In Lyme disease, the characteristic skin manifestation is which of the following?

• A. Vesicular lesions
• B. Bull's-eye erythema migrans
• C. Ringworm
• D. No skin involvement

Answer: (B)

Recognize the skin finding you’d expect in early Lyme disease: an expanding erythematous rash at the bite site that often develops central clearing, giving a bull’s-eye or target-like appearance. This erythema migrans is characteristic and often the first clue prompting diagnosis and treatment. It isn’t vesicular, which would suggest lesions like those seen with chickenpox or herpes; it isn’t a ringworm fungal ring, which has its own scaling border; and there is indeed skin involvement in Lyme disease, unlike the option that implies no skin findings. If you see a gradually enlarging rash with central clearing after a tick bite, Lyme disease should be considered.