Letters Section Editor: Robert M. Golub, MD, Senior Editor.
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
Tibbles C, Edlow J. Diagnosis of Erythema Migrans—Reply. JAMA. 2007;298(10):1159-1160. doi:10.1001/jama.298.10.1160-a