Bull’s eye rash is key sign of Lyme disease, leading health watchdog tells doctors

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PEOPLE with the bull’s eye rash that is associated with Lyme disease can now be diagnosed with the condition using clinical assessment alone, experts say.

Patients will no longer be required to have blood tests to be diagnosed with Lyme.

Once infected, most sufferers tend to develop a bull's eye-type rash
Once infected, most sufferers tend to develop a bull’s eye-type rash
Getty – Contributor

The disease, which affects a host of celebs including Bella and Yolanda Hadid, Avril Lavigne, Kelly Osbourne, Shania Twain, Alec Baldwin, and Ben Stiller, tends to be spread by infected ticks.

Most people develop a distinctive red rash (called erythema migrans) which is the shape of a circle with a ring around it, between three and 30 days after they were bitten.

The rash can vary in size significantly and can expand over the course of days or weeks.

Typically, this blemish grows to around 15cm in diameter.

Bella Hadid is among a host of stars who are fighting the disease
Getty Images – WireImage

The faster the disease is diagnosed, the sooner the risk of developing further symptoms.

The National Institute for Health and Care Excellence (NICE) says that by diagnosing the illness based on the rash, patients may be saved vital time.

The rash is present in approximately two-thirds of all cases and usually appears in one to four weeks following a tick bite.

Lyme antibodies don’t appear in the blood, however, for up to eight weeks – with early lab tests often not detecting the disease.

Symptoms of Lyme disease

If left untreated, Lyme disease sufferers can develop much more serious symptoms including:

  • Serious joint pain
  • Nervous system pain which can lead to paralysis of facial muscles, memory problems and difficulties concentrating
  • Heart problems, such as inflammation of the heart muscle
  • Inflammation of the membranes around the brain and spinal cord as with meningitis

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “For most people with Lyme disease, a course of antibiotics will be effective, so it is important we diagnose and treat people as soon as possible.

“A person with Lyme disease may present with a wide range of symptoms, so we have clear advice for professionals about the use of lab tests for diagnosis and the most appropriate antibiotic treatments.

“If a characteristic bull’s eye rash is present, healthcare professionals should feel confident in diagnosing Lyme disease.”

If people don’t have the rash but do have other symptoms, then a lab test can be used.

The disease tends to be spread via ticks
The disease tends to be spread via ticks
Getty – Contributor

Saul Faust, Professor of paediatric immunology and infectious diseases at the University of Southampton and chair of the guideline committee, said: “Prompt diagnosis of Lyme disease is essential for effective management of the condition.

“This draft quality standard highlights key areas to help healthcare professionals and people affected by Lyme disease.

“Lab tests are necessary when a person’s symptoms are unclear, but they are not needed if a person presents the characteristic red rash, erythema migrans.


“Doctors should feel confident to prescribe antibiotics immediately for those with erythema migrans.”

Veronica Hughes, CEO, Caudwell LymeCo Charity, said her charity often hears from people whose doctors have spotted the rash but delayed things by insisting on a blood test – “not realising that the rash is the more reliable of the two”.

“Waiting for blood test results always delays treatment; when a patient has the rash, this delay is unnecessary and reduces the likelihood of total cure.”


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