[The spectrum of Lyme borreliosis from the dermatologic viewpoint]

Erythema chronicum migrans, lymphadenosis benigna cutis and acrodermatitis chronica atrophicans represent the dermatological manifestations of the multi-organ disease Lyme borreliosis. Koch's requirements of evidence for an infectious disease, demonstration of the bacterium, transfer, and culture have proven Borrelia burgdorferi to be the causative agent of the above mentioned skin diseases. This justifies a penicillin therapy, that has been administered in Europe empirically for the last 30 years. Correct and prompt diagnosis is important since delayed treatment is less effective, presumably because the spirochete becomes sequestered in immune-privileged sites. Recent observations in several laboratories that antibody titers to Borrelia burgdorferi are also elevated in several other skin diseases and that the spirochete can be detected in tissue sections of different organs may imply extension of the dermatological spectrum of Lyme disease. The significance of these findings in such heterogeneous diseases as morphea, lichen sclerosus et atrophicans, etc. however awaits final examination.