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Lyme disease is a tick-transmitted inflammatory disorder characterized by an early focal skin lesion, and subsequently a growing red area on the skin (erythema chronicum migrans or ECM). The disorder may be followed weeks later by neurological, heart or joint abnormalities. Symptomatology The first symptom of Lyme disease is a skin lesion. Known as erythema chronicum migrans, or ECM, this usually begins as a red discoloration (macule) or as an elevated round spot (papule). The skin lesion usually appears on an extremity or on the trunk, especially the thigh, buttock or the under arm. This spot expands, often with central clearing, to a diameter as large as 50 cm (c. 12 in.). Approximately 25% of patients with Lyme disease report having been bitten at that site by a tiny tick 3 to 32 days before onset of ECM. The lesion may be warm to touch. Soon after onset nearly half the patients develop multiple smaller lesions without hardened centers. ECM generally lasts for a few weeks. Other......

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