Erythema migrans - causes and treatment

Erythema chronicum migrans

Erythema migrans (also called Erythema chronicum migrans) is the characteristic key symptom of Lyme disease in the first stage. An erythema is an inflammatory reddening and an erythema migrans is a so-called “reddening”. This skin appearance does not necessarily have to appear after a tick bite. Days to weeks after the sting, reddening of the skin may form around the puncture site, which slowly spreads in a circle.

This erythema migrans can occur not only at the puncture site, but also on other skin areas. That also makes it a "blush". This is triggered by the borrelia, which “wander” through the skin. The skin reaction can sometimes be enormous, but it can also heal spontaneously without symptoms.

The blush

The blush, the erythema migrans, develops about ten to 30 days after infection. The slight redness, which in some cases forms directly around the sting and is usually associated with massive itching, usually heals again after about ten days and has nothing to do with the blush. This only develops afterwards. It has an oval to circular rim and, starting from the stitch, spreads outward and can grow to a diameter of approximately 60 centimeters.

As the process progresses, the erythema in the middle fades away, which creates a ring-like structure. Erythema migrans only occurs if the tick has also been infected with Lyme disease pathogens. However, as already mentioned, this can also be avoided despite infection.

The skin reaction usually disappears on its own after about ten weeks without treatment. However, the Lyme disease, which is characterized by three stages, can also be accompanied by erythema migrans the entire time. In the second stage, for example, it can show up as a rash in several places that are independent of the bite site. This is the case if the pathogen has already spread through the bloodstream. However, it is also possible that the erythema, as described above, is not discovered at all or heals again early. However, this is not a sign that there is no Lyme disease or that it has healed.

Together with the appearance of erythema migrans, a so-called lymphadenosis cutis benigna (synonym: Borrelia lymphocytoma; nodular, blue-red swelling of the skin areas) is possible. This mainly affects the earlobes, the mamillae (nipples) or the scrotal region (area of ​​the testicles). This disease can also be associated with viral infections. The blush often shows peculiarities in children. It occurs mainly in the head and neck area and on the face with uncharacteristic redness. Furthermore, it is possible that the erythema migrans "scatters" and thus shows up on different parts of the body.

Additional symptoms

In addition to reddening of the skin, additional symptoms are possible in the early stages of Lyme disease. These are flu-like symptoms such as body aches, headaches, general weakness, muscle aches, swelling of the lymph nodes, nausea, conjunctivitis and fever.

Lyme disease

Borrelia can trigger very different infectious diseases. For example, relapse fever is also transmitted by Borrelia. However, when we speak of Lyme disease, it means Lyme disease. This is the most common. The borrelia responsible for the disease are transmitted by a tick bite. The symptoms differ from person to person. What definitely raises the suspicion of Lyme disease is erythema migrans.

The visit to the doctor

After a tick bite, the spot should be observed. If erythema migrans occurs, a visit to the doctor is a must. But also a persistent reddening of the skin without being able to remember a tick bite should be clarified. Rapid tests are not recommended. Therefore, an examination at the doctor is absolutely necessary. If Lyme disease is suspected, an antibiotic is prescribed immediately. A blood test is not necessary in the early stages because no pathogens can be detected at this point in time.

Differential diagnosis

The following diseases are distinguished from the erythema migrans by differential diagnosis. Other insect bites can also cause a skin reaction that is reminiscent of a blush. An important differential diagnosis is tinea corporis. This is a fungal disease that shows up by scaling and itching.

Drug eruptions must also be distinguished from erythema migrans. These are usually acute and can therefore be easily distinguished from the skin symptoms associated with Lyme disease in the context of a detailed medical history. Furthermore, the erysipelas must be included in the differential diagnosis. Erysipelas, also known as erysipelas, is an acute skin infection caused by penetrated streptococci. The main symptoms are a shiny, painful, fiery red erythema, accompanied by a general feeling of illness, fever and chills.

What should also be excluded is the erythema annulare centrifugum. This acute skin disorder with an unclear cause appears ring-shaped, red, with emphasis on the edges and slightly flaky. If the face is affected, rubella must be excluded. The causative agent here is the parvovirus B19. School children are mostly affected by this infectious disease, also called the fifth disease. The skin appearance that occurs is called erythema infectiosum.

Protection from ticks

In order not to get erythema migrans at all, adequate tick protection is necessary. Vaccination protects against getting TBE (early summer meningoencephalitis), but not against Lyme disease. It is best not to get stung at all. Please note the following:

If you are outside, you should wear long trousers and long-sleeved tops that are closed at the cuffs. The socks are best pulled over the legs of the pants. The head is covered with a hat. The risk is greater in tall grass, in hedges and in the undergrowth, as ticks like to be there. Accordingly, these areas are best avoided. Rubber boots make it difficult for ticks to access the skin. Light-colored clothing should be preferred, since the ticks can be recognized more quickly here. The skin that is not covered must be rubbed with a suitable insect repellent. The pharmacy has a wide variety of products.

After each excursion into nature, it is best to search the whole body for ticks, including the head and neck. If a tick has bitten despite all the precautions, it will be removed as soon as possible. The pathogen takes about twelve hours (details vary) to penetrate the human organism.

Erythema migrans can of course also develop in Lyme disease if it is transmitted by insects other than the tick. Lice, mosquitoes and brakes come into question here, but they are rarely the transmitters of infection.
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Natural countermeasures

Those who prefer a natural defense can use and try the following methods. However, everyone reacts differently to natural preparations. Aromatherapy recommends essential oils such as rosemary (please do not use for high blood pressure), tea tree, lemon balm, juniper, grapefruit, lavender, clove and myrrh. Put together a mixture for yourself.

Use a good, cold-pressed carrier oil, such as almond oil, and high-quality essential oils. 20 milliliters of carrier oil are mixed with four drops of essential oil. Use it to rub the pulse, neck and neck. Try this first with a drop in the crook of your arm. If you are allergic, this type of prevention is not for you.

You can also fill the finished oil into a so-called roll-on bottle. This makes it easy to apply on the go. These small bottles are available in natural cosmetic stores or online. Another option is to rub it with coconut oil. This can be used all over the body. Incidentally, this also protects dogs from annoying tick bites or reduces the attacks of these bloodsuckers.

What can also help is black cumin oil. The ticks don't like the smell at all. Rub yourself with it, you can also take a high-quality black cumin oil (available in capsule form). This increases the effect. By the way, black cumin oil, used orally, is also a good way to protect yourself against allergies.

Another smell that ticks don't like at all is garlic. A real hearty meal with lots of garlic before the walk also helps prevent it.

More tips

As already mentioned, the tick should be pulled as quickly as possible so that no erythema migrans develops at all. Then the homeopathic remedy Ledum is required, both internally and externally. A few globules are mixed with a little boiled water and the puncture site is dabbed several times a day. If the blush has already formed, taking and using Ledum externally are still worth trying. (sw)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Susanne Waschke, Dr. med. Andreas Schilling


  • Heidelore Hofmann et al .: Guideline of the German Dermatological Society: Cutaneous Lyme Disease, German Dermatological Society (DDG), (accessed July 10, 2019), AWMF
  • Hildegard Gabel, Hans-Peter Gabel: Tick borreliosis, ZAG Verlag, 2015
  • M.Gaubitz et al .: Recommendations for the therapy of Lyme disease, German Society for Rheumatology e. V. (DGRh), (accessed 10.07.2019), DGRh
  • Sebastian Rauer et al .: Neuroborreliosis - Guidelines for Diagnostics and Therapy in Neurology, German Society for Neurology, (accessed July 10, 2019), AWMF
  • Robert Koch Institute: Lyme Disease, (accessed July 10, 2019), RKI

ICD codes for this disease: A69.2ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.

Video: Lyme Disease - Plain and Simple Part 1 (October 2021).