Lyme Disease Rash

Pediatric Dermatology Basics

The classic erythema migrans rash on a patient with Lyme disease.
The classic erythema migrans rash on a patient with Lyme disease. Photo by CDC/ James Gathany

After getting bit by a deer tick that is infected with the bacteria Borrelia burgdorferi, children can develop a circular rash at the site of a tick bite, known as "erythema migrans." It usually develops about 7 to 14 days after the tick bite, although it may begin as early as 3 days or as late as 32 days later.

The Lyme disease rash is usually described as:

  • looking like a target or bull's eye, with a central red spot, an area of clear skin, and a red border
  • being itchy, warm, and sometimes painful
  • gradually expanding to a size of 7 to 14 inches
  • lingering for about 2 weeks

In addition to the erythma migrans rash, other Lyme disease symptoms resemble flu-like symptoms and can include fever, myalgia (muscle aches), chills, headache, fatigue, and joint pain (arthralgia).

What You Need to Know

  • Only about two-thirds of children with Lyme disease actually have the Lyme disease rash, which makes remembering a tick bite important if your child later develops flu-like symptoms or other mysterious symptoms.
  • In the United States, most cases of Lyme disease (hyperendemic areas) occur in southern New England, New York, New Jersey, Pennsylvania, Minnesota, Wisconsin, and the northern Pacific coast.
  • Since a tick usually has to be on your child for at least 48 hours to transmit Lyme disease, it is important to do daily tick checks if your child has been in an area where he might be bitten by a tick, such as while camping.



    Gershon: Krugman's Infectious Diseases of Children, 11th ed.

    Long: Principles and Practice of Pediatric Infectious Diseases, 3rd ed.

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