CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Lyme disease - Management
Basis for recommendation
The description and differential diagnosis of erythema migrans are derived from a US guideline [Wormser et al, 2006], a systematic review of the history and physical examination characteristics for the diagnosis of erythema migrans [Tibbles and Edlow, 2007], guidance from the UK Health Protection Agency [HPA, 2009e], narrative reviews [Edlow, 2002; Hengge et al, 2003; Stanek and Strle, 2003], and a standard textbook [Graham and Cox, 2004], with some modification from CKS expert reviewers.
- A systematic review reported that a history of a tick bite was present in only 64% (95% CI 52 to 74) of people with erythema migrans in a meta-analysis of eleven European studies, and in just 26% (95% CI 18 to 37) of people in nine US studies [Tibbles and Edlow, 2007].
- The locations for erythema migrans of around the waistband and under the breasts were suggested by a CKS expert reviewer.
© NHS Institute for Innovation and Improvement