# Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society

## TL;DR

This updated guideline from the German Dermatology Society provides recommendations for diagnosing and treating skin-related Lyme borreliosis, based on the latest international research up to 2022.

## Contribution

The guideline incorporates recent international literature and includes a patient information sheet for prevention.

## Key findings

- Oral penicillin V is as effective as doxycycline and amoxicillin for treating erythema migrans.
- Improved early detection has led to a decrease in constitutional symptoms and atrophy in acrodermatitis chronica atrophicans.
- No significant changes in diagnosis and treatment methods were found compared to previous guidelines.

## Abstract

The current S2k guideline “kutane Borreliose” has been updated in accordance with the methodological standards of the “Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.”. It has received consensus from 18 AWMF member societies, the Robert Koch Institute, the “Paul-Ehrlich-Gesellschaft für Infektionstherapie e.V.”, “Instand e.V. – Gesellschaft zur Förderung der Qualitätssicherung in medizinischen Laboratorien”, the “Deutsche Borreliose-Gesellschaft” and the two German patient organisations “Borreliose und FSME Bund Deutschland” and “Aktionsbündnis gegen zeckenübertragene Infektionen Deutschland e.V.”.

This guideline of the German Dermatology Society primarily focuses on the diagnosis and treatment of cutaneous manifestations of Lyme borreliosis and 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 and recommendations for the treatment of the different manifestations erythema migrans, multiple erythemata migrantia, borrelial lymphocytoma, and acrodermatitis chronica atrophicans.

The current update of the guideline incorporates the international literature on cutaneous manifestations of Lyme borreliosis up to 2022. There have been no significant changes in diagnosis and treatment. The Cochrane network analysis on the treatment of erythema migrans has only shown that, in addition to doxycycline and amoxicillin, oral penicillin V is equally effective. A Slovenian analysis of patients with acrodermatitis chronica atrophicans over the past 30 years has shown a decrease in the incidence of constitutional symptoms and atrophy, likely due to improved early detection. In addition, an information sheet for patients containing recommendations for the prevention of Lyme borreliosis is attached to the guideline.