FURTHER EVIDENCE FOR BORRELIA-BURGDORFERI INFECTION IN MORPHEA AND LICHEN-SCLEROSUS-ET-ATROPHICUS CONFIRMED BY DNA AMPLIFICATION

We present further evidence in support of the notion that Borrelia bur gdorferi is possibly involved in the pathogenesis of morphea and liche n sclerosus et atrophicus (LSA). Running a nested polymerase chain rea ction (PCR) with a primer set specific for the flagellin gene of B. bu rgdorferi enabled us to demonstrate the presence of Borrelia DNA in sk in biopsies of patients with morphea (nine of nine) or LSA (six of six ). Biopsy specimens obtained from patients with erythema chronicum mig rans (two patients, four of four samples) and acrodermatitis chronica atrophicans (one patient, one of one sample) also showed positive PCR results. By contrast, there was no amplification of Borrelia DNA in co ntrol biopsies either from patients with chronic eczema (three of thre e) or psoriasis (two of two) or from normal skin (three of three). Ant ibodies directed against B. burgdorferi were only detected in the seru m of patients with erythema chronicum migrans (two of two) and acroder matitis chronica atrophicans (one of one) but were not present in case s of morphea (five of five), LSA (three of three), or in control subje cts (three of three). These data suggest that B. burgdorferi may play a role in the pathogenesis of both morphea and LSA. Furthermore, we co nclude that PCR analysis provides an important diagnostic tool, even i n seronegative Borrelia infections.