Recognising the “wandering flush” and lymphocytoma

It is not the case that every Lyme patient develops a “wandering flush”; or they may develop one but not notice it due to it appearing over an ‘inaccessible’ body part. With the rise in ‘single’ households where people live without partners, there is no one else to notice e.g. a rash on their back. Also, some patients may not visit the doctor with erythema migrans simply because often it doesn’t hurt or itch. Alternatively, the erythema migrans may not be recognised as such by the patient and/or the doctor and is frequently misdiagnosed as an allergic reaction, insect bite, haematoma or genital mycosis (fungal infection in the genital area).


Furthermore, in practice it can be very difficult to detect an erythema migrans on sun- or solarium-tanned, dark or sunburned skin. This means that these early cases of Lyme disease in stage I (early stage) go undiagnosed and therefore not properly treated. The patient often cures the flu-like stage (stage II) alone at home or it is diagnosed as a viral infection.


We would like to draw your attention to how difficult the practical situation of dealing with Lyme can be. It is undisputed in the medical community that all Lyme disease infections that are not detected in their early stages (early stages I and II) or are not treated properly (treated with fenistil gel, fungicide ointment, cooling, zinc ointment, ‘wait and see’) at least have the potential to change into the chronic form (late stage).

Practical examples:

The following pictures show what an erythema migrans, lymphocytoma and acrodermatitis chronica atrophicans (ACA) look like in reality and where they can be found (they can also be multilocular, i.e. in different places, sometimes simultaneously). We have been provided with relevant pictures from the dermatological practice of Dr. med. R. Schulte-Beerbühl from Dortmund. Pictures were also sent to us by colleagues from ILADS showing the possible appearance of the erythema migrans (also multilocular) on dark skin. Even from a purely practical point of view, we think that there could be a large group of dark-skinned people infected with Lyme who are yet to discover their erythema migrans.

Example of a lymphocytoma

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Example of a Wandering Flush