CLINICAL FEATURES OF LOCALIZED SCLERODERMA IN PATIENTS WITH LYME BORRELIOSIS
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i1.13008Keywords:
localized scleroderma, Lyme borreliosis, clinical featuresAbstract
SUMMARY. The aim – to establish the clinical features of localized scleroderma in patients with Lyme borreliosis.
Material and Methods. There were 78 patients with localized scleroderma (LS) aged 18 to 74 years under supervision; in 2015–2021 they were on outpatient and inpatient treatment at Ternopil Regional Clinical Dermatological and Venereological Dispensary. There were 69 women (81.2 %) and 16 men (18.8 %), aged 18 to 74.
For serological confirmation of Lyme borreliosis (LB), the ELISA method was used using test systems from Euroimmun AG (Germany): IgM class – Anti-Borrelia burgdorferi ELISA (IgM) test system, IgG class – Anti-Borrelia plus VIsE ELISA (IgG). The results were evaluated as positive, intermediate or negative and interpreted according to the manufacturer's recommendations.
Specific IgM and IgG (positive or intermediate results) for the B. burgdorferi s.l complex were diagnosed in the serum of 32 (37.6 %) of 85 patients with circumscribed scleroderma. According to the obtained results, all patients were divided into two groups: group 1 – 32 patients with СS with LB and group 2 – 53 patients only with СS without LB.
To assess the activity of LS we used a modified index of severity of localized scleroderma – the modified Localized Skin Severity Index (mLoSSI), which was summarized by the following criteria for lesions:new lesion/lesion extension (N/E) – a new lesion and/or enlargement of an existing lesion within the past month; erythema (ER): the degree of erythema at the edge of a lesion; the modified Rodnan skin thickness system (ST) was determined at the edge of a lesion.
Results. It was found that patients with localized scleroderma with LB, noted a number of complaints associated with lesions: a feeling of tightness of the skin, itching and tingling. Itching of the lesions significantly prevailed in patients of the LS group with LB: 46.9 % vs. 18.9 %, p<0.05.
In addition, patients have been diagnosed with a number of other clinical manifestations: impaired concentration, fatigue / general weakness, muscle pain, lymphadenopathy, swelling and joint pain, headache, and fever. prevailed in patients with LS without LB, p<0,05.
In individuals with LS with LB, multiple (4 or more) of small size (1–5 cm) lesions predominated comparatively with LS without LB : 53.1 % vs. 20.8 %, p<0.05.
The induration of lesions of LS according to the modified skin score by G.P. Rodnan was significantly higher in patients with LS without LB, compared with patients with LS with LB: 3.09±0.30 vs. 1.44±0.29, p<0.05.
Conclusions. In patients with LS with LB activity of LS lesions (by mLoSSI) was higher than in patients with LS without LB due to the appearance a new lesion and/or enlargement of an existing lesion within the past month (N \ E): 56.3 % vs. 26.4 % and the intensity of erythema at the edge of a lesion (ER): 2.11±0.16 points against 0.68±0.11 points, p<0.05.
References
Andreichyn, M.A., Kopcha, V.S., & Shkilna, M.I. (2019). Laim–borelioz. Diahnostychni kryterii, likuvannia i profilaktyka: metod. Rekomendatsii [Lyme borreliosis. Diagnostic criteria, treatment and prevention: method. Recommendations]. Ternopil: TDMU [in Ukrainian].
Stanek, G., Wormser, G.P., Gray, J., & Strle, F. (2012.) Lyme borreliosis. Lancet, 4, 379(9814), 461-73.
Raileanu, C., Moutailler, S., Pavel, I., Porea, D., Mihalca, A. D., Savuta, G., & Vayssier-Taussat, M. (2017). Borrelia Diversity and Co-infection with Other Tick Borne Pathogens in Ticks. Frontiers in Cellular and Infection Microbiology, 7, 36. DOI: 10.3389/fcimb.2017.00036.
Zinchuk, O.M., & Kaliuzhna, L.D. (2016). Urazhennia shkiry u khvorykh na Laim-borelioz piznoho periodu [Skin lesions in patients with late-onset Lyme disease], Dermatolohiia, kosmetolohiia, seksopatolohiia – Dermatology, Cosmetology, Sexopathology, 1-2, 10-14 [in Ukrainian].
Shkilna, M.I. (2021). Kliniko-epidemiolohichni ta imunolohichni aspekty Laim-boreliozu, vdoskonalennia diahnostyky i terapii [Clinical and epidemiological and immunological aspects of Lyme borreliosis, improvement of diagnosis and therapy]: PhD dissertation: 14.01.13. Ternopil [in Ukrainian].
Pedrycz-Wieczorska, A. (2017). Analysis of the methods for diagnosing borreliosis − Lyme disease. Health Problems of Civilization, 11(2), 80-86. DOI: 10.5114/hpc.2017.69022.
Careta, M.F., & Romiti, R. (2015). Localized scleroderma: clinical spectrum and therapeutic update. Anais brasileiros de dermatologia, 90(1), 62-73. DOI: 10.1590/abd1806-4841.20152890.
Mahmoud, A. (2020). Patohenetychna rol oksydatyvnoho stresu pry vohnyshchevii sklerodermii [Pathogenetic role of oxidative stress in Localized scleroderma]. Visnyk Vinnytskoho natsionalnoho medychnoho universytetu – Reports Of Vinnytsia National Medical University, 24(4), 714-719. DOI: 10.31393/reports-vnmedical-2020-24(4)-27 [in Ukrainian].
Choi, M.S., Seong, G.H., Park, M.J., Park, M., Hong, S.P., Park, B.C., & Kim, M.H. (2020). Rapidly Progressing Generalized Morphea with High Lyme Disease Titer. Indian Journal of Dermatology, 65(5), 432-434. DOI: 10.4103/ijd.IJD_279_18.
Șandru, F., Popa, A., Petca, A., Miulescu, R.G., Constantin, M.M., Petca, R. C., Constantin, T., & Dumitrașcu, M.C. (2020). Etiologic role of Borrelia burgdorferi in morphea: A case report. Experimental and Therapeutic Medicine, 20(3), 2373-2376. DOI: 10.3892/etm.2020.8815.
Eisendle, K, Grabner, T, & Zelger, B. (2007). Morphoea: a manifestation of infection with Borrelia species? Br. J. Dermatol,157(6), 1189-1198.
Aberer, E, Stanek, G, Ertl, M, & Neumann, R (1987). Evidence for spirochetal origin of circumscribed scleroderma (morphea). Acta Derm. Venereol, 67(3), 225-231.
Khanna, D., Furst, D.E., Clements, P.J., Allanore, Y., Baron, M., Czirjak, L., … & Denton, C. P. (2017). Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis. Journal of Scleroderma and Related Disorders, 2(1), 11-18. DOI: 10.5301/jsrd.5000231.
Teske, N.M., & Jacobe, H.T. (2020). Using the Localized Scleroderma Cutaneous Assessment Tool (LoSCAT) to classify morphoea by severity and identify clinically significant change. The British Journal of dermatology, 182(2), 398-404. DOI: 10.1111/bjd.18097.
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