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- One of the great myths of Lyme disease
is that it causes the classic bullseye rash
in the majority of cases.
This is a myth because the average rash of Lyme disease
actually doesn't look like a bullseye.
It is round like a bullseye,
but it doesn't have the concentric ring within a ring
like you'd see in a Target department store bullseye.
That's actually the minority of rashes.
The majority of Lyme rashes actually are round,
but uniformly red or sometimes even darker in the middle
and then fade out towards the edges.
So when these rashes appear
without the classic target lesion,
people often dismiss them
and don't think they're Lyme disease.
That's a huge mistake.
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Another myth about Lyme disease
is that everyone has a rash.
Unfortunately not everyone has
or recognizes a rash of Lyme disease.
This may occur because the rash is in an area
where they can't see it.
It may occur in dark-skinned individuals
where the rash isn't as apparent.
It also just doesn't appear in some people.
It's known that not everyone with acute Lyme disease
will have a rash.
When this occurs, it becomes very difficult
to make a diagnosis.
If the patient with acute Lyme disease does not have a rash
and only has those flu-like symptoms,
acute Lyme disease looks like any of a number of infections.
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The common cause of misdiagnosis in early Lyme disease
is the failure of people to recognize the Lyme rash.
Both patients and clinicians often attribute Lyme rashes
to non-specific bug bites or spider bites
because when they don't see the ring
within a ring target appearance, they dismiss the round
or oval red lesion as just a bug bite or a spider bite.
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Early Lyme disease is what we call a clinical diagnosis.
The diagnosis of early Lyme disease
is based on the accurate identification of the Lyme rash.
This is so important because the blood tests
actually don't work in the early initial weeks
of Lyme disease.
It takes several weeks for the body's immune system
to make the antibodies that are measured
by the Lyme disease blood test.
During this initial two to three week period,
the blood tests for Lyme disease will be negative.
In that period, the antibodies haven't formed
to a high enough level to give a positive blood test.
The basis of the diagnosis of acute Lyme disease
is the accurate identification of the Lyme disease rash.
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Our research has been trying to focus on ways
to aid patients and physicians in the identification
of this critical Lyme disease diagnostic rash.
One way we've found to be helpful
is actually through the training of computers
to do computerized deep learning or image recognition.
This is similar to the way cars are taught
to drive without a driver.
They're taught to identify features in the environment.
Similarly we've taught computers
to identify the typical Lyme rash based on photographs
that patients take of their skin.
Using patient-obtained images from cell phones,
we've been able to train computers to read the rash.
We've found that the computer is actually more accurate
than humans at identifying the Lyme disease rash.
If you have hundreds or even thousands of images,
the computer can be trained in a way
that it recognizes all the variations in the rash,
not just the rare classic ring within a ring target lesion,
but all the variants that don't have the target appearance,
all the variants that may be reddish blue instead of red,
all the variants that may be oval instead of round.
Computerized identification of Lyme rash
really has the promise to cut down on misdiagnosis.
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Our future plans are to integrate
this computerized reading of Lyme rashes
and eventually to integrate that into telehealth.
We've already begun
doing telehealth diagnosis of Lyme disease.
When I see those images on the patient's medical record,
I can consult with them via televisits
and make a diagnosis of acute Lyme disease
based on their story and the image of the rash
that are all there on a televisit.
They're obtained in a way that's private
and into a confidential medical record
that includes their pictures.
The combination of talking to the patient on a televisit
with those uploaded images of their skin rash,
we can accurately make the diagnosis of acute Lyme disease
without the patient ever having to come into the office.
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