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The look of Lyme: How your dermatologist can help identify this common disease

According to the CDC, roughly 300,000 Americans are diagnosed with Lyme Disease each year. Of those 300,000 cases, 96% are reported in just 14 states.

We often think about bites and rashes with Lyme Disease. However, its impact is more than skin-deep. Lyme disease affects the central nervous system, musculoskeletal system, and cardiovascular system. Rapidly seeking treatment when the visual cues of Lyme appear is key to positive outcomes. Most patients who address the disease early on have a good prognosis following a three-week course of antibiotics.

Bullseye rash

A bullseye rash is the hallmark of Lyme Disease. It's large (typically greater than 2” in diameter), flat, and rarely itches. Generally, the rash will form within 72 hours of a tick bite but it can take up to 30 days. When you see this rash, it is a sign of spreading bacterial infection. It will expand and resolve without treatment; however, that does not mean the infection has resolved gone away.

Ick! You may have missed your tick.

You can develop Lyme without this classic rash. Roughly 30% of patients with Lyme report that they did not have or do not remember having a rash. Nearly 50% of all patients don't recall being bitten by a tick in the first place. That’s understandable. Ticks are tiny, about the size of a poppyseed, and can embed in your scalp, between toes, and inside skin folds. Ticks also thrive in warm, moist areas with high blood flow.

Multiple, smaller bullseye-like rashes

About a month after the initial infection, Lyme Disease can cause several smaller bullseye rashes to form. These look similar to the classic rash and signify the bacteria have spread throughout the body's tissues.

Unexplained bruises

The bullseye rash from the initial tick bite is frequently mistaken for an injury. Often, it looks purple, especially on darker skin. Additionally, Lyme Disease can cause irregular bruising in the later stages of the illness.


Lyme Disease can also cause skin eruptions that mimic psoriasis. These patches are scaly and typically red or pink, but can occasionally be brown or yellow. Psoriasis will eventually thicken and usually presents on the elbows, scalp, and lower back. Paraporisasis can appear anywhere and will not thicken. A dermatologist can help you determine the difference.

Getting help

If you develop any of these symptoms, t’s time to see a physician. This is especially true if you know you’ve been bitten by a tick or spend a lot of time in the woods or locations with high grass. Be sure to let your doctor know if your lifestyle leaves you prone to tick-borne illness or if you have recently been bitten as you conduct your online visit. Our online dermatologists are available 24/7/365 to help you get answers quickly and without leaving your home.