Everything about Erythema Chronicum Migrans

Erythema Chronicum Migrans

This is the erythema chronicum migrans the so-called “eye rash,” a reddish circular rash, which a few days to weeks after a tick bite occurs in the bite site, centrifugally spread outward, thereby fades away centrally and the first stage of Lyme disease is considered.

What is erythema chronicum migrans?

According to fun-wiki.com, Tick bites are one of the few dangers that still lurk in nature in this country. Borreliosis as a secondary disease occurs frequently in Germany, there is no vaccination yet.

Recognized in time, however, it can be treated excellently. The first stage of Lyme disease, the erythema chronicum migrans, should therefore be known to everyone who is out and about in the German forest from time to time and to all parents whose children still play outside in the summer.


Borreliosis is caused by bacteria, which are conveniently called Borrelia. These Borrelia are transmitted by ticks, which are at home in German forests and, contrary to popular belief, do not fall from trees, but wait for human contact in about waist-high bushes and then nestle in the skin of those who pass by.

Depending on the region (south more than north), between 10 and 50 percent of domestic ticks are infested with Borrelia. Only about 3 percent of all people bitten by ticks become infected with the bacteria via the tick’s saliva, which is probably mainly related to the suckling time: If the tick is discovered and professionally removed within 6-12 hours, the risk of transmission is very low.

Again, only about 10 percent of those infected actually get Lyme disease, which is probably due to our excellent immune system. Nevertheless, tick bites are common and therefore Lyme disease cases occur frequently in Germany. It is important to recognize the symptoms in good time.

Symptoms, ailments & signs

Erythema chronicum migrans is a very serious disease that must be treated by a doctor in any case, as in the worst case it can also lead to the death of the person concerned. First and foremost, the patients suffer from reddening of the skin and the formation of papules and pustules in the affected area.

The area can also be painful or itchy. The usual symptoms of the flu or cold also appear, leaving people feeling tired, fatigued, and chills. As a rule, sleep cannot compensate for tiredness.

Furthermore, erythema chronicum migrans also leads to severe headaches and a significant reduction in the patient’s quality of life. Significant pain in the back or joints can also occur and make everyday life difficult. If the disease is not treated, the disease will spread to the heart and nervous system of the person affected and damage it.

In the worst case, the patient can die from this damage. For this reason, the life expectancy of the person affected is often significantly reduced as a result of erythema chronicum migrans.

Diagnosis & course

About 5 to 29 days after the tick bite, a small papule usually appears where the tick was. A circular reddening then forms around it, which within days spreads centrifugally, i.e. from the inside out, and fades in the middle. The result is the image of a ring that is getting bigger and wandering outwards. It is from this behavior that the rash owes its name to “wandering blush”, or, in medical terms, erythema chronicum migrans.

Since the disease does not hurt, the wandering redness is often not discovered at all. Fever, general well-being, tiredness or headache only occur occasionally, but these disappear after a few days and are too unspecific to be associated with the onset of Lyme disease. Also, muscle pain and flu-like symptoms may occur. The erythema itself can disappear after days without the Lyme disease having healed. But it can also last for months.

If Lyme disease is not discovered and treated in this first stage, the pathogens can spread in the body, cause further symptoms and ultimately turn into a serious, life-threatening disease: In the second stage, after four weeks at the earliest, the heart and the peripheral nervous system are attacked, which is noticeable through arrhythmias, paralysis and pain. In the late stages, often months later, the skin, individual joints and the central nervous system are affected. A encephalitis can cause death.

Erythema chronicum migrans as a skin phenomenon is typical enough to be diagnosed as the onset of borreliosis after a tick bite. In addition, a doctor will perform a blood test for Borrelia antibodies, which, however, are often not detectable at all in the early stages of the disease.


Because of the erythema chronicum migrans, complications arise from a tick bite. These do not have to appear immediately and lead directly to complaints, in most cases these only spread in the course of the disease. The patient suffers from severe fatigue and also n headaches.

Papules form on the body and a relatively high fever occurs. The joints and extremities also hurt and the affected person suffers from a general feeling of illness. In most cases, these symptoms do not appear until a few weeks after the tick is bitten. In the worst case, other organs are also affected, which can lead to problems in the heart or lungs. If the central nervous system is damaged, paralysis of various parts of the body can occur. This leads to a restriction of movement.

In most cases, antibiotics are used in the treatment, which lead to a positive course of the disease. Usually, the person is dependent on bed rest for a few days before the body can be subjected to stress again. In most cases, life expectancy is not affected by erythema chronicum migrans.

When should you go to the doctor?

In the event of a tick bite, a visit to the doctor is necessary if the tick cannot be completely removed from the wound by its own means. Particular care should be taken if the trunk has detached from the tick and the head is still in the wound. A doctor should always be consulted in these situations.

If the person concerned complains of various complaints, a doctor should also be consulted if the tick has been removed properly. If you have a fever or chills, there is cause for concern. Symptoms such as headache, back pain or joint pain should be clarified by a doctor.

If pain occurs directly in the region of the tick bite, a doctor’s visit is necessary. If the wound becomes inflamed or the wound becomes enlarged, a doctor should be consulted. If poplars or reddened skin develop, these are considered unusual and should be examined by a doctor. In the event of tiredness, nausea, dizziness or vomiting, the person concerned must be examined and treated.

If the entry point does not heal within a few days after the tick bite, it should be presented to a doctor. If general well-being, the usual level of performance drops or if weakness sets in, a visit to a doctor is advisable. The complaints must be treated medically so that no serious illnesses develop.

Treatment & Therapy

In the first stage, Lyme disease can be treated very well with antibiotics; Doxycycline as a tablet for a few days allows most of the infections to heal without consequences. A blood test checks the success.

In later stages, harder clubs must be used; cephalosporins are then the means of choice, sometimes also by infusion over a longer period of time. Incidentally, not every tick bite is treated, as is often assumed: the probability of actually contracting Lyme disease is simply too low to expose yourself to the possible risks and side effects of antibiotic treatment.

However, the occurrence of wandering redness is an urgent reason for therapy and every day earlier that one receives antibiotic therapy reduces the risk of a chronic infection.

Outlook & forecast

The prognosis for erythema chronicum migrans is positive if the disease is completely cured. This is possible with antibiotic therapy.

Despite adequately treated erythema chronicum migrans, about 5 percent of patients subsequently suffer from “post-treatment Lyme disease symptoms”. The symptoms are similar to those of Lyme borreliosis. The resulting occurrence of joint and muscle pain, constant tiredness and concentration disorders reduce the quality of life. But since erythema chronicum migrans is viewed as a preliminary stage to Lyme disease, the occurrence of such sequelae is not entirely surprising.

The wandering redness caused by tick bites can be treated well in most cases. It is unlikely that those affected will develop Lyme disease after antibiotic treatment. This prognosis obviously also applies to the 5 percent of those affected who develop symptoms similar to Lyme disease despite treatment.

If left untreated, however, the prognosis looks different. The untreated erythema chronicum migrans can lead to a reduced quality of life due to severe pain. If left untreated, erythema chronicum migrans can reduce the life expectancy of those affected. If treatment is still neglected, the heart can be affected. The nervous system can also be affected. In the worst case, the untreated erythema chronicum migrans leads to the death of the patient.


As a preventive measure, after playing outdoors, children should also be thoroughly examined for ticks; adults should also remember this. Defense sprays and long-range clothing can also minimize the attack surface for ticks. Ticks should be removed professionally and completely; if this happens within twelve hours, the risk of borreliosis is very low.

Medicinal measures are then initially necessary. However, specific attention should be paid to the appearance of wandering redness within the next four weeks.


In the case of erythema chronicum migrans, in most cases no special or direct measures and options for follow-up care are possible. With this disease, the person concerned must first receive a thorough examination and treatment in order to prevent further complications. The earlier the disease is recognized, the better the further course is usually.

In general, it is advisable to protect yourself against ticks and avoid the infested areas as much as possible. Vaccination against ticks is also very useful to prevent the occurrence of erythema chronicum migrans. In most cases, this infection is treated with the help of antibiotics. The person concerned is dependent on regular intake and the correct dosage.

If you have any questions or are unclear, a doctor should be contacted first. Even after the symptoms have subsided, the antibiotics usually have to be taken for a few more days. You should also refrain from alcohol when taking it. The further course of the erythema chronicum migrans depends on the exact stage of the disease. In general, those affected should take it easy with this disease and not expose themselves to exertion or other stressful activities.

You can do that yourself

In everyday life, it is important to be particularly careful about tick bites. Particularly in the months of spring or summer, care should be taken not to get tick bites when walking or spending time outdoors. For this, insect sprays can be applied to the skin for protection. These keep ticks away and at the same time protect against further insect bites.

Before staying in meadows or in forests, it is advisable to collect information about the current regional tick distribution. Long clothes and closed footwear make it difficult for ticks to gain access to the human body. Seating pads should be used on meadows. Large blankets or towels are sufficient to avoid direct contact with the floor.

Immediately after a walk in the forest or a stay in a meadow, the skin should be checked thoroughly for tick bites. Remove the tick with a steady hand and a tick tweezer. Care should be taken to ensure that the entire body of the tick is completely removed.

If this does not succeed or if the tick is in an area on the body that is difficult to access, it is necessary to consult a doctor. You should avoid removing the tick’s head on your own with tweezers or similar tools.

Erythema Chronicum Migrans