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Sunday, September 25, 2011

Could it be?


I've read of recurring Erythema Migrans before I started my antibiotics. I have had this rash start about 2 weeks into Doxycycline. I don't remember a mosquito or anything biting me as of late to get such a large welt there. It did have a very faint ring around it that went up to my wrist about 6 days ago. Now the top is raising and has a reddish purple ring around it. It was itching pretty intensely when the large ring was around it but it has died down. It has just remained a raised 3/4 inch red flat welt/bump with the ring around it. Could this be my original bite recurring now that I am taking antibiotics?

I found some information on a recurring EM rash with antibiotic therapy from the Jemsek Specialty Clinic website:

A little recognized fact about the EM rash is that it can recur, usually in the original site, with or without antibiotic therapy. We estimate that between 5-10% of patients demonstrate this phenomenon during their illness. Other patients remark that they have migratory rashes of moderate duration from time to time that remain unexplained. It is more common, in our experience, to observe the presence of recurrent EM after the onset of antimicrobial therapy. We note that some patients erupt with rash repeatedly while on antibiotic therapy, often in different areas. Eventually this dissipates as the patient improves on antibiotic therapy. Pressure points may play a role in the appearance of the rash, but gravitational influence does not appear to play a role in terms of the site of eruption, i.e. as one would see in a vasculitis-like presentation characteristic of most drug reactions. The first appearance of rash has been reported as late as 6 months into therapy (personal observation). This has led to obvious diagnostic challenges when one is on antibiotic therapy and has to consider a drug reaction. However, we have come to recognize that the LD rash on treatment presents as flat or occasionally raised coalescent islands of erythema, in contrast to the classic generalized morbilliform rash caused by a drug reaction. When confronted with this clinical picture, the Jemsek Specialty Clinic views this as a positive indication of therapeutic benefit, probably representing a dermal form of the "Herxheimer reaction", and so we generally proceed cautiously on with antibiotic therapy, usually with eventual resolution of the rash.


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