> Thank you for your continuing good work.  I would like to enter a plea
> that other types of rash be mentioned in addition to the classic
bull's
> eye.  In my own case, after a known tick-bite and 9 days of gross
> fatigue, malaise, and abnormal sweating, a hives-like rash broke out
all
> over my back.  I showed it to a doctor in residence at local hospital,
> and asked if it were a "Lyme rash."  "Absolutely not, " he replied.
He
> assured me that he had seen real Lyme rashes on his rounds at the
> teaching hospital.  So I let the rash go away, and when my regular
> doctor got back to town from vacation, I told him the story and also
> that I had been told that the {*filter*} test was "very expensive."  "We'll
> take a sed rate," he exclaimed, "That will show up any infection."
> Well, the sed rate showed nothing.  The early ills went away.  But 10
> months after the bit, I developed severe arthritis, and at one point
> could hardly hold pen in hand to sign my name.  This responded to Doxy
> treatment, but various long-term effects lingered for 2-3 years.
>     Why not say that rash may resemble bruise, particularly on dark
> skin, may be jagged line, may look like hives or poison ivy rash?
best,
> Lora Mermin, editor and publisher of Lyme Disease 1991.

> Note from Lora:  I want to share this with the whole wide world because
> there are still so many brochures (including the one from the CDC which
> is currently distributed by our state of Wisconsin), which mention only
> the "classic" bulls's-eye EM.

> [Forwarded message]


> Subject: RE: EM rash as diagnostic
> Date: Tue, 3 Aug 1999 13:47:20 -0400
> Hello Lora Mermin:
> I shared your question with Dr. David Dennis, CDC's Lyme disease expert,
> and
> he indicated that you are correct, not all Lyme disease rashes are the
> characteristic bull's eye rash. There have been good publications
> describing
> the variations in localized erythema migrans (EM).  As well, about 15%
> of
> patients with Lyme disease rash present with multiple EM, that may be
> quite
> variable in character and probably most do not show the typical bull's
> eye
> appearance.

> Hope this helps.

> James Herrington, MPH, CHES, PhD (candidate)
> Public Health Education Specialist
> Office of the Director
> Division of Vector-Borne Infectious Diseases
> Centers for Disease Control & Prevention
> P.O. Box 2087
> Fort Collins, CO 80522

> tel 970-221-6429
> fax 970-221-6476
> http://www.***.com/
> > -----Original Message-----

> > Sent: Tuesday, August 03, 1999 8:06 AM

> > Subject: EM rash as diagnostic

> > Thank you for your continuing good work.  I would like to enter a plea

> > that other types of rash be mentioned in addition to the classic
> bull's
> > eye.  In my own case, after a known tick-bite and 9 days of gross
> > fatigue, malaise, and abnormal sweating, a hives-like rash broke out
> all
> > over my back.  I showed it to a doctor in residence at local hospital,

> > and asked if it were a "Lyme rash."  "Absolutely not, " he replied.
> He
> > assured me that he had seen real Lyme rashes on his rounds at the
> > teaching hospital.  So I let the rash go away, and when my regular
> > doctor got back to town from vacation, I told him the story and also
> > that I had been told that the {*filter*} test was "very expensive."  "We'll

> > take a sed rate," he exclaimed, "That will show up any infection."
> > Well, the sed rate showed nothing.  The early ills went away.  But 10
> > months after the bit, I developed severe arthritis, and at one point
> > could hardly hold pen in hand to sign my name.  This responded to Doxy

> > treatment, but various long-term effects lingered for 2-3 years.
> >     Why not say that rash may resemble bruise, particularly on dark
> > skin, may be jagged line, may look like hives or poison ivy rash?
> best,
> > Lora Mermin, editor and publisher of Lyme Disease 1991.