Lyme disease: Epidemiology and Cutaneous Clinical Presentations
Lyme disease is the tick-borne disease with highest incidence in Europe and North America. Climate change seems to be modifying its geographic distribution, with spreading of endemic areas. Simultaneously, an increasingly number of cases is being diagnosed as the knowledge of its clinical presentations is growing.
Most individuals come to the Dermatology visit after a tick bite or with lesions diagnosed as erythema migrans. Other cutaneous clinical presentations, like borrelial lymphocytoma and acrodermatitis chronica atrophicans, are rare. In the presence of a tick bite, doctors should remove it from the body surface and perform clinical vigilance for a period of at least 30 days. Prophylactic antibiotic therapy is not recommended in Europe. Preventive measures as the use of protective clothing in endemic areas should be promoted.
The diagnosis of erythema migrans is clinical and first line antibiotic therapy is doxyxycline, which has a high success rate. Serologic tests are essential for the diagnosis of less common cutaneous presentations. Histopathologic examination of skin biopsies also supports the diagnosis. Prompt treatment allows faster and greater improvement, with less irreversible lesions.
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