Skin Manifestations of Chronic Lyme

On this more recent printable document it has an explanation and shows photos.

No Photos Below....

New Skin Manifestations Chronic Lyme September 2013

Open Neurol J. 2012 Dec 31;6:179-86. doi: 10.2174/1874205X01206010179.

Damage of collagen and elastic fibres by borrelia burgdorferi- known and new clinical and histopathological aspects. Müller KE.

“More recently, further skin conditions have been identified by the new microscopic investigation technique of focus floating microscopy: granuloma annulare, necrobiosis lipoidica, necrobiotic xanthogranuloma, erythema annulare centrifugum, interstitial granulomatous dermatitis, cutaneous sarcoidosis and lymphocytic infiltration.

Granuloma annulare

Granuloma annulare is a fairly rare, chronic dermatological autoimmune condition which presents as reddish bumps on the skin arranged in a circle or ring.

The rings are caused by an autoimmune reaction that causes over- productive leukocytosis, an over abundant production of white blood cells.

These WBCs do not flow freely through the blood but instead clump together and can not effectively move through thin capillaries, rising to just underneath the surface of the patient's skin, resulting in the characteristic rings.

Necrobiosis lipoidica

Necrobiosis lipoidica is a necrotising skin condition that usually occurs in patients with diabetes but can also be associated with Rheumatoid Arthritis.[1]

In the former case it may be called necrobiosis lipoidica diabeticorum (NLD). NLD occurs in approximately 0.3% of the diabetic population, with the majority of sufferers being women (approximately 3:1 females to males affected).

Necrobiotic xanthogranuloma

Eleven patients (65%) showed involvement of the periorbital area, and the trunk was affected in 8 patients (47%). Twelve patients (71%) had a monoclonal gammopathy; of these, 3 (18%) had multiple myeloma.

Erythema annulare centrifugum

Erythema annulare centrifugum (EAC) is classified as one of the figurate or gyrate erythemas. First described by Darier in 1916, it is characterized by a scaling or nonscaling, nonpruritic, annular or arcuate, erythematous eruption. It tends to spread peripherally while clearing centrally. Histologically, an intense lymphohistiocytic cuffing occurs about the superficial and deep dermal vessels without epidermal involvement.

Interstitial granulomatous dermatitis dermatitis.html

Interstitial granulomatous dermatitis is a rare skin disorder in which there is a particular pattern of granulomatous inflammation.

The classic original clinical description of interstitial granulomatous dermatitis was of linear erythematous palpable cords on the lateral aspects of the trunk, called “the rope sign”. However, several different types of rash have been described with the same histological appearance.

Clinical features of interstitial granulomatous dermatitis

The features of interstitial granulomatous dermatitis are variable.

▪ Red or skin-coloured patches, papules and/or plaques

▪ The shape of the lesions may be round, annular or cord-like.

▪ Lesions wax and wane, and may vary in size and shape over a period of

days to months.

▪ They are usually symptomless, but some patients complain of mild itch

or burning sensation.

▪ The lesions tend to be symmetrically distributed on the trunk but

proximal limbs may also be affected.

▪ It most commonly affects middle-aged women.

Many affected patients also suffer from other autoimmune diseases.

Cutaneous sarcoidosis

Sarcoidosis involves the skin in about 25% of patients. The most common lesions are erythema nodosum, plaques, maculopapular eruptions, subcutaneous nodules, and lupus pernio. Treatment is not required, since the lesions usually resolve spontaneously in two to four weeks. Although it may be disfiguring, cutaneous sarcoidosis rarely causes major problems.[7]

Lymphocytic infiltration

Jessner lymphocytic infiltrate is an uncommon skin condition that presents as non-scaly red patches and lumps on the face, neck and upper back. They are usually painless and do not itch. Lesions may go through periods of remission and exacerbation over months or years. Total spontaneous resolution has also occurred in some cases.

The condition is known by many other names including benign lymphocytic infiltration, Jessner disease, Jessner-Kanof syndrome, and benign chronic T-cell infiltrative disorder. It has been thought to be in the same disease spectrum as lupus erythematosus (lupus tumidus) but on histology, monoclonal antibody Leu 8 staining indicates they may be separate conditions. infiltrative/jessner.html

Last Updated- April 2019

Lucy Barnes