Multiple lesions of erythema migrans in a “Christmas tree” pattern as a presenting sign of Lyme disease

The “Christmas tree” orientation of scaling lesions along the skin tension (Langer) lines in pityriasis rosea is well known. This pattern is best appreciated on complete examination of the trunk, in which the eruption follows the long axis of the V-shaped lines of the upper chest and back, emanating around the axillae, and running transversely along the abdominal wall and lower back. Secondary syphilis has a similar presentation. When patients present with asymptomatic, larger, nonscaling patches along Langer lines, another condition deserves diagnostic consideration.
Source: Journal of the American Academy of Dermatology - Category: Dermatology Authors: Tags: JAAD Online Source Type: research