DOCSLIB.ORG

Research Article Bull's-Eye and Nontarget Skin Lesions of Lyme

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Research Article Bull's-Eye and Nontarget Skin Lesions of Lyme Hindawi Publishing Corporation Dermatology Research and Practice Volume 2012, Article ID 451727, 6 pages doi:10.1155/2012/451727 Research Article Bull’s-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans John N. Aucott,1 Lauren A. Crowder,2 Victoria Yedlin,2 and Kathleen B. Kortte3 1 Department of Medicine, Johns Hopkins University, 10755 Falls Road, Suite 200, Lutherville, MD 21093, USA 2 Division of Clinical Research, Lyme Disease Research Foundation, 10755 Falls Road, Suite 200, Lutherville, MD 21093, USA 3 Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Phipps 174, 600 North Wolfe Street, Baltimore, MD 21287, USA Correspondence should be addressed to John N. Aucott, [email protected] Received 27 June 2012; Accepted 15 August 2012 Academic Editor: Jag Bhawan Copyright © 2012 John N. Aucott et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Lyme disease is an emerging worldwide infectious disease with major foci of endemicity in North America and regions of temperate Eurasia. The erythema migrans rash associated with early infection is found in approximately 80% of patients and can have a range of appearances including the classic target bull’s-eye lesion and nontarget appearing lesions. Methods.Asurvey was designed to assess the ability of the general public to distinguish various appearances of erythema migrans from non-Lyme rashes. Participants were solicited from individuals who visited an educational website about Lyme disease. Results. Of 3,104 people who accessed a rash identification survey, 72.7% of participants correctly identified the classic target erythema migrans commonly associated with Lyme disease. A mean of 20.5% of participants was able to correctly identify the four nonclassic erythema migrans. 24.2% of participants incorrectly identified a tick bite reaction in the skin as erythema migrans. Conclusions. Participants were most familiar with the classic target erythema migrans of Lyme disease but were unlikely to correctly identify the nonclassic erythema migrans. These results identify an opportunity for educational intervention to improve early recognition of Lyme disease and to increase the patient’s appropriate use of medical services for early Lyme disease diagnosis. 1. Introduction least 5 cm or greater in size [7, 8]. The localized rash appears three to thirty days after an infected tick bite and disappears Lyme disease (LD), which is caused by the tick-borne naturally if left untreated over days to weeks. Though it has spirochete Borrelia burgdorferi, is an important cause of been documented that EM can have various manifestations infection in endemic regions of North America and Eurasia [9], the classic “target” shaped EM is best known in the and has a strong seasonality with the majority of the cases literature and most common on public health information occurring during the months of May through August. In and handouts [10]. In reality, a classic target EM manifests North America, over 90% of cases are reported from the East in only approximately 20% of patients with EM, with the Coast of the United States, although significant numbers of majority of EM lacking the central clearing or ring-within- cases are also reported from the upper Midwest of the United a-ring pattern [7, 9]. States and certain areas of Canada and the West Coast. In LD is an emerging infectious disease in many areas of Eurasia, cases have been reported from temperate regions the world including North America and temperate Eurasia. such as Germany [1, 2], Norway [3], Finland [4], and the LD is the most commonly reported vector borne disease United Kingdom [5]. Erythema migrans (EM) is the most in the US and the 3rd most common reportable infectious common manifestation of LD, with at least 80% of infected disease in the Northeast and Mid-Atlantic United States [11]. persons developing a variation of this skin lesion in the first As such, LD is a public health concern for many people, weeks of infection [6]. EM is characterized by a round red especially in periurban residential areas of the northeast and patch gradually expanding over time, typically reaching at Mid-Atlantic. However, a review of the published literature 2 Dermatology Research and Practice on LD has documented both under- and overdiagnosis of group included a small insect bite reaction, an immediate the EM rash of LD [12, 13]. Additionally, a study showed skin reaction with tick still attached, as well as rashes that up to 72% of physicians surveyed are not able to from poison ivy exposure, shingles, cellulitis, hand-foot- correctly identify the EM accompanying LD [14] when mouth disease, and Staphylococcus aureus infection (Figure 1, shown both EM as well as other rashes common in an numbers 6–12). ambulatory population. Early diagnosis of LD is dependent on patients seeking evaluation, which depends on patients’ 2.2. Administration. Access to the survey was available ex- ability to recognize rashes or skin lesions that have a high clusively through the Lyme Disease Research Foundation probability of being EM. However, no literature to date website, which has been accessible to the public since 2007. has been published on patients’ ability to recognize EM. Google search terms that directed users to the site include The current study is aimed at determining the ability of “Lyme disease,” “Lyme disease foundation,” “Lyme disease the general public accessing an LD website to accurately symptoms,” “symptoms of Lyme disease,” “what is Lyme identify the EM rash. It is presumed that individuals who disease,” “signs and symptoms of Lyme disease,” “treatment conclude that a rash is not EM will be less likely to pursue for Lyme disease,” and “signs of Lyme disease.” The website medical services for evaluation of LD. By discovering how receives, on average, 10,000 hits per month, with peaks accurately the public is in identifying EM lesions, we can during the spring and summer seasons. Advertisement for then predict which lesions would lead the general public the rash survey was accomplished through word-of-mouth, to pursue health care services. Additionally, by determining the Foundation’s Twitter account, and a quarterly newsletter the identification pattern, educational interventions for the sent to those who signed up to receive it through the public can be targeted to increase knowledge and, therefore, Foundation website. Once on the website, participants were hypothetically increase pursuance of appropriate clinical directed via hyperlink to the survey, which was administered services. The hypothesis tested was that respondents will be via http://www.SurveyMonkey.com/. The survey includes able to correctly recognize the classic target EM, but not five rashes from known EM cases of early LD and seven nonclassic EM. rashes from common skin conditions not due to LD. Participants were asked to respond to one of the following three questions for each rash: “I am sure this is a Lyme disease 2. Methods rash,” “I am sure this is not a Lyme disease rash,” or “I do not know whether or not this is a Lyme rash.” After completion 2.1. Instrument Development. In order to develop the LD of the survey, regardless of performance, each participant was rash survey, a review of the literature was conducted for redirected to a detailed explanation of the causes of each rash. articles on EM and the reports of misidentification of The survey was conducted between August 1, 2011 and EM in the diagnosis of LD. In addition, expert opinions January 31, 2012. SAS (Statistical Analysis System Institute, were solicited from published authorities in the field when Cary, NC) and SPSS (IBM Corporation, Armonk, NY) were choosing examples of both classic target and nonclassic EM used for data analysis. This study was approved by the Johns [15]. Both EMs and non-Lyme lesions were included in the Hopkins Institutional Review Board number NA 00071093. survey. A determination could then be made of which EMs would most likely alert a potential surveyor to a possibility of LD and which non-Lyme lesions might lead to the incorrect 3. Results and Discussion self-diagnosis of LD. EM photographs were selected based on professional 3.1. Results. Over the six-month study period between experience of one of the authors (JA) in order to represent August 1, 2011 and January 31, 2012, there were 42,068 the widest variety of EM appearances that were identified visits or page clicks to the Lyme Disease Research Foundation from a review of the current literature. Presentation of website (Figure 2). Of the visitors to the website, 3,902 EM has been reported most commonly as a homogenous people were recruited by the rash survey and were redirected red lesion, with central clearing or a target appearance to the http://www.SurveyMonkey.com/ website where the occurring less frequently in a US population [9, 15–21]. survey was carried out. Of those visitors, 3,898 participated Also commonly reported are secondary disseminated lesions in the survey by answering at least one question, with 3,104 [16, 19–23], occurring in 8–25% of cases [7, 9, 15, 17]. answering all questions. Figure 3 shows the accuracy of the Less common, but consistently reported manifestations of 3,104 respondents and shows the percentage of incorrect, EM include vesiculopustular
Load more

Recommended publications
  • Inflammatory Or Infectious Hair Disease? a Case of Scalp Eschar and Neck Lymph Adenopathy After a Tick Bite
    Case Report ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2021.35.005688 Adherent Serous Crust of the Scalp: Inflammatory or Infectious Hair Disease? A Case of Scalp Eschar and Neck Lymph Adenopathy after a Tick Bite Starace M1, Vezzoni R*2, Alessandrini A1 and Piraccini BM1 1Dermatology - IRCCS, Policlinico Sant’Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Italy 2Dermatology Clinic, Maggiore Hospital, University of Trieste, Italy *Corresponding author: Roberta Vezzoni, Dermatology Clinic, Maggiore Hospital, University of Trieste, Italy ARTICLE INFO ABSTRACT Received: Published: April 17, 2021 The appearance of a crust initially suggests inflammatory scalp diseases, although infectious diseases such as impetigo or insect bites should also be considered among April 27, 2021 the differential diagnoses. We report a case of 40-year-old woman presentedB. Burgdorferi to our, Citation: Starace M, Vezzoni R, Hair Disease Outpatient Service with an adherent serous crust on the scalp and lymphadenopathy of the neck. Serological tests confirmed the aetiology of while rickettsia infection was excluded. Lyme borreliosis can mimic rickettsia infection Alessandrini A, Piraccini BM. Adherent and may present as scalp eschar and neck lymphadenopathy after a tick bite (SENLAT). Serous Crust of the Scalp: Inflammatory Appropriate tests should be included in the diagnostic workup of patients with necrotic or Infectious Hair Disease? A Case of Scalp scalpKeywords: eschar in order to promptly set
    [Show full text]
  • Erythema Marginatum
    Figurative Erythemas Michelle Goedken, DO Affiliated Dermatology Scottsdale, AZ Figurative Erythemas • Erythema annulare centrifugum • Erythema marginatum • Erythema migrans • Erythema gyratum repens • Erythema multiforme Erythemas • Erythemas represent a change in the color of the skin that is due to the dilation of blood vessels, especially those in the papillary and reticular dermis • The color is blanchable and most last for days to months • Figurative erythemas have an annular, arciform or polycyclic appearance ERYTHEMA ANNULARE CENTRIFUGUM ERYTHEMA ANNULARE CENTRIFUGUM • Pathogenesis: EAC represents a reaction pattern or hypersensitivity to one of many antigens – IL-2 and TNF-alpha may have a role – Most patients do not have an underlying disease identified ERYTHEMA ANNULARE CENTRIFUGUM • Associated with: – Infection » Dermatophytes and other fungi (Candida and Penicillium in blue cheese) » Viruses: poxvirus, EBV, VZV, HIV » Parasites and ectoparasites – Drugs: diuretics, antimalarials, gold, NSAIDs, finasteride, amitriptyline, etizolam, Ustekinumab (2012) ERYTHEMA ANNULARE CENTRIFUGUM – Foods – Autoimmune endocrinopathies – Neoplasms (lymphomas and leukemias) – Pregnancy – Hypereosinophilic syndrome – Lupus (2014) ERYTHEMA ANNULARE CENTRIFUGUM http://www.dermaamin.com Rongioletti, F., Fausti, V., & Parodi, A ERYTHEMA ANNULARE CENTRIFUGUM • 2 major forms: – Superficial: classic trailing scale, may have associated pruritus – Deep: infiltrated borders, usually no scale, edges are elevated, usually not pruritic ERYTHEMA ANNULARE CENTRIFUGUM
    [Show full text]
  • Belly Button…
    KNOWLEDGE TO PRACTICE DES CONNAISSANCES À LA PRATIQUE Diagnostic Challenge A “ticklish” belly button… Tahira Daya*; Conor McKaigney, MD† CASE HISTORY A 42-year-old woman presented to the emergency department (ED) with acute onset periumbilical pain and erythema, which started that morning. She felt nauseated but denied vomiting. Her bowel movements were regular and non-bloody. She did not have a fever. She had no significant prior medical history, no recent trauma, and had no previous surgeries. In the ED, she appeared uncomfortable from pain but was not in acute distress. Vital signs upon initial presentation included a heart rate of 120 beats/min, a blood pressure of 145/111 mm Hg, respiratory rate of 16 breaths/min, temperature of 36.8°C (98.2°F), and an oxygen saturation of 99% on room air. Her vital signs two hours later after a fluid challenge and analgesics had improved to a heart rate of 74 beats/min and blood pressure of 132/83 mm Hg, and the remaining vitals were the same. Her abdomen demonstrated periumbilical erythema, with a central clearing; the area was tender to Figure 1. Periumbilical rash with central clearing. palpation, and warm to touch. Images of her periumbilical region are shown in Figure 1. The rest of the abdomen was soft and non-tender, with no masses or organomegaly. An ED ultrasound was performed to assess for possible b) Cellulitis subcutaneous abscess, which was not seen. Cardiovascular and respiratory exams were unremarkable. c) Lyme disease d) Subcutaneous abscess e) Erythema multiforme QUESTION For the answer to this challenge, see next page.
    [Show full text]
  • Lyme Disease Diagnostic Support Tool
    1 / 11 For further details, click on the DIAGNOSTIC SUPPORT TOOL underlined words. Localized and disseminated stages of Lyme disease This diagnostic support tool is intended mainly for primary care clinicians. It is provided for information purposes only and should not replace the judgement of the clinician who performs the activities reserved under a statute or regulation. The recommendations in this tool were developed using a systematic process and are supported by the scientific literature and the knowledge and experience of Québec health professionals, experts and patients. For further details, go to the “Publications” section of INESSS’s website inesss.qc.ca. This tool does not deal with other tick-borne infections or with the much-debated form of Lyme disease, which is sometimes referred to as the chronic form. WHAT IS LYME DISEASE ? WHAT ARE THE DIFFERENT STAGES OF THE DISEASE? GENERAL INFORMATION • Lyme disease is an infectious disease caused by bacterial Localized stage (sometimes called the early stage): Beginning Patient with a tick genospecies of Borrelia burgdorferi, which are transmitted of the infection before dissemination of the bacteria in the • If tick is attached, refer to the procedure for removing it. to humans by black-legged ticks that are carriers. bloodstream. • Refer to the tick surveillance procedure. • Main manifestation observed: • It is a notifiable disease (MADO) • Consult the decision support tool or the Québec’s national and is on the increase in Québec. Not always present or noticed. medical protocol on post-exposure prophylaxis. • It can affect several anatomical systems at the same time. If present, usually appears • Identifying the tick and obtaining proof that it carries of Lym 3 to 30 days after infection or e d B.
    [Show full text]
  • Lyme Disease
    Volume 91 No. 7 July 2008 Lyme Disease UNDER THE JOINT VOLUME 91 NO. 7 July 2008 EDITORIAL SPONSORSHIP OF: Medicine Health The Warren Alpert Medical School of Brown University HODE SLAND Edward J. Wing, MD, Dean of Medicine R I & Biological Science PUBLICATION OF THE RHODE ISLAND MEDICAL SOCIETY Rhode Island Department of Health David R. Gifford, MD, MPH, Director Quality Partners of Rhode Island Richard W. Besdine, MD, Chief Medical Officer COMMENTARIES Rhode Island Medical Society Nick Tsiongas, MD, MPH, President 206 When Is a Somatic Disorder Psychiatric? Joseph H. Friedman, MD EDITORIAL STAFF Joseph H. Friedman, MD 207 The Awkward Birth Pangs of Bolero Editor-in-Chief Stanley M. Aronson, MD Joan M. Retsinas, PhD Managing Editor CONTRIBUTIONS Stanley M. Aronson, MD, MPH SPECIAL ISSUE: Lyme Disease Editor Emeritus Guest Editors: Jerome Larkin, MD, and Jennifer Mitty, MD, MPH EDITORIAL BOARD 208 Introduction: Lyme Disease Stanley M. Aronson, MD, MPH Jerome Larkin, MD, and Jennifer Mitty, MD, MPH Jay S. Buechner, PhD John J. Cronan, MD 209 Ticks and Tick-Related Illness James P. Crowley, MD Jerome M. Larkin, MD Edward R. Feller, MD 212 Lyme Disease In Children and Pregnant Women John P. Fulton, PhD Peter A. Hollmann, MD Jerome M. Larkin, MD Sharon L. Marable, MD, MPH 213 Musculoskeletal Manifestations of Lyme Disease Anthony E. Mega, MD Imad Bitar, MD, and Edward V. Lally, MD Marguerite A. Neill, MD Frank J. Schaberg, Jr., MD 216 Neurological Complications of Lyme Disease Lawrence W. Vernaglia, JD, MPH Syed Rizvi, MD, and Amanda Diamond, MD Newell E. Warde, PhD 219 Updates and Controversy In the Treatment of Lyme Disease OFFICERS Jennifer Mitty, MD, MPH, and David Margolius Nick Tsiongas, MD, MPH President COLUMNS Diane R.
    [Show full text]
  • Paediatric Cookbook
    ® Paediatric Cookbook Paediatric bits and pieces for your own practice Anita Mang, MD, MRCPCH 2 Disclaimer The purpose of this publication is neutral information and training, it does not endorse or recommend any of the described diagnostic methods or treatments. All product and company names are trademarks or registered trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. The publication does not claim to be a complete by any means. While every precaution has been taken in the preparation of these contents, the publisher and authors assume no responsibility for errors or omissions, or for damages resulting from the use of the information contained herein. License This publication is licensed under Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0). To get a copy of this license visit https://creativecommons.org/licenses/by-nc- nd/4.0/legalcode.de or write to Creative Commons, postbox 1866, Mountain View, California, 94042, USA. Icons/Symbols by Font Aswome (www.fontawsome.com) licensed under Creative Commons BY 4.0 3 Acknowledgements I want to thank my supportive husband Clemens Schmuck, who is responsible for the layout in this project. Bibliographical data Author: Dr. Anita Mang, MRCPCH; General Practitioner, Paediatrician, Stadt 1, 8832 Oberwoelz, Austria; www.drmang.at Source This document is available at: www.drmang.at/bpp Change history Version change 2017-05-30 First Version Contents 4 1. Newborns / Infants < 3 mo 7 1.1 Bronchiolitis ........................................................................................................... 7 1.2 Conjunctivitis, acute bacterial ................................................................................. 7 1.3 Diaper rash ............................................................................................................. 8 1.4 Erythema toxicum ..................................................................................................
    [Show full text]
  • Dermatology from the Outside in Rob Danoff, DO, MS, FACOFP, FAAFP
    Dermatology from the Outside In Rob Danoff, DO, MS, FACOFP, FAAFP + A Pictorial Review of Primary Care Dermatology ACOFP Intensive Review Update 8-22-15 Rob Danoff, DO, MS, FACOFP, FAAFP + In the Beginning Proof that babies are delivered by storks + What’s the diagnosis? 1 + Erythema Toxicum Neonatorum “E-Tox” Benign transient self-limiting eruption in the newborn seen in 40% of healthy full-term infants Follicular aggregation of eosinophils and neutrophils Resemble flea bites (yellow/beige papule on an erythematous base) Presents within first four days of life, peak at 48 hours Most cases resolve within five to fourteen days No treatment necessary + What is the diagnosis? + Distribution Crawling Children in diapers – typicaly seen on elbows and knees Older children and adults – typically present in folds of skin opposite to the elbow and kneecap, but spares armpits Other areas commonly involved include the cheeks, neck, wrists, and ankles. 2 + Atopic Dermatitis / Eczema Treatment: Avoid triggers—cold, wet, irritants, emotional stress Aggressive hydration with cream based or petrolatum based moisturizer to restore skin barrier Less irritating soap Infants--Low potency corticosteroid ointments for maintenance Older children and adults—medium potency corticosteroid ointments, sparing the face Stronger corticosteroids ointments should be used for flares or refractory plaques short term only to avoid thinning of skin Calcineurin inhibitors (tacrolimus or picrolimus) –useful on face or eyelids Short course oral Prednisone only
    [Show full text]
  • Annular Erythema As a Cutaneous Sign of Recurrent Ductal Breast Carcinoma, Misdiagnosed As Erythema Chronicum Migrans
    Volume 26 Number 9| September 2020| Dermatology Online Journal || Case Presentation 26(9):7 Annular erythema as a cutaneous sign of recurrent ductal breast carcinoma, misdiagnosed as erythema chronicum migrans Zoltan Szep1-3, Juraj Majtan3 Affiliations: 1Department of Dermatovenerology, St. Elisabeth´s Oncological Institute and Slovak Medical University, Bratislava, Slovakia, 2Alpha Medical Ltd, Diagnostic Center of Clinical Pathology, Bratislava, Slovakia, 3Institute of Molecular Biology, Slovak Academy of Sciences, Bratislava, Slovakia Corresponding Author: Dr. Juraj Majtan, Institute of Molecular Biology, Slovak Academy of Sciences, Dubravska cesta 21, 845 06, Bratislava, Slovakia. Email: [email protected] axilla. After mastectomy, dissection of axillary lymph Abstract nodes, radiotherapy, and chemotherapy, the patient Annular erythema as a clinical manifestation of was in complete remission on long-term tamoxifen locoregional recurrence of breast cancer is extremely treatment. Five years later, a solitary 6×6cm annular rare. Only three papers with the description of five erythematous plaque with a raised red border was cases have been published in the current literature to detected in the left pectoral area (Figure 1A). The our knowledge. Herein, we describe two additional patient reported a tick bite at the site of the lesion; cases of annular erythema as a cutaneous sign of recurrent ductal breast carcinoma; both were serological examination (ELISA method) detected misdiagnosed as erythema chronicum migrans. IgM positivity and IgG negativity of anti-Borrelia antibodies. The dermatologist diagnosed erythema chronicum migrans and put the patient on oral Keywords: annular erythema breast cancer, metastasis, doxycycline with a dosage of 200mg daily for 21 erythema migrans Introduction Annular erythema as a clinical manifestation of locoregional recurrence of malignant tumor disease is extremely rare.
    [Show full text]
  • RASH in INFECTIOUS DISEASES of CHILDREN Andrew Bonwit, M.D
    RASH IN INFECTIOUS DISEASES OF CHILDREN Andrew Bonwit, M.D. Infectious Diseases Department of Pediatrics OBJECTIVES • Develop skills in observing and describing rashes • Recognize associations between rashes and serious diseases • Recognize rashes associated with benign conditions • Learn associations between rashes and contagious disease Descriptions • Rash • Petechiae • Exanthem • Purpura • Vesicle • Erythroderma • Bulla • Erythema • Macule • Enanthem • Papule • Eruption Period of infectivity in relation to presence of rash • VZV incubates 10 – 21 days (to 28 d if VZIG is given • Contagious from 24 - 48° before rash to crusting of all lesions • Fifth disease (parvovirus B19 infection): clinical illness & contagiousness pre-rash • Rash follows appearance of IgG; no longer contagious when rash appears • Measles incubates 7 – 10 days • Contagious from 7 – 10 days post exposure, or 1 – 2 d pre-Sx, 3 – 5 d pre- rash; to 4th day after onset of rash Associated changes in integument • Enanthems • Measles, varicella, group A streptoccus • Mucosal hyperemia • Toxin-mediated bacterial infections • Conjunctivitis/conjunctival injection • Measles, adenovirus, Kawasaki disease, SJS, toxin-mediated bacterial disease Pathophysiology of rash: epidermal disruption • Vesicles: epidermal, clear fluid, < 5 mm • Varicella • HSV • Contact dermatitis • Bullae: epidermal, serous/seropurulent, > 5 mm • Bullous impetigo • Neonatal HSV • Bullous pemphigoid • Burns • Contact dermatitis • Stevens Johnson syndrome, Toxic Epidermal Necrolysis Bacterial causes of rash
    [Show full text]
  • Ectopic Erythema Migrans in an Adolescent with a Skin Disorder
    Pediatric Oral Pathology Ectopic erythema migrans in an adolescent with a skin disorder Catherine M. Flaitz, DDS, MS Dr. Flaitz is a professor, Oral and Maxillofacial Pathology and Pediatric Dentistry, Department of Stomatology, University of Texas at Houston Health Science Center Dental Branch, Houston, Texas. Abstract Red and white circular lesions of the buccal and labial mucosa were observed in an adolescent. Periodically, these nontender patches would resolve and move to other oral sites. Detection of ectopic erythema migrans aided in the diagnosis of a bothersome skin condition. (Pediatr Dent 22:63-64, 2000.) Case history uring a routine oral examination, multiple red and white patches were observed on the buccal and labial Dmucosa in a healthy 16 year-old African-American female. Review of her medical history was positive for envi- ronmental allergies, chronic sinusitis, and eczema. Hypoallergenic soaps and lotions, loratadine, naproxen and oral Fig 1. Ectopic erythema migrans presenting as a circinate red and white contraceptives were the medications used by this teenager. In- lesion of the manibular labial mucosa. traoral examination revealed oval to circinate red patches with slightly raised white margins on the mandibular labial mucosa (figure 1) and bilateral, coalescing, red patches of the anterior buccal mucosa (figures 2 a, b). The patient was aware of in- creased surface roughness at these sites, but denied having any oral tenderness. These recurrent oral lesions would resolve in a couple weeks and then reappear at different mucosal sites. Except for localized gingivitis and a coated tongue, no other intraoral soft tissue abnormalities were observed. Mildly pru- ritic, hyperpigmented papules and plaques with scaly surfaces were noted around the hairline, hands and elbows.
    [Show full text]
  • Overview of Tick-Borne Diseases
    TAKE-HOME MEDICAL GRAND ROUNDS WILLIAM S. WILKE, MD, EDITOR POINTS FROM LECTURES BY CLEVELAND CLINIC AND VISITING FACULTY Tick trouble: Overview of tickrborne diseases ALAN J. TAEGE, MD positive until several weeks after the patient Department of Infectious Diseases, Cleveland Clinic has been infected; therefore, these tests must be used for confirmation, not screening. • ABSTRACT It is important for physicians to learn Tick-borne diseases can be severe or about the varying clinical characteristics and even fatal, but when identified early, the epidemiology of these diseases. In this most can be easily treated. Tick-borne article, I will first call attention to three of the diseases often present with nonspecific less familiar tick-borne diseases: Rocky symptoms. Therefore it is important for Mountain spotted fever, ehrlichiosis, and the primary care physician to be familiar babesiosis. I will conclude with an update on with the epidemiology of these diseases the most common of the tick-borne diseases, and their presentations. Although Lyme Lyme borreliosis. disease is the most common and well- • ROCKY MOUNTAIN SPOTTED FEVER known of the many tick-borne diseases, Rocky Mountain spotted fever, An acute febrile illness, Rocky Mountain ehrlichiosis, and babesiosis are also spotted fever is caused by Rickettsia rickettsii, a More threats throughout the United States. gram-negative intracellular bacillus transmit- Americans are ted by tick bites. The disease is misnamed: not S SUBURBS EXPAND and deer populations all patients develop rash, and fewer than 2% coming into 0continue to increase, more Americans of cases occur in Rocky Mountain states. contact with are coming into contact with rural problems Symptoms and course.
    [Show full text]
  • Derm World: a Journey Through a "Rash" of Clinical Presentations
    Derm World: A Journey Through a "Rash" of Clinical Presentations Rob Danoff, DO, MS, FACOFP, FAAFP Derm World: + A Journey Through a “Rash” of Clinical Presentations Rob Danoff DO, MS, FACOFP, FAAFP OMED 2015 + Cutaneous findings in the Newborn Or, what is this? 1 + What is this? + Cutis Marmorata Mottling of skin Transient phenomena Vascular response to cold with immature nervous system Superficial small blood vessels in the skin dilating (red color) and contracting (pale color) at the same time May persist for months Re-warming usually restores the skin to its normal appearance Occurs in about 50% of infants Generally resolves with increasing age and of no significance for most infants 2 + In the Beginning Proof that babies are delivered by storks + What’s the Diagnosis? 3 + Nevus simplex = Stork bite= Salmon patch Red dilitation of blood vessels often on eyelid, face, or nape of neck (stork bite) They are usually small flat patches of pink or red skin with poorly defined borders These exanthems are very common and occur in over 40% of all newborns The facial patches are sometimes referred to as an “angel's kiss” and tend to fade over the first year of life + Nevus simplex = Stork bite= Salmon patch Often deepen in color with crying, straining with defecation, breath holding or with changes in ambient temperature Not painful or itchy Benign course, reassurance, lighten with age Those on the eyelids and below towards the nose usually disappear by 2 to 3 years of age Salmon patches are rarely detected after age 6 years
    [Show full text]