Internal Medicine

Wandering redness

What is a wandering red?

The wandering redness is also known as erythema migrans. This is a symptom in the form of a skin manifestation of Lyme disease. This skin phenomenon spreads in a circular shape from the point where the tick sticks and presents itself as a round reddening with a central pale.

causes

Wandering redness occurs after a tick bite. If the tick is infected with the bacterium “Borrelia burgdorferi”, this bacterium can be transmitted to the person affected, which leads to the disease picture of Lyme disease. In about half of the cases, wandering redness is one of the first symptoms of this disease. The reddening is an expression of the infection, as the bacterium spreads in the body from the puncture site. This spreading process leads to the fact that the wandering redness, i.e. the skin appearance, changes in position and size and appears pale in the middle.

diagnosis

The diagnosis is usually made on the basis of the anamnesis and the clinical appearance of the wandering redness. If the patient can remember a tick bite, for example because he removed the tick himself, this is a decisive indication that a wandering redness is present. The doctor should also ask about the course over time. Wandering redness can occur days to weeks after a tick bite. The appearance of the skin manifestation can also provide information about its origin. Typically the reddening of the skin is rounded with a central pale and not raised. However, there may also be atypical shapes that appear evenly reddened or raised.

Normally, the criteria just mentioned should be sufficient to make a diagnosis. A blood analysis can also be carried out, which either detects specific antibodies or directly detects the pathogen. However, this examination is negative in half of the cases in the presence of wandering redness and should only be carried out if there are other symptoms of Lyme disease.

Laboratory examination

As mentioned above, a blood analysis can provide information about the presence of Lyme disease. If this blood test is positive, the likelihood that the unclear reddening is traveling red is higher. However, the blood test is negative in 50 percent of the cases, even though there is an infection with Borrelia. The blood analysis consists of the detection of Borrelia-specific antibodies. A single positive test result is only indicative when viewed together with the typical symptoms, as it can also be present in other infectious diseases (e.g. hepatitis). Direct pathogen detection is an additional diagnostic option. Since it recognizes the DNA of the bacterium, this is very specific, but also very time-consuming.

Symptoms

Wandering redness is an early symptom of Lyme disease. The name Wanderröte originated from the fact that the rash spreads in a circle from a central puncture point. Occasionally it can be itchy and rarely pain. As a rule, the diameter of the traveling red is 5 cm or larger. Most of the time the reddening of the skin is flat, but in rarer cases it can be raised. Another characteristic of wandering redness is the fading in the center of the circular redness. In rare cases, however, this may be missing. Papules, spots or blisters are other symptoms that can occur with atypical wandering redness.

Possible accompanying symptoms

Occasionally, in addition to the reddening of the skin, itching or pain may occur. Other, rare accompanying symptoms can be nausea, fatigue, muscle pain or fever. In addition, other symptoms of Lyme disease can occur, which can be very variable. Wandering redness is the local early manifestation of borreliosis. If the pathogen reaches other organs in the body, numerous symptoms can occur. If the pathogen gets into the central nervous system, for example, symptoms of paralysis of the limbs are typical. Headaches can also occur as the bacteria can attack the meninges. The heart can also be affected in the form of myocarditis. In the late stages of Lyme disease, the joints are often affected, especially large joints such as the knee. This condition is called Lyme arthritis. Since the pathogen can settle in any organ system, a variety of symptoms are possible, which can make diagnosis difficult.

Read more about the Symptoms of borreliosis

itching

The wandering red is caused by a reaction of the immune system to the invading pathogen. This can cause itching. However, this is a rather atypical and very unspecific symptom, as itching can occur in a variety of skin diseases.

What can you do about itching?

Various measures can be taken against itching. Non-medication can provide relief from cooling. Itch-relieving creams can also be used. Some have a cooling effect, others contain pharmacological agents such as glucocorticoids. In severe cases, antihistamines can be taken as tablets. Medicinal measures are rarely indicated in case of wandering redness, however, since itching rarely occurs and stops after treatment of the underlying disease.

Pain

As a rule, wandering reddening is not painful. However, pain can occur in rare cases and does not rule out the presence of erythema migrans. However, since it is a rare symptom, other diagnoses associated with painful skin manifestations should also be considered.

How long is the wandering red visible?

The question of how long the wandering red is visible cannot be answered across the board. Since it is an expression of a reaction of the immune system of the person concerned, the duration of the visibility varies greatly from person to person. If the wandering redness is not recognized as such and treated, it lasts an average of ten weeks. If therapy is initiated earlier, it disappears promptly.

Can you get a traveling blush without a tick bite?

The Borrelia bacterium is normally transmitted to humans by ticks. Numerous wild animals are attacked by the bacterium. If they are bitten by a tick that then stings a person, the pathogen gets into the skin of the person concerned via the tick's saliva. Theoretically, the pathogen can also be transmitted by other insects such as mosquitoes. However, this is very rare. If there is no tick bite, the existing reddening of the skin is probably not a wandering reddening.

Wandering redness after an insect bite

In principle, it is possible that Borrelia can be transmitted to humans by insects other than ticks, as these can also have previously stung an infected wild animal and the pathogen is therefore in their saliva. In principle, wandering redness could then occur after a mosquito bite. Fleas or horseflies could also carry the pathogen. If the typical skin appearance occurs after an insect bite, a doctor should be consulted. The cases in which a wandering redness occurred after a bite other than that of a tick, however, are very rare. The reason for this could be that ticks carry more of the borreliosis pathogen and penetrate deeper into the skin than other insects.

therapy

Often the body's own immune system manages to fight the borreliosis pathogen. Therapy is not necessary in this case. If there is wandering redness, however, therapy should be initiated, as otherwise it can spread into various organ systems, which can have serious consequences. Borreliosis is treated with antibiotics. The main active ingredient used is doxycycline. Ceftriaxone or amoxicillin are also used. If there is wandering redness, it is recommended to take doxycycline or amoxicillin orally for 2 weeks.

forecast

Symptoms usually resolve completely. Wandering redness often responds well to antibiotic therapy, and in many cases it can also heal spontaneously. If the borreliosis is already in a more advanced stage, the regression of the symptoms can be delayed. If, for example, neurological structures have been damaged, functional losses such as paralysis may persist even after therapy has been carried out. A renewed infection with Borrelia after an infection that has already gone through is possible.

Course of disease

Wandering redness is a local early manifestation of borreliosis, which often remains the only symptom of the disease. It is an expression of the reaction of the immune system to the borrelia pathogen that has entered from outside. Also in the early stages of Lyme disease, swelling of the lymph nodes can occur, this is called lymphadenosis cutis benigna. If Lyme disease is not treated in the early stages and the body's own immune system does not manage to eliminate the pathogen, the pathogen can spread. This is known as acute disseminated infection. Various organ systems can be affected by the infection, such as nerves, meninges or the heart muscle. If no therapy is initiated at this stage either, the pathogen can persist in the body for months to years and infect different organ systems and in this way imitate a large number of diseases, which often makes diagnosis difficult. So-called Lyme arthritis often occurs, in which the pathogen often affects large joints such as the knee, which leads to intermittent joint problems. A dermatological or neurological manifestation is also possible. Theoretically, any organ can be attacked by the pathogen.

Read here: How can you recognize Lyme disease?

Wandering redness gets bigger despite antibiotics - what to do?

If the skin manifestation spreads despite antibiotic therapy, this can have various causes. One possible would be that the pathogen is resistant to the selected antibiotic. This can be counteracted by changing antibiotics. In any case, it should be clarified whether there is actually wandering redness or whether the skin appearance may be another disease. In particular, if no tick bite can be remembered, the diagnosis must be questioned. In this case a doctor should be consulted.

When to the doctor

If the person concerned can remember a tick bite and if it comes to a circular reddening in the area of the bite, a doctor should be consulted in any case. The pathogen should be prevented from spreading, as this can lead to severe organ damage. If no tick infestation can be remembered and such redness occurs, a doctor should also be consulted, who can then make a decision based on the anamnesis and appearance of the redness. Since such reddening of the skin can also be a symptom of another infection, for example, a visit to a doctor is recommended in any case.

How do I differentiate between wandering redness and eczema / allergy?

There are numerous diseases that lead to dermatological phenomena and can be similar in shape. The most decisive indication of a wandering blush is the memory of a tick bite. The erythema that then becomes established is usually painless and does not itch. If, for example, there is an allergy-related reddening, this is usually accompanied by severe itching. The affected area appears rather swollen, wheal-like and possibly pulsates, which is not the case with wandering redness. The easiest way to determine whether an allergy is present is through contact with an allergen.

What else can you confuse the wandering redness with?

As mentioned above, a variety of diseases can lead to reddening of the skin. Often these are allergic reactions that are accompanied by itching. Psoriasis, also known as psoriasis, leads to reddened plaques on the skin that are very itchy. However, these are also characterized by strong scaling and occur in different parts of the body. Another differential diagnosis is erysipelas. This is a sharply defined, tight reddening of the skin that is often very painful. The origin is a bacterial infection that spreads through the lymphatic vessels. In this case, the pathogens, mostly streptococci, often enter the body through small skin injuries. The erysipelas is often accompanied by fever and should be treated with antibiotics.

Additional information

You might also be interested in these topics: