Can Lyme Disease Be Mistaken for Herpes? Atypical Rash Explained
Lyme rashes are not always classic
Blistering lesions can mimic herpes
Misdiagnosis can delay treatment
Lyme disease mistaken for herpes is a recognized clinical problem when rashes do not follow the classic bull’s-eye pattern.
In the report “Disseminated Lyme disease with a herpetiform center”, Zhang and colleagues describe a patient whose rash resembled herpes rather than typical erythema migrans.
This type of presentation highlights the variability described in the Lyme disease symptoms guide, where early signs are often atypical.
Case: Lyme Disease Mimicking Herpes
A woman in her 30s developed a rash that began as a small red bump with surrounding swelling.
Additional findings included:
- Rash in the left armpit
- Swollen lymph node on the same side
- Progression to larger, painful lesions
She was initially treated with antibiotics for presumed cellulitis. However, the rash continued to worsen.
Skin examination revealed a circular erythematous plaque with a central cluster of vesicles and bullae—features resembling herpes.
Atypical Lyme Rash: Vesiculobullous Erythema Migrans
This case was diagnosed as vesiculobullous erythema migrans, an uncommon form of Lyme disease rash.
Blistering or vesicular Lyme rashes may resemble herpes, cellulitis, or other skin conditions.
Two additional rashes on the chest and breast supported early disseminated Lyme disease.
These atypical presentations are also discussed in Lyme disease rash misdiagnoses, where non-classic patterns lead to confusion.
Response to Treatment
The patient completed a course of doxycycline and experienced full resolution of symptoms.
However, she also developed a Jarisch-Herxheimer reaction shortly after starting treatment—a temporary worsening of symptoms seen in some Lyme cases.
Follow-up testing confirmed Lyme disease with positive antibody and Western blot results.
Why Lyme Disease Is Misdiagnosed as Herpes
Several factors contribute to confusion:
- Blistering or vesicular rash appearance
- Painful skin lesions
- Lack of classic bull’s-eye pattern
- Overlap with other dermatologic conditions
Because of this variability, Lyme disease may be missed unless clinicians consider atypical presentations.
Why This Matters
Misdiagnosis can delay appropriate treatment.
Not all Lyme rashes look like a bull’s-eye—recognizing atypical patterns is critical.
Failure to identify Lyme disease early may allow progression to disseminated infection.
For more on early treatment decisions, see tick bite treatment considerations.
Clinical Perspective
Lyme disease should remain in the differential diagnosis when evaluating unusual or blistering rashes.
In endemic areas, clinicians should consider Lyme disease even when the rash resembles herpes or other skin conditions.
Early recognition improves outcomes and prevents progression.
Frequently Asked Questions
Can Lyme disease look like herpes?
Yes. Some Lyme rashes form blisters or vesicles, making them resemble herpes lesions.
What is vesiculobullous erythema migrans?
It is an atypical Lyme rash with blistering or bullous features rather than a classic bull’s-eye appearance.
Why is Lyme disease misdiagnosed?
Symptoms and rashes can vary widely and may mimic other conditions.
Does Lyme disease always cause a bull’s-eye rash?
No. Many patients have atypical rashes or no rash at all.
Does treatment still work if diagnosis is delayed?
Yes, but earlier treatment generally leads to better outcomes.
Related Reading
- Erythema Migrans Rash Variations
- Lyme Disease Rash Misdiagnoses
- What Does a Lyme Disease Rash Look Like?
References
- Zhang ZZ, Hashemi DA, Kroshinsky D. Disseminated Lyme disease with a herpetiform center. JAAD Case Rep. 2022.
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
My daughter went through this, but vaginal and buttocks. She was told it’s herpes and EBV . A couple of months later we finally found a specialist who diagnosed her with Lyme/Morgellons.
Diane,
bless you for continuing to look for the real cause.
This disease is mind boggling when we put all of our symptoms out there. Some of which can be embarrassing when it comes to look like an std. who wants to go tell a doctor that we have issues in this area but we know we’ve never done anything to cause. Seems like an unending problem.
I do wish for all who go through Lymes/coinfections to be healed in the Name of Jesus and lord please really soon
What an interesting case to highlight. Thank you.
Thanks. And thanks for your work.
Who was the specialist
Also looks like bacillary angiomatosis from bartonella spp
Good morning, Thank you so much for helping people all over the world with Lyme.
May you consider evaluating the sufferings of a teenager who is expected to undergo surgery soon to remove “under the arm skin complications”? She has suffered for years. She has been diagnosed with hidradenitis suppurativa which is a rare disease of which there is not a lot of information. She suffers pain, besides all the complications of numerous skin lesions, etc. physically, emotionally and mentally.
Is it possible that Lyme disease could be the underlying issue?
I know you cannot diagnose over the Internet, but any feedback will help.
I appreciate your expertise and support to the population dealing with Lyme disease. I have been diagnosed with Lyme disease – June 2021.
I have not seen a case of Hidradenitis suppurativa in my Lyme disease patients. Their painful skin condition would typically be followed by a dermatologist. I have had patients with Lyme disease that has been overlooked while being treated for another condition.
I was treated for Lyme for 10 days with Doxycycline Hyclate 100 MG CAP, two days after taking the last cap I got a tiny tick behind my knee. I developed a rash over practically my entire leg with little swelling, redness and itching worst than I can describe. Called my doctor and he said I was probably still protected from taking the meds ending two days ago, and did not need to see me. I called my GP again and they told me to go to Urgent Care if I was conserned and gave me an appointment for Tuesday, a week after calling them. I did go to UC because it was not getting better, it was red, swollen some and a rash that wouldn’t stop. At the UC I was prescribed Triamicinolone Acetinide Ointmrnt USO and 14 days Doxycycline Mono 100MC CAP. I was told to use the ointment and take the meds in 2 days if it doesn’t improve.The rash is not quite as bad after 1 day but the red around the bite still there, swelling gone down. I don’t know whether I should take the meds or not, as too much taking antibiotics can also cause problems. I still have an appointment with my GP in 3 days. This is rediculouse…..I know Lyme is in my system, will I ever get rid of it?
I am sorry to hear how complicated things have become. It typically use an individualized plan. I also consider Babesia, a coinfection