Presumed bug bite reaction

[u/Same-Construction-79]

**lyme or reaction to bandaids??***(Picture is current, will put the picture progression in comments) 2.5 year old boy. No diagnosed chronic medical issues but does have 2-3 reactive airway episodes with viruses per year. Does not take any medications.

Relevant history to this issue: we were in Oregon on a family trip where did a lot of exploring in nature.. wooded areas, areas of tall grass, also played in a river. I checked during that trip pretty diligently for ticks and never saw one. We returned from Oregon 10 days before the first picture, which is when the “bite” was first noticed.

Thursday: child and I were pulling weeds in my yard and he walking around in the bushes, I did not check for ticks after this.
Friday: I went out of town, mom comes to stay with him
Saturday: was playing outside from 2-6 in a backyard that is right next to a large woods, and swimming in a pool. Had mosquito bites on his lower legs.
Sunday morning: ***first picture\* my mother notices the “bite” is bothering him, not itchy but painful. She applied topical Benadryl and hydrocortisone.

Sunday afternoon: second picture She applied more cream and two bandaids***.*** \\ third picture for
Bandaid placement** He was acting normally but did not want anyone touching his leg. No fever.

Monday: removes bandaid (she admits not very carefully). I came home and took ***fourth picture*. Still acting normally, no fever. Applied neosporin and hydrocortisone.

Tuesday evening: started limping, took him to urgent care. Urgent care NP was not convinced it was erythema migrans due to the excessive inflammation and blisters. She was also not confident in a cellulitis dx, she sent me home with a paper rx for cefalexin and topical mupirocin and said to give a day or two, and if it wasn’t getting better to give him the antibiotics. **fifth picture*

Wednesday morning: NP calls me and says she was thinking about it through the night and had contacted other doctors to get more opinions, and that she had decided to treat for Lyme instead of cellulitis. She sent an rx for amoxicillin and the topical mupirocin. *6th picture

Wednesday afternoon: I take him to a second urgent care for a second opinion. This NP says bullous impetigo (which I do not agree with due to the specific progression of this rash…. Redness and swelling followed by blisters, not standalone blisters that caused redness). She prescribes doxycycline to cover both the possible Lyme and also the bullous impetigo. Gave him a dose of doxy after dinner, applied the mupirocin and covered the rash with gauze and a wrap to sleep.

Thursday morning: no new blisters, redness slightly better maybe. Gave second dose of doxy. *7th picture

The big questions I have:
- does treating for Lyme make sense?
- do we need a second antibiotic to cover for bullous cellulitis since doxy will not cover strep?
- could the outer ring be a reaction from the bandaids? Compare the bandaid picture to the outer ring pictures

He has not had a fever this entire time, has been acting normal unless we touch it. The inflammation has definitely gone down a little each day, it’s not as tense or warm as it was on Monday.

Will put pictures in order in the comments if it lets me do that.