Role of Borrelia burgdorferi in the pathogenesis of morphea/scleroderma and lichen sclerosus et atrophicus: a PCR study of thirty‐five cases

Abstract

Morphea (localized scleroderma), and lichen sclerosus et atrophicus (LSA) share common features with acrodermatitis chronica atrophicans (ACA), a known chronic form of borreliosis. These include similar histologic findings such as diffuse dermal fibrosis. These observations have led several investigators to consider the possibility of Borrelia burgdorferi (Bb) as a common etiologic factor among all of these diseases. The aim of this study is to investigate the role of Bb in the pathogenesis of morphea and LSA, by assaying for its presence in lesional skin biopsies from patients with these diseases. We utilized the nested polymerase chain reaction (PCR) technique to selectively amplify a longer segment of a Bb-specific somatic gene, on DNA from paraffin-embedded, formalin-fixed tissues. The results revealed no Bb-specific DNA sequence in 28 specimens of morphea/scleroderma and 7 of LSA with varying stages of disease. Furthermore, confirmatory Southern blot of the PCR product, resulted in similar findings. These data seriously question the role played by this spirochete in the pathogenesis of morphea and LSA, at least in the southeastern part of the USA.

Chronic Borreliosis Presenting with Morphea- and Lichen sclerosus et atrophicus-Like Cutaneous Lesions

“…However, the link between borreliosis, morphea and LSA has been controversial [7, 8]. The attempts to detect B. burgdorferi in the lesions of morphea and LSA by PCR techniques by different investigators have been unsuccessful, questioning the role of this microorganism in the pathogenesis of these diseases [9, 10]. On the other hand, coexistent ACA and morphea have also been reported [11].…”

Possible Role of Borreliaburgdorferi Sensu Lato Infection in Lichen Sclerosus

“…Thus, the reliability of the DNA extraction method for small DNA amounts or the PCR technique used in these studies remains somewhat debatable. 14,16 There is still another explanation for negative PCR results: B burgdorferi sensu lato includes B burgdorferi sensu stricto, Borrelia garinii and Borrelia afzelii VS461, but newer Borrelia species have been identified. The pathogenic significance of these species, such as Borrelia valaisiana, B hermsii, Borrelia turicatae, Borrelia duttonii, B parkeri, and most recently Borrelia spielmanii is not yet fully answered.…”

Methodological Aspects

“…However, samples of skin lesions from patients with morphea were positive by PCR in other German studies (151,152,183) and in 6 of 10 patients in Italy (176). In North America, B. burgdorferi DNA was undetectable in patients with morphea, as shown by tests with different sets of primers (33,35,41,113). These negative findings might be because B. burgdorferi sensu stricto, the predominant strain in North America, has never been found associated with late dermatological manifestations of Lyme disease.…”