Müllegger Robert R, Glatz Martin
Department of Dermatology, Central Hospital Wiener Neustadt, Wiener Neustadt, Austria.
Am J Clin Dermatol. 2008;9(6):355-68. doi: 10.2165/0128071-200809060-00002.
Lyme borreliosis is a multisystem infectious disease caused by tick-transmitted spirochetes of the Borrelia burgdorferi sensu lato complex. The three characteristic cutaneous manifestations are erythema migrans, borrelial lymphocytoma, and acrodermatitis chronica atrophicans. Erythema migrans occurs in acute Lyme borreliosis, lymphocytoma is a subacute lesion, and acrodermatitis is the typical manifestation of late Lyme borreliosis. Clinical appearances of erythema migrans and lymphocytoma (when located on the ear or breast) are characteristic, whereas acrodermatitis is often confused with vascular conditions. The diagnosis of erythema migrans is made clinically. Serologic analyses often yield false-negative results and are not required for the diagnosis. However, serologic proof of the diagnosis in lymphocytoma (approximately 90% positive) and acrodermatitis (100% positive) is mandatory. Histopathologic examination often adds substantial information in patients with skin manifestations of Lyme borreliosis and is recommended in clinically (and serologically) undecided cases of erythema migrans or lymphocytoma and is obligatory in acrodermatitis. Polymerase chain reaction for Borrelia-specific DNA (rather than culture of the spirochete) and immunohistochemical investigations (lymphocytoma) are sometimes necessary adjuncts for the diagnosis. Antibacterial treatment is necessary in all patients to eliminate the spirochete, cure current disease, and prevent late sequelae. Oral doxycycline, also effective against coinfection with Anaplasma phagocytophilum, is the mainstay of therapy of cutaneous manifestations of Lyme borreliosis. Other first-line antibacterials are amoxicillin and cefuroxime axetil. Erythema migrans is treated for 2 weeks, lymphocytoma for 3-4 weeks, and acrodermatitis for at least 4 weeks.
莱姆病是一种由蜱传播的伯氏疏螺旋体狭义复合体引起的多系统感染性疾病。三种典型的皮肤表现为游走性红斑、伯氏淋巴细胞瘤和慢性萎缩性肢端皮炎。游走性红斑出现在急性莱姆病中，淋巴细胞瘤是亚急性病变，而肢端皮炎是晚期莱姆病的典型表现。游走性红斑和淋巴细胞瘤（位于耳部或乳房时）的临床表现具有特征性，而肢端皮炎常与血管性疾病相混淆。游走性红斑通过临床诊断。血清学分析常产生假阴性结果，诊断时不需要。然而，淋巴细胞瘤（约90%阳性）和肢端皮炎（100%阳性）的血清学诊断证据是必需的。组织病理学检查常为莱姆病皮肤表现患者提供大量信息，对于游走性红斑或淋巴细胞瘤临床（及血清学）诊断不明确的病例建议进行，对于肢端皮炎则是必须的。检测伯氏疏螺旋体特异性DNA的聚合酶链反应（而非螺旋体培养）和免疫组织化学检查（淋巴细胞瘤）有时是诊断的必要辅助手段。所有患者都需要进行抗菌治疗以清除螺旋体、治愈当前疾病并预防晚期后遗症。口服多西环素对嗜吞噬细胞无形体共感染也有效，是莱姆病皮肤表现治疗的主要药物。其他一线抗菌药物是阿莫西林和头孢呋辛酯。游走性红斑治疗2周，淋巴细胞瘤治疗3 - 4周，肢端皮炎治疗至少4周。
