The Truth About Erythema Migrans

LYME DISEASE in Europe and the United States is caused by different strains of the spirocheteBorrelia burgdorferi. Therefore, the clinical manifestations of Lyme disease may be different in these 2 locations.1-3For example, in the United States, the pathognomonic rash erythema migrans (EM) will persist for 1 to 4 weeks without treatment, whereas in Europe the rash will persist for 2 to 16 weeks if left untreated. In Europe, the rash is termederythema chronicum migrans(ECM). Multiple EM and arthritis occur more frequently in the United States than in Europe. Borrelia lymphocytoma, acrodermatitis chronica atrophicans, and focal neuralgias occur commonly in Europe but are unusual in the United States. Because of these differences, conclusions based on European studies cannot be generalized to the United States. In this issue of theArchives, Hulshof and colleagues4from the Netherlands report on the excellent outcome of 44 European patients