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abnormal redness of the skin resulting from dilation of blood vessels (as in sunburn or inflammation)

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紅斑(こうはん)(炎症などにより皮膚が異常に赤くなること)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/01/19 05:57:02」(JST)

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Erythema chronicum migrans (New Latin, literally, "chronic migrating redness") refers to the rash often (though not always) seen in the early stage of Lyme disease. It can appear anywhere from one day to one month after a tick bite. This rash does not represent an allergic reaction to the bite, but rather an actual skin infection with the Lyme bacteria, Borrelia burgdorferi sensu lato. "Erythema migrans is the only manifestation of Lyme disease in the United States that is sufficiently distinctive to allow clinical diagnosis in the absence of laboratory confirmation.".^[1] It is a pathognomonic sign:^[2] a physician-identified rash warrants an instant diagnosis of Lyme disease and immediate treatment without further testing, even by the strict criteria of the Centers for Disease Control and Prevention. These rashes are characteristic of Borrelia infections and no other pathogens are known that cause this form of rash.

A similar condition called Southern Tick Associated Rash Illness (STARI) produces a similar rash pattern although it develops more quickly and is smaller. The associated infectious agent has not been determined. Antibiotic treatment resolves the illness quickly.^[3]

This erythema is also sometimes called erythema migrans^[4] or EM. However, a less common meaning of the term "erythema migrans" is a mucosal condition of the tongue, also called geographic tongue.

History

In a 1909 meeting of the Swedish Society of Dermatology, Arvid Afzelius first presented research about an expanding, ring-like lesion he had observed. Afzelius published his work 12 years later and speculated the rash came from the bite of an Ixodes tick, meningitic symptoms and signs in a number of cases and that both sexes were affected. This rash is now known as erythema chronicum migrans, the skin rash found in early-stage Lyme disease.^[5]

In the 1920s, French physicians Garin and Bujadoux described a patient with meningoencephalitis, painful sensory radiculitis, and erythema migrans following a tick bite, and they postulated the symptoms were due to a spirochetal infection. In the 1940s, German neurologist Alfred Bannwarth described several cases of chronic lymphocytic meningitis and polyradiculoneuritis, some of which were accompanied by erythematous skin lesions.

Description

The erythema migrans rash is classically 5 to 6.8 cm in diameter, appearing as an annular homogenous erythema (59%), central erythema (30%), central clearing (9%), or central purpura (2%).^[6] Because of the "bull's-eye" description to describe the Lyme disease rash, the condition commonly called ringworm is sometimes confused with Lyme disease.^[6] Uncommonly, EM may be less than 5 cm in diameter.^[7] Multiple painless EM rashes may occur, indicating disseminated infection.

The EM rash occurs in 80%^[8] to 90%^[9] of those infected with Borrelia. A systematic review of the medical literature^[10] showed 80% of patients have an expanding EM rash, at the site of the tick bite,^[11] although some patients with EM do not recall a tick bite. In endemic areas of the United States, homogeneously red rashes are more frequent.^[12]^[13]

Advocates of a diagnosis called "chronic lyme disease" dispute the generally accepted incidence of the rash, claiming it occurs in less than 50% of infections.^[14]^[15]

Oral erythema migrans

Oral erythema migrans also called migratory stomatitis when extensive areas in the oral cavity mucosa are affected, or geographic tongue when confined to the dorsal and lateral aspects of the tongue mucosa, is a very common entity of unknown etiology and pathogenesis that affects 1% to 2.5% of the general population.^[16]

References

^ Wormser GP, Dattwyler RJ, Shapiro ED, et al. (November 2006). "The clinical assessment, treatment, and prevention of Lyme disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America". Clin. Infect. Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130. "pp. 1101–2 Background and Diagnosis of Erythema Migrans
^ Ogden NH, Lindsay LR, Morshed M, Sockett PN, Artsob H (January 2008). "The rising challenge of Lyme borreliosis in Canada". Can. Commun. Dis. Rep. 34 (1): 1–19. PMID 18290267.
^ Lone Star Tick a Concern @ CDC
^ Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology. St. Louis: Mosby. ISBN 1-4160-2999-0.
^ Lipschütz, B. (1931). "Zur Kenntnis der "Erythema chronicum migrans"". Acta dermato-venereologica (Stockholm) 12: 100–2.
^ ^a ^b Feder HM, Abeles M, Bernstein M, Whitaker-Worth D, Grant-Kels JM (2006). "Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis". Clin. Dermatol. 24 (6): 509–20. doi:10.1016/j.clindermatol.2006.07.012. PMID 17113969.
^ Weber K, Wilske B (2006). "Mini erythema migrans—a sign of early Lyme borreliosis". Dermatology (Basel) 212 (2): 113–6. doi:10.1159/000090650. PMID 16484816.
^ CDC Lyme Disease Erythema Migrans Disease Retrieved May 13 2007
^ Dandache P, Nadelman RB (2008). "Erythema migrans?". Infect Dis Clin North Am 22 (2): 235–60. doi:10.1016/j.idc.2007.12.012. PMID 18452799.
^ Rational Clinical Examination
^ Tibbles CD, Edlow JA (2007). "Does this patient have erythema migrans?". JAMA 297 (23): 2617–27. doi:10.1001/jama.297.23.2617. PMID 17579230.
^ Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, Holman MS, Persing DH, Steere AC (2002). "Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans" (PDF). Ann Intern Med 136 (6): 421–8. doi:10.7326/0003-4819-136-6-200203190-00005. PMID 11900494.
^ Edlow JA (2002). "Erythema migrans". Med Clin North Am 86 (2): 239–60. doi:10.1016/S0025-7125(03)00085-3. PMID 11982300.
^ Donta ST (2002). "Late and chronic Lyme disease". Med Clin North Am 86 (2): 341–9, vii. doi:10.1016/S0025-7125(03)00090-7. PMID 11982305.
^ Cameron D, Gaito A, Narris N, Bach G, Bellovin S, Bock K, Bock S, Burrascano J, Dickey C, Horowitz R, Phillips S, Meer-Scherrer L, Raxlen B, Sherr V, Smith H, Smith P, Stricker R; ILADS Working Group (2004). "Evidence-based guidelines for the management of Lyme disease" (PDF). Expert Rev Anti Infect Ther 2 (1 Suppl): S1–13. doi:10.1586/14789072.2.1.S1. PMID 15581390.
^ Zadik Y, Drucker S, Pallmon S (Aug 2011). "Migratory stomatitis (ectopic geographic tongue) on the floor of the mouth" (PDF). J Am Acad Dermatol 65 (2): 459–60. doi:10.1016/j.jaad.2010.04.016. PMID 21763590.

External links

DermAtlas 208

(images)

English Journal

Lyme Disease-Human Granulocytic Anaplasmosis Co-Infection - Impact of Case Definition on Co-Infection Rates and Illness Severity.

Horowitz HW, Aguero-Rosenfeld ME, Holmgren D, McKenna D, Schwartz I, Cox ME, Wormser GP.SourceThe Department of Medicine, Division of Infectious Diseases, New York Medical College, Valhalla, New York.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.Clin Infect Dis.2012 Oct 5. [Epub ahead of print]
Background. Lyme disease is transmitted by the bite of Ixodes scapularis ticks, which can also transmit Anaplasma phagocytophilum, the cause of human granulocytic anaplasmosis (HGA). Conflicting data exist on the frequency of co-infection and on whether Lyme-HGA co-infected patients have more symp
PMID 23042964

Treatment Complications in Children With Lyme Meningitis.

Thompson AD, Cohn KA, Shah SS, Lyons T, Welsh EJ, Hines EM, Nigrovic LE.SourceFrom the *Division of Emergency Medicine, Department of Pediatrics, Nemours, Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, DE; †Division of Emergency Medicine; ‡Department of Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA; §Divisions of Infectious Diseases and Hospital Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH; and ¶Division of Infectious Diseases, The Children's Hospital Philadelphia, University of Pennsylvania, Philadelphia, PA.
The Pediatric infectious disease journal.Pediatr Infect Dis J.2012 Oct;31(10):1032-1035.
BACKGROUND:: The rate and type of treatment complications in children treated for Lyme meningitis have not been described. METHODS:: We performed a retrospective cohort study of children with Lyme meningitis who presented to 1 of 3 emergency departments located in Lyme disease endemic areas between
PMID 22592517

Japanese Journal

タカサゴキララマダニ刺症に伴う遊走性紅斑 : Tick-associated rash illness (TARI)

夏秋優,高田伸弘,川端寛樹 [他]
衛生動物 64(1), 47-49, 2013-03-15
NAID 40019672639

タカサゴキララマダニ刺症に伴う遊走性紅斑 : Tick-associated rash illness (TARI)

夏秋優,高田伸弘,川端寛樹,佐藤梢,高野愛
衞生動物 64(1), 47-49, 2013-03-15
NAID 10031152180

タカサゴキララマダニ刺症に伴う遊走性紅斑：Tick-associated rash illness (TARI)

夏秋優,高田伸弘,川端寛樹,佐藤梢,高野愛
衛生動物 64(1), 47-49, 2013
… We report a case of tick bite caused by Amblyomma testudinarium with a clinical feature of erythema migrans. … On the first visit (July 4), an annular erythema of 10 cm in size was recognized on the abdomen. … These results indicate that the skin rash in this case, erythema migrans, was not associated with Lyme disease but an allergic reaction to salivary gland substances of the tick. …
NAID 130004559042

「EM」

Erythema chronicum migrans
	An erythema migrans rash.
Classification and external resources
Specialty	Infectious disease
ICD-10	A69.2 (ILDS A69.22)
ICD-9-CM	088.81, 529.1
DiseasesDB	4439
MeSH	D015787
	[edit on Wikidata]

　　[★]

「遊走性紅斑」

　　[★]

ラ: erythema migrans, EM
関: ライム病

ライム病の症状の一つ。マダニに刺咬された部位から遠心性に紅斑が拡大していく

[1] Wormser GP, Dattwyler RJ, Shapiro ED, et al. (November 2006). "The clinical assessment, treatment, and prevention of Lyme disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America". Clin. Infect. Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130. "pp. 1101–2 Background and Diagnosis of Erythema Migrans

[2] Ogden NH, Lindsay LR, Morshed M, Sockett PN, Artsob H (January 2008). "The rising challenge of Lyme borreliosis in Canada". Can. Commun. Dis. Rep. 34 (1): 1–19. PMID 18290267.

[3] Lone Star Tick a Concern @ CDC

[4] Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology. St. Louis: Mosby. ISBN 1-4160-2999-0.

[5] Lipschütz, B. (1931). "Zur Kenntnis der "Erythema chronicum migrans"". Acta dermato-venereologica (Stockholm) 12: 100–2.

[pmid17113969-6] Feder HM, Abeles M, Bernstein M, Whitaker-Worth D, Grant-Kels JM (2006). "Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis". Clin. Dermatol. 24 (6): 509–20. doi:10.1016/j.clindermatol.2006.07.012. PMID 17113969.

[7] Weber K, Wilske B (2006). "Mini erythema migrans—a sign of early Lyme borreliosis". Dermatology (Basel) 212 (2): 113–6. doi:10.1159/000090650. PMID 16484816.

[8] CDC Lyme Disease Erythema Migrans Disease Retrieved May 13 2007

[9] Dandache P, Nadelman RB (2008). "Erythema migrans?". Infect Dis Clin North Am 22 (2): 235–60. doi:10.1016/j.idc.2007.12.012. PMID 18452799.

[10] Rational Clinical Examination

[pmid17579230-11] Tibbles CD, Edlow JA (2007). "Does this patient have erythema migrans?". JAMA 297 (23): 2617–27. doi:10.1001/jama.297.23.2617. PMID 17579230.

[12] Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, Holman MS, Persing DH, Steere AC (2002). "Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans" (PDF). Ann Intern Med 136 (6): 421–8. doi:10.7326/0003-4819-136-6-200203190-00005. PMID 11900494.

[pmid11982300-13] Edlow JA (2002). "Erythema migrans". Med Clin North Am 86 (2): 239–60. doi:10.1016/S0025-7125(03)00085-3. PMID 11982300.

[14] Donta ST (2002). "Late and chronic Lyme disease". Med Clin North Am 86 (2): 341–9, vii. doi:10.1016/S0025-7125(03)00090-7. PMID 11982305.

[15] Cameron D, Gaito A, Narris N, Bach G, Bellovin S, Bock K, Bock S, Burrascano J, Dickey C, Horowitz R, Phillips S, Meer-Scherrer L, Raxlen B, Sherr V, Smith H, Smith P, Stricker R; ILADS Working Group (2004). "Evidence-based guidelines for the management of Lyme disease" (PDF). Expert Rev Anti Infect Ther 2 (1 Suppl): S1–13. doi:10.1586/14789072.2.1.S1. PMID 15581390.

[MS-16] Zadik Y, Drucker S, Pallmon S (Aug 2011). "Migratory stomatitis (ectopic geographic tongue) on the floor of the mouth" (PDF). J Am Acad Dermatol 65 (2): 459–60. doi:10.1016/j.jaad.2010.04.016. PMID 21763590.

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erythema migrans