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Dermatology Research and Practice
Volume 2012, Article ID 451727, 6 pages
Research Article

Bull’s-Eye and Nontarget Skin Lesions of Lyme Disease: An Internet Survey of Identification of Erythema Migrans

1Department of Medicine, Johns Hopkins University, 10755 Falls Road, Suite 200, Lutherville, MD 21093, USA
2Division of Clinical Research, Lyme Disease Research Foundation, 10755 Falls Road, Suite 200, Lutherville, MD 21093, USA
3Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Phipps 174, 600 North Wolfe Street, Baltimore, MD 21287, USA

Received 27 June 2012; Accepted 15 August 2012

Academic Editor: Jag Bhawan

Copyright © 2012 John N. Aucott et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. Lyme disease is an emerging worldwide infectious disease with major foci of endemicity in North America and regions of temperate Eurasia. The erythema migrans rash associated with early infection is found in approximately 80% of patients and can have a range of appearances including the classic target bull’s-eye lesion and nontarget appearing lesions. Methods. A survey was designed to assess the ability of the general public to distinguish various appearances of erythema migrans from non-Lyme rashes. Participants were solicited from individuals who visited an educational website about Lyme disease. Results. Of 3,104 people who accessed a rash identification survey, 72.7% of participants correctly identified the classic target erythema migrans commonly associated with Lyme disease. A mean of 20.5% of participants was able to correctly identify the four nonclassic erythema migrans. 24.2% of participants incorrectly identified a tick bite reaction in the skin as erythema migrans. Conclusions. Participants were most familiar with the classic target erythema migrans of Lyme disease but were unlikely to correctly identify the nonclassic erythema migrans. These results identify an opportunity for educational intervention to improve early recognition of Lyme disease and to increase the patient’s appropriate use of medical services for early Lyme disease diagnosis.