Skin Challenge: Lyme (stage 1)


Cutaneous manifestations are collectively called as “dermatoborreliosis.”

  • Stage 1: Localized (1–3 weeks)—primary erythema migrans
  • Stage 2: Disseminated (weeks to months)—secondary erythema migrans
  • Stage 3: Chronic (months to years)—acrodermatitis chronic atrophicans


Erythema migrans is the most common cutaneous manifestation of Lyme disease, which occurs at the site of a tick bite. It develops on lower extremities or the upper trunk in about 80% of people infected. When looking for this lesion, you will find various hues of erythema (redness) that can spread outward from the center which is a “bull’s eye,” in which the tick bite mark is at the exact center. The appearance is that of a target lesion and diameter must be at least 5cm (average size is 15cm) to qualify as erythema migrans.

The elongation of these lesions may relate to the direction of collagen fibers along which the organisms move in the ground substance of the skin. The surface is usually smooth; however, scaling or crusting may be present. Burning, itching, or pain can occasionally occur.

The characteristic rash is usually associated with viral infection-like symptoms, including malaise, fever, headache, and muscle pain, all of which may occur prior to the onset of the rash by a few days. Lesions typically resolve spontaneously within weeks to months.


What is the cause of primary erythema migrans in your client?

Erythema migrans is not a reaction to a tick bite, but rather an outward sign of an actual Lyme disease infection in the skin. As with any infection, it can feel warm to the touch.

In people with darker complexions, erythema migrans can look like a bruise.

Determine any medications; contraindications and cautions before proceeding with any spa treatment.

Treatments that can be offered:

  • If the rash is itchy or uncomfortable, the client can try using an antihistamine to relieve itching.
  • Cold compress to cool the rash area with anti-itch ingredients such as menthol, calamine, colloidal oatmeal.
  • Peppermint hydrosol can relieve any itching/burning temporarily.
  • If the discoloration on the skin is a concern for the client, it can be disguised with camouflage makeup.

DISCLAIMER: Work within the scope of your license/certification.

Portrait of Mórag Currin. About the Author

Mórag Currin is a highly sought-after esthetic educator with more than 27 years of spa industry experience and more than twelve years of training and training management experience. She travels around the globe with her training and expertise, helping to raise the bar in the spa industry and to open the door to all people, regardless of skin type or health condition. To learn more about this topic and many other skin challenges, diseases, and symptoms, check out Mórag’s book, Health Challenged Skin: The Estheticians’ Desk Reference.

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