Bell’s Palsy and Lyme Disease: Why Steroids May Worsen Outcomes
Bell’s palsy is often treated with steroids. But when Lyme disease is the cause, that approach may lead to worse outcomes.
A 46-year-old man developed facial palsy after frequent hiking in tick-endemic regions of New England, Quebec, and Ontario. Clinicians recognized the signs of Lyme disease and treated promptly with antibiotics—while avoiding corticosteroids.
The Clinical Presentation
Lyme disease commonly presents with erythema migrans and arthritis, but neurologic findings are also well recognized. According to a case review, Bell’s palsy has been reported in 8.2% of Lyme disease cases in Canada.
The patient presented with left facial drooping and inability to fully close his eye. He also had multiple erythema migrans lesions and a history of outdoor exposure in endemic regions.
Why Avoiding Steroids Matters
The clinicians diagnosed early disseminated Lyme disease and initiated doxycycline without waiting for confirmatory testing.
This decision was important. Treating Lyme-associated facial palsy as idiopathic Bell’s palsy—where steroids are commonly used—can lead to harm.
One study found worse long-term outcomes in patients with Lyme-related facial palsy who received corticosteroids.
For more on diagnostic challenges, see Lyme disease misdiagnosis.
Treatment Considerations
The authors recommended confirmatory testing with Western blot, extending antibiotic therapy to 21 days, and close follow-up.
Most patients with Lyme-associated facial palsy improve with treatment. However, some patients continue to experience symptoms, highlighting the need for individualized care.
For a broader neurologic overview, see Neurologic Lyme disease.
Clinical Perspective
This case illustrates the importance of recognizing Lyme disease as a cause of Bell’s palsy.
Key clinical clues include:
- Tick exposure or outdoor activity in endemic regions
- Presence of erythema migrans (especially multiple lesions)
- Seasonal timing
Early recognition allows for prompt antibiotic treatment and helps avoid therapies—such as corticosteroids—that may worsen outcomes in bacterial infection.
Clinical Takeaway
Bell’s palsy can be an early neurologic sign of Lyme disease. When Lyme is suspected, prompt antibiotic treatment and avoidance of corticosteroids may improve long-term outcomes.
Frequently Asked Questions
Can Lyme disease cause Bell’s palsy?
Yes. Bell’s palsy is a recognized neurologic manifestation of Lyme disease and may occur during early dissemination.
Why can steroids be harmful in Lyme-related Bell’s palsy?
Steroids may suppress immune response to active infection and have been associated with worse long-term outcomes in Lyme-associated facial palsy.
How do clinicians distinguish Lyme from idiopathic Bell’s palsy?
Clues include tick exposure, outdoor activity in endemic regions, erythema migrans rash, and timing during tick season.
Do most patients recover?
Many patients improve with appropriate antibiotic treatment, though some may have persistent symptoms requiring follow-up.
How long is treatment?
Treatment often extends to 21 days or longer for neurologic Lyme disease, depending on clinical response.
Related Reading:
Lyme Disease Misdiagnosis
Neurologic Lyme Disease
Steroids Harmful in Lyme Bell’s Palsy
Bell’s Palsy in Children with Lyme
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
An incident of Bell’s palsy and slurred speech along with a visit to a Lyme literate doctor in the same week changed the course of my life and health. I didn’t choose the Lyme literate doctor but was the driver of a Lyme patient which gave me an “unofficial” visit with the doctor who found my illness that had little by little impacted my life for 13 plus years.