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January 1997, Vol 133, No. 1 >
Article | January 1997

The Truth About Erythema Migrans

Henry M. Feder, Jr, MD; Diane L. Whitaker, MD; Diane M. Hoss, MD
[+] Author Affiliations

University of Connecticut Health Center 263 Farmington Ave Farmington, CT 06030


Arch Dermatol. 1997;133(1):93-94. doi:10.1001/archderm.1997.03890370099015
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References
Comments

LYME DISEASE in Europe and the United States is caused by different strains of the spirochete Borrelia burgdorferi. Therefore, the clinical manifestations of Lyme disease may be different in these 2 locations.1-3 For example, in the United States, the pathognomonic rash erythema migrans (EM) will persist for 1 to 4 weeks without treatment, whereas in Europe the rash will persist for 2 to 16 weeks if left untreated. In Europe, the rash is termed erythema chronicum migrans (ECM). Multiple EM and arthritis occur more frequently in the United States than in Europe. Borrelia lymphocytoma, acrodermatitis chronica atrophicans, and focal neuralgias occur commonly in Europe but are unusual in the United States. Because of these differences, conclusions based on European studies cannot be generalized to the United States.

In this issue of the Archives, Hulshof and colleagues4 from the Netherlands report on the excellent outcome of 44 European patients

REFERENCES

1 +
Steere AC.  Lyme disease . N Engl J Med. 1989;;321:586-596.
2 +
Krause PJ, Feder HM Jr.  Lyme disease and babesiosis . Adv Pediatr Infect Dis. 1994;;9:183-209.
3 +
Malane MS, Grant-Kels JM, Feder HM Jr, Luger SW.  Diagnosis of Lyme disease based on dermatologic manifestations . Ann Intern Med. 1991;;114:490-498.
4 +
Hulshof MM, Vandenbroucke JP, Nohlmans MKE, Spanjaard L, Bavinck JNB, Dijkmans BAC.  Long-term prognosis in patients treated for erythema chronicum migrans and acrodermatitis chronica atrophicans . Arch Dermatol. 1997;; 133:33-37.
5 +
Feder HM Jr, Whitaker DL.  Misdiagnosis of erythema migrans . Am J Med. 1995;:99:412-419.
6 +
Luger SW, Krauss E.  Serologic tests for Lyme disease: interlaboratory variability . Arch Intern Med. 1990;;150:761-763.
7 +
Stobierski MG, Hall WN, Robinson-Dunn B, Stiefel H, Shiflett S, Carlson V.  Isolation of Borrelia burgdorferifrom two patients in Michigan . Clin Infect Dis. 1994;;19:944-946.
8 +
Steere AC, Malawista SE, Newman JH, Spieler PN, Bartenhagan NH.  Antibiotic therapy in Lyme disease . Ann Intern Med. 1980;;93:1-8.
9 +
Steere AC, Hutchinson GJ, Rahn DW, et al.  Treatment of the early manifestations of Lyme disease . Ann Intern Med. 1983;;99:22-26.
10 +
Dattwyler RJ, Volkman DJ, Conary SM, et al.  Amoxicillin plus probenecid versus doxyclycline for treatment of erythema migrans borreliosis . Lancet . 1990;; 336:1404-1406.
11 +
Nadelman RB, Luger SW, Frank E, et al.  Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease . Ann Intern Med. 1992;; 117:273-280.
12 +
Luft BJ, Dattwyler RJ, Johnson RC, et al.  Azithromycin compared with amoxicillin in the treatment of erythema migrans . Ann Intern Med. 1996;;124:785-791.
13 +
Salazar JC, Gerber MA, Goff CW.  Long-term outcome of Lyme disease in children given early treatment . J Pediatr. 1993;;122:591-593.
14 +
Gerber MA, Sharpiro ED.  Lyme disease in children in southeastern Connecticut . N Engl J Med. 1996;;335:1270-1274.
15 +
Feder HM Jr, Hunt MS.  Pitfalls in the diagnosis and treatment of Lyme disease in children . JAMA . 1995;;474:66-68.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Steere AC.  Lyme disease . N Engl J Med. 1989;;321:586-596.
2 +
Krause PJ, Feder HM Jr.  Lyme disease and babesiosis . Adv Pediatr Infect Dis. 1994;;9:183-209.
3 +
Malane MS, Grant-Kels JM, Feder HM Jr, Luger SW.  Diagnosis of Lyme disease based on dermatologic manifestations . Ann Intern Med. 1991;;114:490-498.
4 +
Hulshof MM, Vandenbroucke JP, Nohlmans MKE, Spanjaard L, Bavinck JNB, Dijkmans BAC.  Long-term prognosis in patients treated for erythema chronicum migrans and acrodermatitis chronica atrophicans . Arch Dermatol. 1997;; 133:33-37.
5 +
Feder HM Jr, Whitaker DL.  Misdiagnosis of erythema migrans . Am J Med. 1995;:99:412-419.
6 +
Luger SW, Krauss E.  Serologic tests for Lyme disease: interlaboratory variability . Arch Intern Med. 1990;;150:761-763.
7 +
Stobierski MG, Hall WN, Robinson-Dunn B, Stiefel H, Shiflett S, Carlson V.  Isolation of Borrelia burgdorferifrom two patients in Michigan . Clin Infect Dis. 1994;;19:944-946.
8 +
Steere AC, Malawista SE, Newman JH, Spieler PN, Bartenhagan NH.  Antibiotic therapy in Lyme disease . Ann Intern Med. 1980;;93:1-8.
9 +
Steere AC, Hutchinson GJ, Rahn DW, et al.  Treatment of the early manifestations of Lyme disease . Ann Intern Med. 1983;;99:22-26.
10 +
Dattwyler RJ, Volkman DJ, Conary SM, et al.  Amoxicillin plus probenecid versus doxyclycline for treatment of erythema migrans borreliosis . Lancet . 1990;; 336:1404-1406.
11 +
Nadelman RB, Luger SW, Frank E, et al.  Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease . Ann Intern Med. 1992;; 117:273-280.
12 +
Luft BJ, Dattwyler RJ, Johnson RC, et al.  Azithromycin compared with amoxicillin in the treatment of erythema migrans . Ann Intern Med. 1996;;124:785-791.
13 +
Salazar JC, Gerber MA, Goff CW.  Long-term outcome of Lyme disease in children given early treatment . J Pediatr. 1993;;122:591-593.
14 +
Gerber MA, Sharpiro ED.  Lyme disease in children in southeastern Connecticut . N Engl J Med. 1996;;335:1270-1274.
15 +
Feder HM Jr, Hunt MS.  Pitfalls in the diagnosis and treatment of Lyme disease in children . JAMA . 1995;;474:66-68.

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