Southern Tick-Associated Rash Illness: Erythema Migrans Is Not Always Lyme Disease

Lucas Blanton, MD; Brad Keith, MD; Walter Brzezinski, MD


South Med J. 2008;101(7):759-760. 

In This Article

Abstract and Introduction


Southern tick-associated rash illness (STARI) is a rash occurring after a tick bite. It is a form of erythema migrans, an annular rash with central clearing that is almost identical with the erythema migrans seen in Lyme disease. The etiologic agent is not known but may be a Borrelia species. The tick vector is different in the two diseases. Serious systemic complications are not currently recognized with STARI but treatment with doxycycline is prudent. Differentiating STARI from Lyme disease is discussed.


Erythema migrans is an annular rash that expands from an initial erythematous macule or papule. As the rash border expands, it leaves a partial central clearing.[1] Early Lyme disease is characterized by erythema migrans. In the Southeast it is not uncommon to see Lyme disease-like illnesses associated with tick bites. This Lyme-like entity has been termed southern tick-associated rash illness (STARI), Master disease, and southern Lyme disease. Below are brief descriptions of Lyme disease and its Southeastern mimicker to help raise clinical awareness in the Southeast.


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