Morphoea is neither associated with features of Borrelia burgdorferi infection, nor is this agent detectable in lesional skin by polymerase chain reaction

Background The aetiology of morphoea is still unknown. Borrelia burgdorferi as a causative agent of morphoea has been discussed since 1985, but the re lationship remains uncertain. Objectives We aimed to find evidence for infection with B. burgdorferi by c ombined 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 wi th regard to infection with B. burgdorferi, using a standardized questionna ire. Questions focused on previous tick bites and skin changes suspicious f or erythema migrans (EM). The case history data of 52 patients were compare d with those of 104 matched control subjects and of 25 patients with acrode rmatitis chronica atrophicans (ACA). Serological examinations were performe d 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 a s compared with patients with morphoea. Serological examination was positiv e in only one patient with morphoea alone and in two additional patients wi th 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.