Lyme Disease: Stages, Recognizing Erythema Migrans and Clear Antibiotic Schemes

What is Lyme disease?

Lyme disease (more precisely Lyme borreliosis) is a bacterial infection transmitted by ticks. It is the most common tick-borne disease in Germany. It is caused by bacteria of the Borrelia burgdorferi group.

The bacteria are transmitted through the bite of an infected tick, and usually only once the tick has been feeding for a longer time, often many hours. That is why quick, correct removal of the tick clearly lowers the risk. Reassuringly: not every tick is infected, and by no means every bite from an infected tick leads to Lyme disease. Most tick bites have no consequences.

The stages of Lyme disease

Untreated Lyme disease can run in phases that may overlap in time. Not everyone goes through all phases, and with treatment the course is usually stopped early.

• Early, localized phase (days to weeks): erythema migrans, a slowly spreading red patch around the bite site, sometimes with flu-like symptoms.
• Early, disseminated phase (weeks to months): several skin patches, involvement of the nerves (neuroborreliosis, for example facial palsy or burning nerve pain), rarely involvement of the heart.
• Late phase (months to years): above all joint inflammation (Lyme arthritis), often in the knee, with swelling and pain. More on this: Joint pain. More rarely a particular skin change.

The earlier treatment is given, the less often later forms occur.

Recognizing erythema migrans

Erythema migrans (the "bull's-eye" rash) is the most common and most important sign of early Lyme disease. It appears a few days to a few weeks after a tick bite and typically looks like this:

• a red patch or ring that slowly spreads outwards, often larger than 5 centimetres.
• sometimes with a paler centre, so that a ring pattern forms (the well-known "target"), but often also uniformly red.
• usually not painful and not strongly itchy.

Important: the classic target is only one of several forms. Many cases of erythema migrans are simply uniformly red, without a ring. A small, itchy redness that appears immediately after the bite, on the other hand, is usually just a harmless reaction to the bite and not erythema migrans. More on skin redness: Rash.

Diagnosis: when a test makes sense

For the diagnosis, the clinical picture matters:

• Erythema migrans is a visual diagnosis. It is recognised by its typical appearance and treated immediately. A blood test is not needed here and is often even negative at first.
• For other forms, for example nerve or joint involvement, blood tests that look for antibodies help, usually in two steps (a screening test and a confirmation test). If neuroborreliosis is suspected, the cerebrospinal fluid is examined as well.

Important to know: a positive antibody test only shows that your body once had contact with Borrelia, not necessarily an active disease. Many people have antibodies without being ill. That is why unclear, non-specific symptoms are not treated as Lyme disease on the basis of a blood test alone. Unrecognised special tests are not advisable.

Treatment: clear antibiotic schemes

Lyme disease is treated with antibiotics. Which medicine and for how long depends on the form. An overview of the typical schemes:

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Doxycycline is the first choice in most cases. Erythema migrans is treated immediately, without waiting for a blood test. And as with every antibiotic treatment, the prescribed duration should be completed fully, even when things are already better. A practical note on doxycycline: it makes the skin more sensitive to the sun, and dairy products or preparations with calcium or iron should not be taken at the exact same time, as they reduce absorption. More on the active substance: Doxycycline.

What about chronic Lyme disease?

Hardly any topic causes as much uncertainty as so-called chronic Lyme disease. Here are the most important facts, calmly and according to current knowledge:

• Lyme disease is, as a rule, curable with the right antibiotics. The vast majority of people recover completely.
• There is no scientific evidence that, after adequate antibiotic treatment, living Borrelia permanently cause non-specific symptoms such as tiredness, pain or concentration problems.
• A small proportion of those treated still have symptoms for a while after the therapy (sometimes called post-treatment Lyme disease syndrome). These symptoms are real and distressing. But studies show that prolonged or repeated antibiotic treatment does not help with them and can even be harmful.

Caution is needed with offers of months-long antibiotic courses or unrecognised tests that are supposed to "prove" chronic Lyme disease. Neither is supported by studies, and both can do more harm than good. If symptoms persist after correct treatment, it is worth looking for other causes together with your doctor, instead of assuming a persistent infection.

When to see a doctor

See a doctor if, after time outdoors or a tick bite, you notice a spreading redness (erythema migrans), because it should be treated quickly with antibiotics. You should also be seen with facial palsy, burning nerve pain or a swollen, painful joint.

Stay on top of the antibiotic treatment with brite

Whether 10 days for erythema migrans or 28 days for joint involvement: brite helps you take the course consistently and keep the overview.

• Intake reminders: for every dose, until the prescribed course is fully finished.
• Interaction check: important with doxycycline and your other medicines.
• Symptom diary: record how you are doing, helpful for follow-up.
• Medication plan: all medicines in one place, ready for the next appointment.

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