Lyme disease, atypical skin manifestations

Lyme borreliosis is a multisystemic infection associated with a variety of clinical manifestations. Rather often it causes largely incomplete, hidden clinical findings or quite atypical variants. In the present paper less common skin variants of Lyme borreliosis are reviewed including localized alopecia at the site of erythema migrans, urticaria, erythematous papules, nodular panniculitis (Pfeifer-Weber-Christian), scleroatrophic skin conditions. Raynaud's syndrome, benign lymphocytic infiltrate of Jessner- Kanoff, cutaneous B-cell lymphoma, sarcoidosis, granulomatous thrombophlebitis, generalized exanthema, granuloma annulare, pityriasis rosea and purpura. Different species of Borrelia burgdorferi have been associated with different clinical manifestations. This may explain the rarity of some clinical variants. The agent of Lyme disease may be responsible for some cases, but further observations are necessary to differentiate atypical Lyme variants and casual associations.