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In Reply: We agree with Dr Norton that many patients with erythema migrans are asymptomatic and that when pruritis or local discomfort does occur, these symptoms are typically mild. Nevertheless, pruritis was reported in approximately 33% of North American (Lyme-endemic) cases, 42% of nonendemic North American cases, and 38% of European cases in the case series we reviewed in our article.

As Norton states, the information in Table 2 regarding granuloma annulare was erroneous. Granuloma annulare does not tend to scale.¹

Financial Disclosures: None reported.

Carrie Tibbles, MD
ctibbles@bidmc.harvard.edu

Jonathan Edlow, MD
Department of Emergency Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts

1. Cyr PR. Diagnosis and management of granuloma annulare. Am Fam Physician. 2006;74(10):1729-1734. ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298:1160.

RELATED LETTER

Diagnosis of Erythema Migrans
Scott A. Norton
JAMA. 2007;298(10):1159-1160.
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