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2017 German Dermatology Guidelines

Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society

NOTES

September 2017-  The authors state several times that their guidelines are for “cutaneous” Lyme borreliosis, but proceed to copy IDSA recommendations for the use (or not) of various tests, deciding a clinical diagnosis, treatment for each “stage” of the disease, etc.

They even provide an 8 page printable handout for patients with a lot of questionable information, such as in the prevention section- 
  1. "Only a small proportion of the people infected with Borrelia become ill!  This is why a prophylactic treatment with oral antibiotics is not recommended." 

Their attachment also includes an overview of treatment recommendations from various countries worldwide, although the USA section- the first one- only lists IDSA 2006 guidelines and not ILADS guidelines.  

It does however, have ILADS guideline listed near the bottom in a second USA section, in the 10th position on the list of 11 guidelines.  

The ILADS listing mentioned above, unlike all others, has several of these ** with a note stating in part… “ILADS stresses that currently no fixed treatment schemes have been established as a result of a lack of evidence”.  It also completely leaves out ILADS treatment recommendations (as if they didn’t exist) for the section titled- “Early Disseminated Form (Without Neurological Manifestations)”.  

The patient handout also has a separate alphabetical listing (by author’s last name) of additional Lyme treatment guidelines- - except for the fact Cameron/ILADS is not included in their alphabetical list.  It is out-of-order and was placed at the end of the list instead.

They also provide information on the German version of Worker’s Compensation Insurance, stating, sadly, in part… "As part of this process of determination, the accident insurance will order or carry out the necessary work-related and medical examinations.”

Their Reference section includes 185 papers.  Guess who is number 185?  And there doesn’t appear to be a corresponding #185 in the actual paper itself.  ???  

In contrast- IDSA guideline authors are listed as references… Steere's papers- 6,  Wormser- 12 papers,  Stanek- 11 papers,  Dattwyler- 7 papers,  Krause- 9 papers,  Nadelman- 5 papers,  Barbour- 3 papers,  Shapiro- 3 papers,  Nowakowski- 4 papers, and even McStupid is listed- 1 paper.  

Just for comparison I checked the names of some other doctors and researchers who have published and who typically, and for good reason, don't find the 2006 IDSA guidelines completely accurate or acceptable (my words, not theirs).  For example...  Stricker- 0, Liegner- 0, Burrascano- 0, Sapi- 0, McDonald- 0, Clark- 0, Breitschwerdt- 0, Cook- 0.  Dr. Cameron wins the ILADS position papers with 1 (along with co-authors Johnson and Maloney).

You may find interesting the fact the entire guideline is in English except for their conflict of interest statements, which are in German.

LB- October 1, 2017
 

Ger Med Sci. 2017 Sep 5;15:Doc14. doi: 10.3205/000255. eCollection 2017.

Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society.

Author information

1
Klinik für Dermatologie und Allergologie der TU München, München, Germany.
2
Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) Oberschleißheim, Germany.
3
Zentralinstitut für Labormedizin, Mikrobiologie & Krankenhaushygiene, Krankenhaus Nordwest, Frankfurt, Germany.
4
Professor-Hess-Kinderklinik Klinikum Bremen-Mitte, Bremen, Germany.
5
Immanuel Krankenhaus Berlin, Berlin, Germany.
6
Neurologische Universitätsklinik, Freiburg, Germany.
7
Klinik für Infektiologie Klinik St Georg, Leipzig, Germany.

Abstract

This guideline of the German Dermatology Society primarily focuses on the diagnosis and treatment of cutaneous manifestations of Lyme borreliosis. It has received consensus from 22 German medical societies and 2 German patient organisations. 
It is the first part of an AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.) interdisciplinary guideline: "Lyme Borreliosis - Diagnosis and Treatment, development stage S3”. 
The guideline is directed at physicians in private practices and clinics who treat Lyme borreliosis. 
Objectives of this guideline are recommendations for confirming a clinical diagnosis, recommendations for a stage-related laboratory diagnosis (serological detection of IgM and IgG Borrelia antibodies using the 2-tiered ELISA/immunoblot process, sensible use of molecular diagnostic and culture procedures) and recommendations for the treatment of the localised, early-stage infection (erythema migrans, erythema chronicum migrans, and borrelial lymphocytoma), the disseminated early-stage infection (multiple erythemata migrantia, flu-like symptoms) and treatment of the late-stage infection (acrodermatitis chronica atrophicans with and without neurological manifestations). 
In addition, an information sheet for patients containing recommendations for the prevention of Lyme borreliosis is attached to the guideline.
PMID:
 
28943834
 
PMCID:
 
PMC5588623
 
DOI:
 
10.3205/000255

Link to Full Set of German Guidelines








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