Detection of Borrelia burgdorferi in skin biopsies from patients with morphea by polymerase chain reaction

Aim: We looked for the evidence of Borrelia infection in patients with morphea by serologic means and by polymerase chain reaction (PCR) analysis of skin biopsy samples. Background: The possible relationship between Lyme borreliosis and morphea has been suggested by certain clinical, immunological and microbiological findings, but many authors were hot be able to demonstrate Borrelia burgdorferi infection in patients with morphea and cast doubts on an etiological role for B. bungdorferi in this skin lesion. Patients and methods: Ten patients with morphea, 9 females (range: 8-65 years) and one 44-year-old man were examined. Serological tests for Lyme borreliosis were performed by immunofluorescence assay and flagellin enzyme-linked immunosorbent assay. Skin biopsy specimens were taken from the periphery of morphea lesions for histological examination and PCR. Results: Antibodies to B. burgdorferi were detected in 3 patients and B. burgdorferi DNA was demonstrated in 5 patients. Conclusions: The amplification of DNA with PCR analysis seems to open new prospects for the detection of Borrelia genome in tissues. In the present study we were able to demonstrate the presence of B. burgdorferi DNA in patients with morphea, even in seronegative patients. These data confirm that PCR is an interesting tool in skin lesion diagnosis and support the hypothesis of an etiological association between B. burgdorferi infection and some cases of morphea.