Erythema Migrans on Skin of Different Colors. Panel A shows an erythematous nodule; Panel B shows erythema migrans. The image in Panel A is reprinted from Bhate C, Schwartz RA. Lyme disease: Part I. Advances and perspectives. J Am Acad Dermatol 2011;64:619-36, with permission from Elsevier. The image in Panel B is from the Centers for Disease Control and Prevention/James Gathany.

Lyme Disease Diagnosed Later with More Complications in Black Patients

MedicalResearch.com Interview with:
Dan P. Ly M.D., Ph.D., M.P.P.

Dr. Dan P. Ly

Dr. Dan P. Ly

Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine at UCLA
Los Angeles, CA 

MedicalResearch.com: What is the background for this study?

Response: Lyme disease presents first on the skin with the classic “bull’s-eye” rash. But such rashes in Black patients aren’t well-represented in medical textbooks. This may lead to physicians not recognizing such rashes in Black patients.

As a result, Black patients are more likely to present with later complications of Lyme disease when first diagnosed such as neurologic complications.  

MedicalResearch.com: What could assist in earlier diagnosis?

Erythema Migrans on Skin of Different Colors. Panel A shows an erythematous nodule; Panel B shows erythema migrans. The image in Panel A is reprinted from Bhate C, Schwartz RA. Lyme disease: Part I. Advances and perspectives. J Am Acad Dermatol 2011;64:619-36, with permission from Elsevier. The image in Panel B is from the Centers for Disease Control and Prevention/James Gathany.

Erythema Migrans on Skin of Different Colors.
Panel A shows an erythematous nodule; Panel B shows erythema migrans. The image in Panel A is reprinted from Bhate C, Schwartz RA. Lyme disease: Part I. Advances and perspectives. J Am Acad Dermatol 2011;64:619-36, with permission from Elsevier. The image in Panel B is from the Centers for Disease Control and Prevention/James Gathany.

Response: There have been greater efforts to show what the classic rash of Lyme disease looks like in patients with darker skin. Raising awareness of tick precautions in places with high prevalence of Lyme is important, as well as having patients and physicians better recognize what the rash looks like in all skin types.

Education of both physicians and patients will continue to be important, which starts with getting better representation of diverse skin types in educational and online resources.

MedicalResearch.com: What should readers take away from your report?

Response: Lyme disease is diagnosed later in Black patients than in white patients, so when it is first diagnosed in Black patients, Black patients are more likely to have later neurologic complications of Lyme disease than white patients.

Disclosures: I have nothing to disclose. I am also a physician in the VA, and these views are mine only and do not necessarily represent the views of the US Department of Veterans Affairs or the US government.

Citation:

Ly, D.P. Black-white differences in the clinical manifestations and timing of initial Lyme disease diagnoses. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-021-07129-1 

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Oct 18, 2021 @ 11:52 am

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