Skin Manifestations of Lyme Borreliosis

Abstract

Lyme borreliosis is a multisystem infectious disease caused by tick-transmitted spirochetes of the Borrelia burgdorferi sensu lato complex. The three characteristic cutaneous manifestations are erythema migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans. Erythema migrans occurs in acute Lyme borreliosis, lymphocytoma is a subacute lesion, and acrodermatitis is the typical manifestation of late Lyme borreliosis. Clinical appearances of erythema migrans and lymphocytoma (when located on the ear or breast) are characteristic, whereas acrodermatitis is often confused with vascular conditions. The diagnosis of erythema migrans is made clinically. Serologic analyses often yield false-negative results and are not required for the diagnosis. However, serologic proof of the diagnosis in lymphocytoma (approximately 90% positive) and acrodermatitis (100% positive) is mandatory. Histopathologic examination often adds substantial information in patients with skin manifestations of Lyme borreliosis and is recommended in clinically (and serologically) undecided cases of erythema migrans or lymphocytoma and is obligatory in acrodermatitis. Polymerase chain reaction for Borrelia-specific DNA (rather than culture of the spirochete) and immunohistochemical investigations (lymphocytoma) are sometimes necessary adjuncts for the diagnosis. Antibacterial treatment is necessary in all patients to eliminate the spirochete, cure current disease, and prevent late sequelae. Oral doxycycline, also effective against coinfection with Anaplasma phagocytophilum, is the mainstay of therapy of cutaneous manifestations of Lyme borreliosis. Other first-line antibacterials are amoxicillin and cefuroxime axetil. Erythema migrans is treated for 2 weeks, lymphocytoma for 3-4 weeks, and acrodermatitis for at least 4 weeks.

Lobular Panniculitis due to Borrelia burgdorferi Infection Mimicking Subcutaneous Panniculitis-Like T-Cell Lymphoma

“…(2), (3), (4), (5), (6), (7), (8) Panniculitis is an extremely rare presentation of borreliosis, described to date only in a handful of cases. (9), (10), (11) We present a patient with Borreliosis in whom an initial biopsy revealed lobular panniculitis with a dense infiltrate containing atypical cells with cytotoxic phenotype thus closely mimicking subcutaneous panniculitis-like T-cell lymphoma, a manifestation not previously reported to our knowledge.…”

Rezidivierende Ohrschwellung

“…Der mykologische und bakterielle Abstrich von der betroffenen Ohrmuschel und dem Gehörgang waren ohne pathologischen Befund. Die bei unserem Patienten vorliegende kutane Lyme-Borreliose wird in drei Stadien unterteilt, die lokalisierte kutane Frühinfektion (Erythema migrans, Borrelien-Lymphozytom) [ 4 ] , die disseminierte kutane Frühmanifestation (multiple Erythemata migrantia) und die kutane Spätmanifestation (Acrodermatitis chronica atrophicans) [5][6][7] .…”

Therapy of Lyme Disease

“…The treatment duration for all three drugs is 21 days (range 14-30 days) (38). An alternative therapy advised by some authors is intravenous cefotaxime 50 mg/kg/day in one dose (maximum dose 2,000 mg/day) for at least 4 weeks [55]. Importantly, high quality controlled studies comparing oral and parenteral antibiotic for the treatment of acrodermatitis chronica atrophicans are missing [11].…”