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Klaus Eisendle, MD, PhD; Tanja Grabner, MD; Heinz Kutzner, MD; Bernhard Zelger, MD, MSc

Arch Dermatol. 2008;144(5):591-598.

Objective  To assess the evidence for Borrelia burgdorferi sensu lato infection in patients with lichen sclerosus by focus-floating microscopy.

Setting  Dermatology department of a university hospital.

Design  Tissue sections were stained with a polyclonal B burgdorferi antibody using standard histological equipment and then scanned simultaneously in 2 planes: horizontally in a serpentinelike pattern and vertically by focusing through the thickness of the section, ie, focus-floating microscopy. Part of the material was also investigated by Borrelia-specific polymerase chain reaction.

Patients  The study population comprised 61 cases of lichen sclerosus and 118 controls (60 negative controls and 68 positive controls).

Main Outcome Measure  The presence of B burgdorferi sensu lato within tissue specimens.

Results  Using focus-floating microscopy, we detected Borrelia species in 38 of 60 cases (63%) of lichen sclerosus and in 61 of 68 (90%) of positive controls of classic borreliosis, but Borrelia species were absent in all negative controls. Borrelia species were detected significantly more often in early inflammatory-rich (31 of 39 [80%]) than in late inflammatory-poor (7 of 21 [33.3%]) cases (P = .001). Polymerase chain reaction findings were positive in 25 of 68 positive controls (37%) and negative in all 11 cases of lichen sclerosus and all 15 negative controls.

Conclusions  Focus-floating microscopy is a reliable method to detect Borrelia species in tissue sections. The frequent detection of this microorganism, especially in early lichen sclerosus, points to a specific involvement of B burgdorferi or other similar strains in the development or as a trigger of this disease.

Author Affiliations: Department of Dermatology and Venerology, Innsbruck Medical University, Innsbruck, Austria (Drs Eisendle, Grabner, and Zelger); and Dermatopathological Private Laboratory Friedrichshafen, Friedrichshafen, Germany (Dr Kutzner).

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