Dermatological manifestations of Lyme borreliosis: All pathogenic Borrelia burgdorferi s.l. genospecies typically cause an expanding skin lesion known as erythema migrans, which occurs at the site of the tick bite. a | Classic erythema migrans lesions, with a brighter red outer border, partial central clearing and a bull's eye centre. Other erythema migrans lesions can have a more-intense inflammation and purplish discolouration in the centre. b | Borrelial lymphocytoma (arrows) is a subacute lesion that typically occurs on the nipple in adults or on the earlobe in children. c | Acrodermatitis chronica atrophicans is the most common late manifestation of Lyme borreliosis in Europe. These lesions have an inflammatory phase with a reddish or blue colour followed by an atrophic phase, in which the skin thins considerably, sometimes with fibrotic features. Borrelial lymphocytoma and acrodermatitis chronica atrophicans have been noted in Europe and Asia, but not in North America.
Steere, A., Strle, F., Wormser, G. et al. Lyme borreliosis. Nat Rev Dis Primers 2, 16090 (2016). https://doi.org/10.1038/nrdp.2016.90