Cutaneous and systemic Lyme disease

Lyme disease is currently the most common tick-borne disease in temperate regions of the northern hemisphere. The pathogen Borrelia burgdorferi is a slow growing, microaerophile, Gram-negative spirochete. The spirochete is transmitted by ticks of the Ixodes ricinus species complex. Borreliosis has a variety of presentations at different stages of infection. It often leads to various skin affections, but it might also compromise multiple organs, especially the central and peripheral nervous system, joints and muscles. The diagnostic detection methods for this organism in skin biopsies have recently been improved with focus ‘floating microscopy’ and allowed the reliable detection of spirochetes in other ‘non classical’ skin disorders. Although Lyme disease has been known for almost 20 years, the known spectrum of its skin manifestations is continuously expanding and cannot be regarded as completed. Therapeutic choices are variegated and should be adequately chosen regarding the clinical manifestation.