title: Possible role of Borrelia burgdorferi sensu lato infection in lichen sclerosus.
abstract: OBJECTIVE
  To assess the evidence for Borrelia burgdorferi sensu lato infection in patients with lichen sclerosus by focus-floating microscopy.
  
  
  METHODS
  Dermatology department of a university hospital.
  
  
  METHODS
  Tissue sections were stained with a polyclonal B burgdorferi antibody using standard histological equipment and then scanned simultaneously in 2 planes: horizontally in a serpentine-like pattern and vertically by focusing through the thickness of the section, ie, focus-floating microscopy. Part of the material was also investigated by Borrelia-specific polymerase chain reaction.
  
  
  METHODS
  The study population comprised 61 cases of lichen sclerosus and 118 controls (60 negative controls and 68 positive controls).
  
  
  METHODS
  The presence of B burgdorferi sensu lato within tissue specimens.
  
  
  RESULTS
  Using focus-floating microscopy, we detected Borrelia species in 38 of 60 cases (63%) of lichen sclerosus and in 61 of 68 (90%) of positive controls of classic borreliosis, but Borrelia species were absent in all negative controls. Borrelia species were detected significantly more often in early inflammatory-rich (31 of 39 [80%]) than in late inflammatory-poor (7 of 21 [33.3%]) cases (P = .001). Polymerase chain reaction findings were positive in 25 of 68 positive controls (37%) and negative in all 11 cases of lichen sclerosus and all 15 negative controls.
  
  
  CONCLUSIONS
  Focus-floating microscopy is a reliable method to detect Borrelia species in tissue sections. The frequent detection of this microorganism, especially in early lichen sclerosus, points to a specific involvement of B burgdorferi or other similar strains in the development or as a trigger of this disease.
authors.affiliation: Department of Dermatology and Venerology, Innsbruck Medical University, Anichstr 35, 6020 Innsbruck, Austria. Klaus.eisendle@uki.at
authors.forename: Klaus
authors.initials: K
authors.lastname: Eisendle
authors.forename: Tanja
authors.initials: T
authors.lastname: Grabner
authors.forename: Heinz
authors.initials: H
authors.lastname: Kutzner
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zelger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015748:Borrelia burgdorferi Group / Q000235:genetics / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D018459:Lichen Sclerosus et Atrophicus / Q000382:microbiology*; D008193:Lyme Disease / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008853:Microscopy / Q000379:methods; D008875:Middle Aged; D016133:Polymerase Chain Reaction
chemical_list: D004269:DNA, Bacterial