Is my daughter's rash a lyme rash?

My 21 month old daughter got what looked like 2 bad mosquito bites 11 days ago.  Over the course of a few days the "bites" got redder and bigger.  The pediatrician said they were spider bites.  After that, she developed an oval shaped patch that encompassed both bumps.  The bumps went away and there are two punctures in their place.  The oval shape is a rough texture and has gotten redder and larger for days.  She is now on Augmentin (the ped thought the "bites" became infected) and a strong rx steroid cream.  I took her to two infectious disease specialists and two dermatologists as well as an allergist and nobody knows what is going on.  It's early to test for lyme, but we had a blood test done this morning anyway.  I'm not sure what to do and am pretty worried about her.  I'll post a picture of her leg rash after about 7 days and then two taken today.  Please help with any comments.  She has not had a fever or any other symptoms, but I'm very worried.

http://img.makeupalley.com/2/7/8/7/2078866.JPG

http://img.makeupalley.com/2/7/8/7/2080389.JPG

http://img.makeupalley.com/2/7/8/7/2080387.JPG

[JackieCalifornia]

Poor little one!  She is lucky you take it seriously.  It's easy to overlook things like that.

First thing:  I'm not medically trained, nor is anyone here that I am aware of, so we're just going on whatever we've encountered.

That said:  not everyone with Lyme gets a rash at all.  And a lot of those who get rashes don't always get the classic bullseye-shaped rash that docs are taught is a prerequisite for Lyme diagnosis.  AND Lyme ticks often (maybe half the time) carry other diseases in addition to Lyme, so that could mess up the look of the bite area, perhaps.

I don't know that Augmentin is effective against Lyme, but I'd think about asking the docs, who seems to be trying!, about treating your daughter with antibiotics that would be more likely effective against Lyme, like doxycycline.  I believe doxy can be contraindicated in children, tho, because it can damage the enamel of developing teeth, but maybe there is something else.  I had Lyme (as an adult, so no enamel issues) and was treated with other antibiotics, so I know it's possible.  I think docs who are not Lyme specialists tend to default to doxy, because it was the first drug used to treat Lyme.  There are other possibilities, tho.

I don't think fever necessarily occurs with Lyme.

And btw, steroids (at least oral) are contraindicated in Lyme, because it suppresses the immune system, which is what you don't want to do in a bacterial infection.  Whether that's true of topical steroids, I don't know, but it would be less likely to be harmful, I would guess.  But like I said, I'm not medically trained, and anyway little ones react differently to things compared to adults.

If you want data, I'd suggest ILADS dot org, which is the main organization of Lyme specialists (LLMDs, which is a slang term used by patients to signify a doc who thinks progressive thoughts about Lyme cf to the standard views held by most infectious disease docs and neurologists, who were the first to study Lyme and really haven't moved on as more has been learned about Lyme.

At the ILADS website, the tab 'About Lyme' has a pdf by Joseph Burrascano MD, called 'Diagnostic Hints etc.'.  It's a few years old now, but still useful, and written in a fairly accessible fashion.  You might also look at the Columbia U medical center Lyme website. There is a lot of research being done there.

There are a lot of other patient-oriented websites similar to this one that vary in quality.  truthaboutlymedisease is one that I think is pretty well thought of.  You may also find one in your area.  If you live in, say Philadelphia, you can search LLMD Philadelphia or Lyme Philadelphia and see what hits you get.  Because this is a rogue and developing area of medicine, keep your suspicion level high, and know that your doc may think you're wacko for considering Lyme as something very serious ... which is definitely is.

Points to you for watching out for your daughter.  The faster she is diagnosed, the better, because once Lyme established (if that's what she has), the surer the cure.

Let us know how she does, ok?  Best wishes to you both --

[JackieCalifornia]

Sorry, I should proofread BEFORE I post.  The second to last paragraph above should say:

"Points to you for watching out for your daughter.  The faster she is diagnosed, the better, because once Lyme IS established (if that's what she has), the MORE DIFFICULT AND LESS SURE the cure."  That is:  treat it fast, if it's Lyme.

[tiffw]

Thank you for your very helpful response!

She is too young for doxycycline (only 21 months) and I've read augmentin is ok (it's amoxicillin with a booster) on the website you suggested.  I am incredibly worried for her because the rashes are not improving at all.  I will cease the steroid cream immediately.  I wish more doctors knew this kind of thing, how frustrating.  I look forward to the results of her lyme blood test, but know that these tests are often not helpful most of the time.  Uggh!

Also, have you ever seen puncture marks in a lyme rash like my daughter has?

Thanks,
Tiffany

[JackieCalifornia]

Please don't stop the steroid cream on account of my remark!  I *really* am not medically trained and don't want to inadvertently cause your baby harm.

I thought the same about the 'bite'-like marks ... and the raised nature of the rash.  I never had a rash with Lyme, but the photos I have seen are flatter, redder, and seem ... thinner.  You can search on google under images for 'lyme rash'.  There are a ton of them.

If the doc can't tell from the tests whether he thinks it's Lyme, then the good news is that you saw the bite and acted right away, so antibiotics would stand a very good chance of heading off trouble.  It's the entrenched infections that are difficult to dislodge.

As far as I can tell, you're doing everything I would do.  Take care of yourself, get some sleep, your baby needs to see your smiling face.

Keep us posted, ok?