Figure 1.

Middle-aged female with two types of rashes on left knee: (A) homogeneous rash with a punctum in the centre, 12 d after tick bite; (B) early inflammatory phase of acrodermatitis chronica atrophicans (ACA) rash, reddish-blue discoloration with punctum, 14 d after tick bite; (C) early inflammatory phase of ACA, more pronounced, extensive purple discoloration, 24 d after tick bite; (D) purple discoloration fading as spirochetes disseminate, 52 d after tick bite; (E) second rash, homogenous type, on inside of left knee with partial reddish-blue discoloration, punctum from tick bite is apparent; and (F) second rash, homogeneous type, purple discoloration fading, and punctum evident.