title: Morphoea is neither associated with features of Borrelia burgdorferi infection, nor is this agent detectable in lesional skin by polymerase chain reaction.
abstract: BACKGROUND
  The aetiology of morphoea is still unknown. Borrelia burgdorferi as a causative agent of morphoea has been discussed since 1985, but the relationship remains uncertain.
  
  
  OBJECTIVE
  We aimed to find evidence for infection with B. burgdorferi by combined evaluation of different clinical and laboratory data in a group of 54 patients with morphoea.
  
  
  METHODS
  In each patient, an evaluation of the case history was performed with regard to infection with B. burgdorferi, using a standardized questionnaire. Questions focused on previous tick bites and skin changes suspicious for erythema migrans (EM). The case history data of 52 patients were compared with those of 104 matched control subjects and of 25 patients with acrodermatitis chronica atrophicans (ACA). Serological examinations were performed in 53 patients with morphoea. Furthermore, lesional skin was examined for borrelial DNA in 33 patients, using nested polymerase chain reaction (PCR) for the ospA and the borrelial rRNA gene.
  
  
  RESULTS
  Results of the questionnaire showed no differences between patients with morphoea and matched controls. In contrast, patients with ACA showed a much higher prevalence of tick bites and skin changes suspicious for EM as compared with patients with morphoea. Serological examination was positive in only one patient with morphoea alone and in two additional patients with coexistent ACA. No borrelial DNA was detected by PCR in lesional skin of 33 patients with morphoea.
  
  
  CONCLUSIONS
  No evidence was found for B. burgdorferi infection in patients with morphoea.
authors.affiliation: Department of Dermatology, Eberhard-Karls-University of Tübingen, Liebermeisterstrasse 25, D-72076 Tübingen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Weide
authors.forename: B
authors.initials: B
authors.lastname: Schittek
authors.forename: T
authors.initials: T
authors.lastname: Klyscz
authors.forename: K
authors.initials: K
authors.lastname: Schüz
authors.forename: M
authors.initials: M
authors.lastname: Stark
authors.forename: G
authors.initials: G
authors.lastname: Rassner
authors.forename: B
authors.initials: B
authors.lastname: Wilske
authors.forename: C
authors.initials: C
authors.lastname: Garbe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000907:Antibodies, Bacterial / Q000097:blood; D001733:Bites and Stings / Q000150:complications; D015748:Borrelia burgdorferi Group / Q000276:immunology / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D012594:Scleroderma, Localized / Q000382:microbiology*; D017192:Skin Diseases, Bacterial / Q000382:microbiology*; D013987:Ticks
chemical_list: D000907:Antibodies, Bacterial; D004269:DNA, Bacterial