What Does a Lyme Disease Rash (Erythema Migrans) Look Like?

A telling sign of Lyme disease is a red, circular or oval rash that expands over time like a bullseye. This type of rash is clinically called "erythema migrans." However, Lyme disease rashes don't always show up with a bullseye pattern. What else does a Lyme rash look like?

They can present in different ways—depending, in part, on how long you've had it, where it shows up on your body, and what your skin tone is. It's also possible to have Lyme disease with no visible rash, or a rash that clears up on its own before you notice it. Here's what else you need to know.

Classic Bulls-Eye Pattern Rash

This is the image you often see in articles and stories on Lyme disease. Erythema migrans is the concentric circle pattern consisting of a red bulls-eye dead center and a ring of "central clearing" bordered by an outer red ring. It's typically an early sign, occurring within 30 days of having the disease.

A rash that looks like erythema migrans doesn't always mean you have Lyme disease, however. Another tick-borne disease, called southern tick-associated rash illness, can cause a circular lesion too.

Uniformly Red Rash

A circular or oval rash that's red throughout may be a Lyme disease rash. This rash is also considered an early sign and might appear anywhere on the body. While the bulls-eye rash may be more associated with Lyme disease, you're more likely to have a rash like this one.

Multiple Red Rashes

Between 30 to 45 days following a tick bite, multiple red lesions may happen when early Lyme disease spreads or "disseminates" through the body via the bloodstream. When this happens, bacteria are no longer isolated to the area of the skin where the tick bite occurred. The CDC describes these rashes as having "dusky centers."

Red-Blue or Bluish Lesions

One of the later types of skin changes due to Lyme disease, acrodermatitis chronica atrophicans (ACA) can present as bluish-red lesions. It occurs around stage 3 of Lyme disease, which could be months to years after the initial bite.

These bluish rashes may or may not have central clearing. If there's clearing, that portion of the person's skin will take on a bluish tinge, Jennie Johnson, MD, infectious diseases specialist, associate medical director at Infectious Disease and Immunology Center at The Miriam Hospital, and co-director at Lifespan Lyme Disease Center in Providence, Rhode Island, told Health.

Central Blistering Rash

Another type of rash that can indicate Lyme disease is a vesicular rash. This is a type of rash that blisters in the center, but it's an uncommon sign of the disease. People don't realize Lyme disease can cause rashes with central blistering—or even central crusting after the blisters have popped.

How Do I Know If My Rash Is Lyme Disease?

Because rashes due to Lyme disease can vary, it can be difficult to tell if lesions are related to the disease. However, some rash characteristics may help you and a healthcare provider determine if you have Lyme disease. The rashes may:

• Feel smooth and warm when touched
• Have scaly or crusty outer edges
• Itch or be painful
• Result in a burning sensation

How Does it Progress?

A Lyme disease rash can change over time, depending on how long it has been since you were bitten by a tick. The changes are as follows:

• Stage 1, early localized: Oval or circular red rashes that can evolve into erythema migrans
• Stage 2, early disseminated: Multiple red rashes on different parts of the body following time with no treatment
• Stage 3, late: ACA presenting with bluish-red lesions

A Quick Review

People know of the bulls-eye presentation of a Lyme disease rash, but the rash can present in various ways. Some people may have an oval-shaped rash that's red throughout or have multiple lesions as part of a rash.

Other presentations might be a bluish-red rash or one that blisters in the middle. Lyme disease rashes may also change appearance over time, but see a healthcare provider if you have symptoms of the disease.