsy following erythema chronicum migrans, neither IFA nor capture ELISA detected specific intrathecal antibodies and PCR was also negative. " 03/01/1994 - "Early diagnosis of Borrelia burgdorferi infection, hampered by the absence of detectable antibodies in most patients with erythema chronicum migrans is important to prevent late-stage neurologic, rheumatologic, and skin disorders. " 05/01/1996 - "In two children the clinical manifestations consisting of erythema chronicum migrans and facial palsy, the presence of mononuclear CSF pleocytosis, and the presence of Bb specific antibodies in serum supported the diagnosis of neuroborreliosis, despite the absence of intrathecal specific antibodies. "
8.	Immunoglobulin G (IgG)IBA 01/20/1984 - "Of 39 patients with erythema chronicum migrans mostly treated with antibiotics 50% had increased IgG antibody titre (1:64 to 1:1024) against the isolated spirochete, while among 51 untreated patients with tick-transmitted meningopolyneuritis 90% had increased IgG antibody titres. " 02/01/1987 - "In order to prove the etiology of manifestations of erythema chronicum migrans disease of the nervous system like meningopolyneuritis Garin-Bujadoux-Bannwarth or progressive borrelia encephalomyelitis we used the ELISA to measure specific IgG antibodies against Ixodes ricinus borrelia per microgram IgG in serum and cerebrospinal fluid. " 01/06/1984 - "Using indirect immunofluorescence, IgG antibodies against the recently detected Ixodes-ricinus-spirochaeta, which causes erythema chronicum migrans could be demonstrated in all 21 persons with acrodermatitis chronica atrophicans. " 01/01/2017 - " der Leitlinie ist es, Empfehlungen zur Absicherung der klinischen Diagnosen, Empfehlungen zur stadiengerechten Labordiagnostik (serologischer Nachweis von IgM- und IgG-Borrelienantikörpern mit dem 2-Stufenverfahren ELISA/Immunoblot sowie der sinnvolle Einsatz molekulardiagnostischer und kultureller Verfahren) und Empfehlungen zur Therapie der lokalisierten Frühmanifestationen (Erythema migrans, Erythema chronicum migrans und Borrelienlymphozytom), zur Therapie der disseminierten Frühmanifestationen (Multiple Erythemata migrantia und/oder grippeartige Symptomatik nach Zeckenstich) und zur Therapie der Spätmanifestationen (Acrodermatitis chronica atrophicans mit und ohne neurologische Manifestationen) zu geben. " 08/01/1995 - "One hundred patients, aged 6-15 years and presented to El-Shatby University Children's Hospital with chronic/recurrent arthritis and skin lesions suggestive of erythema chronicum migrans (ECM), were investigated for presence of IgG antibodies against Borrelia burgdorferi flagellum antigen ELISA test. "
9.	Tetracycline (Achromycin)FDA LinkGeneric 04/01/1987 - "All 5 patients had been treated for erythema chronicum migrans with a course of tetracycline that met or exceeded current recommendations. " 07/01/1980 - "Erythema chronicum migrans and its associated symptoms resolved faster in patients given penicillin or tetracycline (median duration, 4 and 2 days, respectively) than in untreated patients (10 days; P less than 0.001 and P = 0.005, respectively). " 07/01/1983 - "Erythema chronicum migrans and its associated symptoms resolved faster in penicillin- or tetracycline-treated patients than in those given erythromycin (mean duration, 5.4 and 5.7 versus 9.2 days, F = 3.38, p less than 0.05). " 09/01/1986 - "Although the preferred antibiotic for treating erythema chronicum migrans of Lyme disease has not been conclusively established, tetracycline and penicillin proved effective. " 06/01/1983 - "Physicians in areas where Lyme disease has traditionally not been recognized should be alerted to its characteristic rash (erythema chronicum migrans), tick vector (Ixodes species), possible severe manifestations (neurologic, arthritic, and cardiac), and response to appropriate antibiotic therapy (penicillin or tetracycline)."
10.	Immunoglobulin M (IgM)IBA 08/01/1987 - "Levels of IgM-RF greater than 3 SD above the mean of normal subjects were found in 2 of 15 patients with erythema chronicum migrans, 7 of 10 with neurologic abnormalities, and 7 of 25 with Lyme arthritis (p = 0.038). " 01/01/2017 - " der Leitlinie ist es, Empfehlungen zur Absicherung der klinischen Diagnosen, Empfehlungen zur stadiengerechten Labordiagnostik (serologischer Nachweis von IgM- und IgG-Borrelienantikörpern mit dem 2-Stufenverfahren ELISA/Immunoblot sowie der sinnvolle Einsatz molekulardiagnostischer und kultureller Verfahren) und Empfehlungen zur Therapie der lokalisierten Frühmanifestationen (Erythema migrans, Erythema chronicum migrans und Borrelienlymphozytom), zur Therapie der disseminierten Frühmanifestationen (Multiple Erythemata migrantia und/oder grippeartige Symptomatik nach Zeckenstich) und zur Therapie der Spätmanifestationen (Acrodermatitis chronica atrophicans mit und ohne neurologische Manifestationen) zu geben. " 07/01/1980 - "Heart involvement was usually preceded by erythema chronicum migrans and sometimes accompanied by meningoencephalitis, facial palsy, arthritis, elevated serum IgM levels, or cryoglobulins containing IgM. " 01/06/1984 - "Fourfold decreases could be found only once for each IgG and IgM antibodies.l Serology indicates that acrodermatitis chronica atrophicans as well as erythema chronicum migrans is caused by the Ixodes-ricinus-spirocheta." 01/01/2017 - "Objectives of this guideline are recommendations for confirming a clinical diagnosis, recommendations for a stage-related laboratory diagnosis (serological detection of IgM and IgG Borrelia antibodies using the 2-tiered ELISA/immunoblot process, sensible use of molecular diagnostic and culture procedures) and recommendations for the treatment of the localised, early-stage infection (erythema migrans, erythema chronicum migrans, and borrelial lymphocytoma), the disseminated early-stage infection (multiple erythemata migrantia, flu-like symptoms) and treatment of the late-stage infection (acrodermatitis chronica atrophicans with and without neurological manifestations). "

Therapies and Procedures

1.	Retreatment 01/01/1988 - "Between June 1981 and July 1987 the efficacy of antibiotic treatment of 215 patients with erythema chronicum migrans of Lyme disease was evaluated in terms of the necessity for retreatment and the prevention of the late manifestations of Lyme disease. " 09/01/1986 - "The efficacy of antibiotic treatment of 117 patients with erythema chronicum migrans of Lyme disease was evaluated in terms of the necessity for retreatment and the prevention of the late manifestations of Lyme disease. "
2.	Therapeutics 08/07/1953 - "[Incidence, clinical picture, therapy and etiology of erythema chronicum migrans]." 01/01/1989 - "Antibiotic therapy given during erythema chronicum migrans is often protective with regard to late joint manifestations. " 07/01/1958 - "Part B: penicillin therapy; lymphadenosis benigna cutis & erythema chronicum migrans, connections & etiology; summary]." 10/01/2011 - "Photoallergic erythroderma due to doxycycline therapy of erythema chronicum migrans." 11/01/1987 - "To determine the clinical evolution of Lyme arthritis, 55 patients who did not receive antibiotic therapy for erythema chronicum migrans were followed longitudinally for a mean duration of 6 years. "