Wear a wide-brimmed hat (preferably one with SPF protection), tightly woven clothes, long sleeves and large sunglasses when outdoors. Common symptoms of ringworm include: 6. If left untreated, the bald spots can grow bigger and become permanent. For information on new subscriptions, product Known as discoid lupus because of the round shape of the sores or lesions, this is a type of chronic cutaneous lupus. Rashes occur when immune cells in your skin react to UV light sources, releasing chemicals that inflame your skin. James WD, Berger TG, Elston DM. Atopic Dermatitis, Eczema, and Noninfectious Immunodeficiency Disorders. Policy. About 90 percent of patients who get malar rash have systemic lupus. Everyday Health is among the federally registered trademarks of Everyday Health, Inc. and may not be used by third parties without explicit permission. Early, localized lesions can be treated with topical thiabendazole. Although rashes are not usually an emergency, it is common for emergency physicians to see patients come in with a rash. Acute cutaneous lupus lesions or rashes happen when systemic lupus is active, according to the Lupus Foundation of America. In: James WD, Berger TG, Elston DM. (2013, July 12), How does lupus affect the skin? Treatments may include: Lupus rashes can last for days or weeks. Images 12,13: Used with permission of theJournal of the American Academy of Dermatology. Tuberculoid erythematous plaques with raised, sharply defined borders and atrophic center. Lupus Erythematosus. Subacute Cutaneous LE(SCLE) is a form of lupus that often starts as awidespread rash in areas exposed to sunlight. Non-infectious Granulomas. Common Risk Factors and More, 8 New Things Weve Learned About Lupus in the Past Year, What Managing Lupus for 2 Decades Taught Me About Taking Care of Myself, Lupus, Emotional Stress, and Depression: What You Need to Know, 12 Things People With Lupus Should Know About the COVID-19 Vaccine. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Asymmetric, well-demarcated, erythematous lesion with or without central clearing. But while a rosacea rash may look like lupus, the difference is that a lupus rash doesn't have red bumps that are typical of rosacea, although the rash can be raised. This response creates inflammation in many parts of the body, including the joints, kidneys, brain, heart, and lungs. The rash may be flat, raised or scaly. The trusted source for healthcare information and CONTINUING EDUCATION. Granuloma annulare (gran-u-LOW-muh an-u-LAR-e) is a skin condition that causes a raised rash or bumps in a ring pattern. There are many at-home and prescription treatments available to treat lupus-related pain. Centers for Disease Control and Prevention. It's not contagious and usually not painful, but it can make you feel self-conscious. A small percentage of people will develop both this ring-like rash and the one that looks like eczema or psoriasis. Nummular Eczema vs. Ringworm: What's the Difference? - Healthline We look forward to having you as a long-term member of the Relias Sometimes, a rash or other sign of lupus causes a symptom like itch or pain. To learn why someone may get any type of lupus, go to:Lupus and your skin: Causes. The cutaneous infestation is self- It has a red, ring like pattern,sometimes with a little scaling in sun exposed areas, and may be confused withpsoriasis or ringworm. Peroni A, Colato C, Schena D, Girolomoni G. Urticarial lesions: If not urticaria, what else? Family history may be helpful in revealing relatives with the disease. This article interested me because it broadened my awareness about this type of rash. Lupus can make your skin extremely sensitive to sunlight and other types of light. Favor the face, neck, and areas of trauma. Red to pink plaques with raised borders and central clearing. (2012). Lupus can also lead to pulmonary hypertension, a form of high blood pressure in which the blood vessel connecting the heart to the lungs thickens. Lupus doesnt cause blisters, says Stojan. Okon LG, Werth VP. Localized granuloma annulare produces annular lesions with smooth, non-scaly contours. Fingers and toes may also feel numb or painful in response to cold. Doxycycline (adults)/amoxicillin (pregnant women and children). and article library. Some people say it helps them feel more in control. ENT. Consider one of the subscription options below to receive full access to this article and many more. Some people get blisters. Wood GS, Reizner GT. Generally, these secondary lesions will not have the targetoid appearance of the primary lesion and will spare the palms and soles.19 The cutaneous manifestations are self-limiting and, if untreated, will fade within six weeks.17, While the skin manifestations are mostly asymptomatic, accompanying symptoms of Lyme disease are common. Eventually, tracts can coalesce to form annular or ring-shaped lesions. During a first-time flare, this rash can resemble ringworm. You have reached your article limit for the month. The most common type of lupus, systemic lupus erythematosus (SLE), can cause dry, coarse hair to develop along the hairline. Cutaneous lupus erythematosus. In rare instances, a person with discoid lupus also develops chilblain lupus erythematosus. This can cause a condition called hemolytic anemia. Bravo FG. Discoid lupus, a type of cutaneous lupus, causes circular red rashes on your body. Linger for weeks or get worse despite treatment. Consider one of the subscription options below to receive full access to this article and many more. Annular skin lesions are among the most common dermatologic presentations. The fingers can go through different color changes, says Stojan. Lesions are asymptomatic, measuring up to several centimeters in diameter and having a predilection for the hands, fingers, feet, and ankles.31 When multiple lesions are present, they are almost always unilateral and localized.30, Focusing on the furrowed rim formed by the prominent border and depressed center is key in differentiating the lesion from other annular lesions like tinea. (See Figure 2.) When this patient saw a dermatologist, the doctor immediately began testing for lupus. Images 14-15: Used with permission ofDermNet NZ. Urticaria and Angioedema. Lupus is a chronic inflammatory disease that can cause a scaly rash to form on the upper body and face. These dry, coarse hairs break off easily, causing the sparse-looking hair known as lupus hair. How can ringworm, shingles, and other rashes appear on darker skin? There are different types of lupus, and each can affect the skin differently. SCLE rashes tend to develop on parts of your body that get a lot of sun, such as your arms, shoulders, chest and neck. Tinea corporis is associated with a fine scale and commonly affects the trunk, unlike NE, which has a thick crust and occurs almost exclusively on the extremities. When a Red Circle on Your Skin Is Not Ringworm - Healthline If you have discoid lupus, hair loss can be permanent. Mario J. Sequeira, MD, FAAD, Dermatologists team up to improve patient care, JAK inhibitors: A newer type of medication, Free materials to help raise skin cancer awareness, Dermatologist-approved lesson plans, activities you can use. Non-scaly, erythematous to violaceus colored papules or plaques with a thin, smooth border. There are two kinds of subacute cutaneous lupus lesions: papulosquamous lesions and annular lesions. Ivermectin (adults)/albendazole (children). Youll also see ways that lupus can affect the hair and nails. Lupus - Symptoms and causes - Mayo Clinic Hsu S, Le EH, Khoshevis MR. Hello, i've been suffering from sores inside my nose for a few months & worsening. A butterfly rash (malar rash) on the face affects many people with lupus, but lupus rashes can appear anywhere on your body. Lupus is an inflammatory disease that causes a rash to form on the body and, in an initial form, can resemble a ringworm rash. Bacterial Diseases. Sometimes hair loss may be permanent. The term annular is derived from the Latin word annulus, meaning ring shaped.1 These lesions have a characteristic appearance, described as round to oval-shaped patches or plaques with central clearing. Lupus often attacks the nerves, which carry messages from the brain to the rest of the body. Prompt treatment of discoid lupus on the scalp can prevent scarring. Its worth noting that these lesions are not vesicles [fluid-filled cysts, such as a blister]. Doesn't itch or cause pain. A discoid lupus rash typically: Has circular, coin- or disk-shaped red patches that are thick and scaly. When lupus affects the skin, swelling can be one of the first signs of lupus. Dermatologists care for people of all ages. All rights reserved. Can you have lupus without any sort of rashes? In: James WD, Berger TG, Elston DM. It causes rough, scaly skin to develop on the face and scalp. RELATED:Speaking Lupus a Glossary of Terms You Need to Know. Additionally, the disease can trigger carpal tunnel syndrome, which leads to pain and numbness in the hands and fingers. We will certainly can sitter a variety of possibilities. Therefore, referral to a dermatologist is appropriate. In many cases, the diagnosis may not be obvious, even for the experienced clinician. We can sometimes distinguish between different autoimmune diseases based on how those capillaries look under a microscope.. 1996-2023 Everyday Health, Inc., a Ziff Davis company. Its a symptom that you want to have evaluated, but it doesnt mean you have lupus.. Warning signs to look for, tests the rheumatologist might run, and everything else you need to know about a lupus diagnosis. James WD, Berger TG, Elston DM. The most common signs and symptoms include: Fatigue. Centrally, lesions may be hyperpigmented or skin-colored.24 LP may mimic tinea, granuloma annulare, or porokeratosis of Mibelli (discussed later). Lesions of discoid lupus erythematosus vary greatly; however, they rarely are annular. Heres what you need to know. A butterfly-shaped rash on your face called a malar rash often occurs. The key is reapply frequently and avoid sun expos in sle, this is not required for diagnosis. When you have a butterfly rash, people may think that youre flushing, blushing or have a bad sunburn. In: James WD, Berger TG, Elston DM. Dr. Miller reports he is on the speakers bureau for Abbvie and Allergan. People who have lupus often develop symptoms similar to that of the flu. Ring-shaped rash. by doing a simple scraping. It can be an indication of systemic lupus, but it can also happen on its own, according to NYU Langone Health. In: Bolognia JL, Schaffer JV, Cerroni L. James WD, Berger TG, Elston DM. Chronic discoid lupus rashes or sores may put you at risk for skin cancer. Drago F, Ciccarese G, Rebora A, et al. Discoid lupus can cause sores inside the mouth. Ringworm: Symptoms, Pictures, Treatment, Diagnosis & More - Healthline Many patients will report that when theyre in the sun their rash worsens, or maybe they notice that their rash gets worse during the summer months, he says. 26 Common Skin Rash Pictures - How to ID Skin Rash Symptoms - Prevention Lichen planus (LP) is an idiopathic, inflammatory disease of the skin and mucus membranes that primarily affects middle-aged adults.23 Mediated by T-lymphocytes, the reaction can be triggered by medications, vaccinations, or viral infections, especially hepatitis C.24 The eruption begins as small, pinpoint papules that expand into plaques that are classically shiny, violaceous, and polygonal-shaped.25 Wickham striae, a diffuse network of white streaking, can be seen embedded throughout the surface.23 Lesions commonly are found on the dorsal hands, flexor wrists, forearms, shins, vulva, and glans penis, but also can be seen in the mouth.23 When lesions are present on the body, patients may be asymptomatic or complain of intense pruritus. Oral and nasal ulcers or sores are one of the most common manifestations of lupus, according to Stojan. Patients might also notice tiny lines on the skin where the mites. Minor skin injuries and some medicines might trigger the condition. As mentioned earlier, individual lesions should not last longer than 24 hours, although an attack may last much longer.21 If lesions persist beyond 24 hours, other causes must be considered and a biopsy may be warranted.22 If food is a suspected trigger, a food diary may be helpful. EM is self-limiting and usually resolves within weeks without complications.14 For limited cutaneous disease, symptomatic treatment with oral antihistamines or low-potency topical corticosteroids is sufficient.43 In recurrent cases precipitated by herpes simplex virus eruptions, chronic suppressive antiviral therapy with valacyclovir is effective.14 When oral lesions are present, topical corticosteroid gels and swish and spit rinses containing a mixture of lidocaine, diphenhydramine, and kaolin are helpful.14 In severely ill patients, systemic corticosteroids should be considered.43, Hansens disease, also known as leprosy, is a rare, chronic granulomatous disease caused by Mycobacterium leprae.44 Although mostly a disease of the developing world, cases in the United States occur in those who have resided in foreign countries or those living in southeastern states with exposure to armadillos, a natural host.1,45 In almost all new cases, a history of close contact with an untreated, infected individual is obtainable.45 Once a patient is infected, the disease has an insidious onset and an incubation period that ranges from three to 20 years.1 Hansens disease primarily presents in two forms, tuberculoid leprosy and lepromatous leprosy.45 In both forms, cooler areas of the body such as the skin, peripheral nerves, upper respiratory tract, and eyes are affected.1,45 Warmer areas such as the axilla, groin, and scalp usually are spared. Allergic urticaria can be IgE-mediated, occurring in response to foods (milk, eggs, wheat, shellfish, nuts), inhalants (pollen, dander), medications (penicillin), or complement-mediated in the case of serum sickness. Ringworm Look-Alikes | by Dr. Alan Greene In erythema multiforme, the characteristic target lesions remain fixed for multiple days, as opposed to the transient lesions of urticaria. In addition, both can happen almost anywhere on the body, head to toe. Tinea corporis is a superficial dermatophyte infection of the body, not involving the scalp, face, hands, feet, or groin.4 Classically, tinea corporis is characterized by an asymmetric, well-demarcated, erythematous, dry, and scaly patch with a raised, red advancing border.2,4 Centrally, lesions clear, forming an annular pattern.4 Individual eruptions vary in size, enlarge over time, and often are associated with mild to moderate pruritus, although smaller lesions may be asymptomatic.4, Tinea cruris, or jock itch, is dermatophytosis of the groin. Prompt treatment of the thick, scaly patches can prevent spots and permanent scarring. Both subacute and chronic lupus can present with red circular patches which may resemble ringworm. In: James WD, Berger TG, Elston DM. Paraneoplastic erythema annulare centrifugum eruption (PEACE). If not, consider one of the subscription options below. In this variant, lesions are characterized by well-demarcated, erythematous plaques with an active border composed of pustules. Inflammation throughout your body causes symptoms like lupus rashes, joint pain, extreme fatigue and fever. Let's look at why and how the process works: Lupus and medications used to treat it can affect your eyes by causing vision changes, rashes around your eyes, or inflammation in your eyes. What it looks like: Scabies is a discolored, splotchy rash that can appear pimple-like on any affected parts of the skin. First- or second-generation antihistamines. Retrieved from, How does lupus affect the heart and circulation? Shiohara T, Mizukawa Y. Lichen planus and lichenoid dermatoses. my face gets red daily & occasionally extra redness in shape of butterfly rashes. When the rash is localized to the trunk, axillae, or groin, it commonly is mistaken for tinea. These other rashes dont necessarily appear in a butterfly shape. If you've seen in your ear nose and throat doctor that might help. Financial Disclosure: Dr. Farel (CME question reviewer) owns stock in Johnson & Johnson. Lesions are characterized by asymptomatic, small, annular papules or plaques with raised borders, typically purple to white in color.24,25 (See Figure 5.) There are different rashes associated with lupus and many don't itch, but some do. Is My Rash Ringworm or Something Else? - lohiderm.com Pityriasis rosea produces diffuse eruption on the trunk and proximal extremities with oval-shaped, scaly plaques. Though it. In: Bolognia JL, Schaffer JV, Cerroni L. Sommer LL, Reboli AC, Heymann WR. Kaushik N, Pujalte GG, Reese ST. Superficial fungal infections. May have a characteristic bulls-eye appearance. Its sometimes itchy but generally isnt painful. Key morphological characteristics of annular lesions can improve diagnostic accuracy, leading to correct initial treatment. Your physician can differentiate these from . J Am Acad Dermatol 2010;62:667-71. Scalp ringworm ( tinea capitis): This causes scaly, red, itchy bald spots on your scalp. Pathogenesis and clinical features of psoriasis. Jock itch, known as tinea cruris, refers to ringworm infection of the skin around the groin, inner thighs, and buttocks. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. Because similar symptoms can occur with other diseases, such as arthritis, fibromyalgia, and thyroid problems, lupus can be difficult to diagnose. Effective sun-protection helps to prevent this rash, which usually develops on the upper back, upper chest, or arms. (2014, March 21). Characteristically anesthetic. Redness and skin discoloration may take longer to go away. One way to make that diagnosis is through a biopsy, in which a doctor takes a tissue sample and examines it under a microscope. Lesions are mildly pruritic and oriented along cleavage lines.12 When stretched, scale hangs, resulting in the pathognomonic hanging curtain sign. Multiple lesions may coalesce, forming a diffuse rash that, when present on the back, exhibits a Christmas tree pattern along Langers lines, the natural folds of the body. There are several lupus subtypes, and each is treated differently. Psoriasis is suggested when lesions occur on the extensor surfaces of the limbs, umbilical region, and sacrum. To learn more, please visit our, It would be very easy for a dermatologist to tell you if you have. Yes: People with lupus can have a variety of cutaneous manifestations. The rash doesnt itch or hurt, but once it fades, it may leave the skin discolored. MD Candidate, Wright State University Boonshoft School of Medicine, Dayton, OH, Richard A. Miller, DO, Program Director, Dermatology Residency Program, Nova Southeastern University College of Osteopathic Medicine/Largo Medical Center, Largo, FL. A small percentage of people will develop both this ring-like rash and the one that looks like eczema or psoriasis. Can have annular lesions. I have lupus & very sensitive skin what kind of sunscreen or block do you recommend or what other things should i do to prevent skin rashes? PDF Lupus and the Skin Learn how we can help 5.9k views Reviewed >2 years ago Thank Dr. PHILIP WALLER and another doctor agree In: Bolognia JL, Schaffer JV, Cerroni L. James WD, Berger TG, Elston DM. Tinea rarely is as widespread, and its lesions generally exude more significant central clearing.12 A negative KOH preparation can be used to exclude tinea. This means the disease is active, causing symptoms. The advancing border is raised and may contain vesicles, pustules, or papules.4 Typically, infection begins unilaterally and extends to the medial thighs, perineum, and anus, sparing the scrotum.5 Tinea cruris commonly is found in conjunction with tinea pedis and/or tinea unguium, as the fungus is spread from the infected foot to the groin when clothing is pulled to the waist.2, For localized tinea corporis or cruris, pedis, and faciei, topical antifungals, such as imidazoles (clotrimazole, miconazole, ketoconazole, econazole, oxiconazole, sulconazole) or allylamines (naftifine, terbinafine), should be used once to twice daily for two to six weeks, including two weeks following clearance.2,6 Nystatin, commonly used to treat Candida infections, should not be used to treat tinea.3, Granuloma annulare (GA) is a relatively common, self-limiting disorder of the dermis that affects women twice as often as men.7 The eruption has a predilection for young adults and children, with most cases presenting before the third decade of life.1,7 Although the etiology remains unknown, GA is controversially associated with diabetes mellitus and hyperlipidemia.8 Several clinical variants of GA exist; however, localized disease primarily affects the dorsal surfaces of the fingers, hands, elbows, feet, and ankles.1,7 Lesions are characterized by asymptomatic, erythematous to violaceus colored papules or plaques with a thin, smooth border.9 Lesions develop slowly, spread peripherally, and involute centrally, conferring an annular appearance.9 An isolated (< 5 cm) lesion on the hand or arm represents most cases.7, Granuloma annulare can be diagnosed clinically by its unique distribution and morphology. They can look like a ring with a darker red circle on the ring's outer edge. In naming dermatophyte infections, the term tinea is used, followed by the Latin name for the anatomical area infected.2 Subtypes include tinea corporis (body), cruris (groin), capitis (scalp), faciei (face), barbae (beard), unguium (nail), and manuum (hand). Parasitic Infestations, Stings, and Bites. Annular LP is a subtype of LP present in 10% of cases and seen scattered among typical lesions described above. Acute cutaneous lupus erythematosus refers to the notorious malar rash that is almost always associated with systemic disease.41 Subacute cutaneous lupus erythematosus (SCLE) describes a photosensitive eruption that commonly forms annular lesions, but is associated with systemic disease only occasionally. . The location is suggestive when plaques are confined to the extensor surfaces of limbs, umbilical region, and sacrum.33 Physically removing scale can produce pinpoint bleeding, referred to as the Auspitz sign, characteristic of psoriasis.32 Extracutaneous manifestations including nail changes and asymmetric, oligoarthritis of the hands and feet commonly are seen in conjunction with cutaneous findings.34. This review also may be helpful especially in cases of suspected tinea that are refractory to treatment. Rarely, patients experience a chronic course lasting longer than six weeks or progress to anaphylaxis.21 In acute cases, a trigger such as infection or allergic reaction may be identified. One symptom. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. Do you know which one? It doesnt mean that all their hair comes out. A rare form of psoriasis, termed annular pustular psoriasis, also is considered when annular lesions are present. Jock itch: Tinea cruris, or jock itch, causes a red, itchy rash in your groin, upper thighs or rectum. Within a few days, smaller lesions appear. When lupus attacks the lungs, it can cause trouble breathing. Cutaneous lupus erythematosus: diagnosis and treatment. Best Pract Res Clin Rheumatol. I had a biopsy on rashes it showed i have lupus. As a general rule, individual wheals do not last longer than 24 hours.20 Urticaria may be accompanied by deeper, ill-defined swellings of the dermis and subcutaneous tissue, termed angioedema.21, Urticaria can be classified as allergic, physical, or idiopathic. In: James WD, Berger TG, Elston DM. These rashes differ a lot. Other eczematous eruptions. Having too few red blood cells can lead to symptoms such as fatigue, shortness of breath, dizziness, and a yellowish color to the skin and eyes (jaundice). For potential or actual medical emergencies, immediately call 911 or your local emergency service. The chronic nature of the disease often leads to complex treatment regimens requiring combination therapy to achieve control. Macrophage/Monocyte Disorders. Once the lupus is under control, the hair grows back in again. Favors the face, upper trunk, and backs of arms. Lupus treatments like immunosuppressants can keep the disease in check, lowering your risk of developing a lupus rash. Retrieved from, What causes hemolytic anemia? Lupus is a systemic autoimmune disease in which the bodys immune system attacks healthy tissues and organs. Seborrheic dermatitis can cause similar symptoms as scalp . Its thought that the rashes occur because of exposure to sunlight, says George Stojan, MD,an assistant professor of medicine in the division of rheumatology at the Johns Hopkins University Medical School and the codirector of the Hopkins Lupus Center in Baltimore. Heres what you need to know about how your rheumatologist can help you deal Lupus is a chronic autoimmune disease that can have serious consequences. Let's look at the support available to you: Yes, about 1 in 10 of the people with lupus are men or assigned male at birth. Most types of lupus are best managed with medication and lifestyle changes. Systemic lupus erythematosus can have dramatic skin involvement that comes in three variants acute, subacute, and discoid. Other Papulosquamous Disorders. (2013, July 12). Like you, Ive had little training in dermatology; most of what I know was learned on the job and through continuing education. Images 6,7: Used with permission of theJournal of the American Academy of Dermatology. Within days, erythematous papules followed by characteristic thin, red, torturous tracts begin to appear.26 (See Figure 6.) Topical 5-fluorouracil with or without topical retinoids; cryosurgery. Discoid sores on your lips or inside of your mouth may develop a type of skin cancer called squamous cell carcinoma. SCLE is characterized by the rapid appearance of small or large, erythematous to pink-colored plaques with raised borders, central clearing, and an easily detached scale.41,42 The eruption is extremely photosensitive and, thus, most commonly will present on the face, upper trunk, and the backs of the arms.41, In differentiating SCLE from other annular lesions, a history of sun exposure in correlation with the appropriate distribution supports the diagnosis. This is a single round or oval-shaped lesion that is 2 to 10 centimeters (cm) in diameter. You can learn more about how we ensure our content is accurate and current by reading our. People with lupus can have a variety of cutaneous manifestations. In: James WD, Berger TG, Elston DM. This condition can occur with certain autoimmune diseases, including lupus, says Stojan. Read More Created for people with ongoing healthcare needs but benefits everyone. Tracts migrate up to several centimeters a day and may disappear then reappear throughout their course.27 Systemic manifestations are not seen, as larvae are unable to invade deeper tissues.27. I trust it will do the same for you. or getting flushed in the face? Tinea is classically more erythematous and scaly than LP, while lesions of GA are less numerous and have smooth borders. Among the common presentations seen on a day-to-day basis are annular lesions. Lupus can cause problems with the kidneys, nervous system, blood vessels, and skin. Silverberg NB. But there's no itching, unlike in the case of ringworm. These lesions can result from a reaction to certain medications. Asymptomatic lesions with smooth, non-scaly contours are differentiated easily from the pruritic, scaly, and rough lesions of tinea. Normally, blood clots form when there is an injury to prevent the body from bleeding too much. Erythema multiforme (EM) is an acute and often recurrent eruption that commonly affects young adults.14 The reaction pattern represents an immune-mediated response to a variety of antigenic agents, most notably herpes simplex. These dermatologists' tips tell you how to protect your skin. The medical term for this type of rash is a malar rash . In contrast, the term nummular, derived from the Latin word nummulus, meaning coin shaped, is used to describe sharply marginated, round to disc-shaped lesions without central clearing. Porokeratosis of Mibelli literature review and a case report. Early in the disease course, a mild flu-like illness consisting of general malaise, fever, headache, nausea, vomiting, arthralgias, myalgias, and photophobia can occur.19 If untreated, the disease can progress over the course of weeks to months, resulting in significant complications such as chronic arthritis, facial nerve palsy, and varying degrees of atrioventricular block.19, Early recognition and accurate diagnosis can prevent progression of disease and subsequent lifelong rheumatologic, neurologic, and cardiac complications.
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