{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T15:00:11Z","timestamp":1778511611396,"version":"3.51.4"},"reference-count":38,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T00:00:00Z","timestamp":1672099200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>The occurrence of skin lesions is the earliest symptom of Lyme disease, and the diagnosis of these lesions and appropriate treatment may prevent complications of the disease, which are mainly neurological. The cutaneous presentation in borreliosis is heterogeneous. There are typical lesions that constitute the basis for the diagnosis of Lyme disease, and atypical ones, which cause significant diagnostic difficulties especially when the patient does not remember the tick bite. This study aims to describe the heterogeneous skin symptoms of Lyme borreliosis, as well as offer a practical approach for the recognition of the disease. Based on pediatric cases from clinical practice, rare cutaneous presentations of Lyme disease at various stages of illness and therapy are presented. Diagnostic recommendations for recognizing individual forms are discussed.<\/jats:p>","DOI":"10.3390\/life13010072","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T07:30:06Z","timestamp":1672126206000},"page":"72","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Cutaneous Manifestations of Lyme Borreliosis in Children\u2014A Case Series and Review"],"prefix":"10.3390","volume":"13","author":[{"given":"Agnieszka","family":"Myszkowska-Torz","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2632-0438","authenticated-orcid":false,"given":"Mateusz","family":"Tomaszewski","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Temporomanidbular Disorders, Karol Marcinkowski University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3273-1639","authenticated-orcid":false,"given":"Micha\u0142","family":"Kotowski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Otolaryngology, Karol Marcinkowski University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cezary","family":"Witczak","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4731-0658","authenticated-orcid":false,"given":"Magdalena","family":"Figlerowicz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2695-4649","authenticated-orcid":false,"given":"Katarzyna","family":"Mazur-Melewska","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases and Child Neurology, Karol Marcinkowski University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,27]]},"reference":[{"key":"ref_1","first-page":"73","article-title":"Choroby odkleszczowe w Polsce\u2014Wyst\u0119powanie i trudno\u015bci diagnostyczne [Tick-borne diseases in Poland: Prevalence and difficulties in diagnostics]","volume":"67","author":"Kmieciak","year":"2016","journal-title":"Med. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Rizzoli, A., Hauffe, H.C., Carpi, G., Vourch\u2019h, G.I., Neteler, M., and Ros\u00e0, R. (2011). Lyme borreliosis in Europe. Euro. Surveill., 16.","DOI":"10.2807\/ese.16.27.19906-en"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1080\/17843286.2019.1694293","article-title":"Lyme disease in Western Europe: An emerging problem? A systematic review","volume":"76","author":"Vandekerckhove","year":"2021","journal-title":"Acta Clin. Belg."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Myszkowska-Torz, A., Tomaszewski, M., Mania, A., and Figlerowicz, M. (Ped. Pol., 2022). Lyme borreliosis in children-trends in epidemiology. A single center study, Ped. Pol., accepted.","DOI":"10.5114\/polp.2023.125956"},{"key":"ref_5","first-page":"421","article-title":"Diagnosis and treatment of tick-borne diseases: Recommendations of the Polish Society of Epidemiology and Infectious Diseases","volume":"69","author":"Pancewicz","year":"2015","journal-title":"Przegl. Epidemiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"7203","DOI":"10.1128\/AEM.71.11.7203-7216.2005","article-title":"Prevalence of Borrelia burgdorferi sensu lato genospecies in Ixodes ricinus ticks in Europe: A metaanalysis","volume":"71","author":"Rauter","year":"2005","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1007\/s15010-003-4007-3","article-title":"Solitary and multiple erythema migrans in children: Comparison of demographic, clinical and laboratory findings","volume":"31","author":"Arnez","year":"2003","journal-title":"Infection"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"355","DOI":"10.2165\/0128071-200809060-00002","article-title":"Skin manifestations of Lyme borreliosis: Diagnosis and management","volume":"9","author":"Glatz","year":"2008","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_9","unstructured":"Post, T.W. (2022). Treatment of Lyme disease. UpToDate, UpToDate."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s00105-011-2256-0","article-title":"The variable spectrum of cutaneous Lyme borreliosis. Diagnosis and therapy","volume":"63","author":"Hofman","year":"2012","journal-title":"Hautarzt"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.medmal.2006.01.024","article-title":"Borr\u00e9liose de Lyme: Mesures pr\u00e9ventives secondaires apr\u00e8s piq\u00fbre de tiques","volume":"37","author":"Patey","year":"2007","journal-title":"Med. Mal. Infect."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/ciaa1215","article-title":"Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease","volume":"72","author":"Lantos","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Cruickshank, M., O\u2019Flynn, N., and Faust, S.N. (2018). Guideline Committee. Lyme disease: Summary of NICE guidance. BMJ, 361.","DOI":"10.1136\/bmj.k1261"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.medmal.2019.04.381","article-title":"Lyme borreliosis and other tick-borne diseases. Guidelines from the French Scientific Societies (I): Prevention, epidemiology, diagnosis","volume":"49","author":"Figoni","year":"2019","journal-title":"Med. Mal. Infect."},{"key":"ref_15","unstructured":"Kimberlin, D.W., Brady, M.T., Jackson, M.A., and Long, S.S. (2018). Lyme disease. Red Book: 2018 Report of the Committee on Infectious Diseases, American Academy of Pediatrics. [31st ed.]."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"421","DOI":"10.7326\/0003-4819-136-6-200203190-00005","article-title":"Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans","volume":"136","author":"Smith","year":"2002","journal-title":"Ann. Intern. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Trevisan, G., Bonin, S., and Ruscio, M. (2020). A practical approach to the diagnosis of Lyme borreliosis: From clinical heterogeneity to laboratory methods. Front. Med., 7.","DOI":"10.3389\/fmed.2020.00265"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1177\/0009922806290026","article-title":"Absence of tooth staining with doxycycline treatment in young children","volume":"46","author":"Volovitz","year":"2007","journal-title":"Clin. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2887","DOI":"10.1093\/jac\/dkx245","article-title":"Dental staining after doxycycline use in children","volume":"72","author":"Nurmi","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1097\/INF.0000000000002453","article-title":"Is Doxycycline Appropriate for Routine Treatment of Young Children with Erythema Migrans?","volume":"38","author":"Wormser","year":"2019","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1080\/0036554021000027009","article-title":"Clinical outcome of erythema migrans after treatment with phenoxymethyl penicillin","volume":"35","author":"Bennet","year":"2003","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1097\/INF.0b013e318225b8c3","article-title":"Borrelia burgdorferi sensu lato bacteremia in Slovenian children with solitary and multiple erythema migrans","volume":"30","author":"Arnez","year":"2011","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4103\/2229-5178.202271","article-title":"Lyme disease: A case report with typical and atypical lesions","volume":"8","author":"Sharma","year":"2017","journal-title":"Indian Dermatol. Online J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.mayocp.2018.11.001","article-title":"Multiple erythema migrans rashes characteristic of early disseminated Lyme disease, before and after therapy","volume":"94","author":"Shah","year":"2019","journal-title":"Mayo Clin. Proc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"565","DOI":"10.2340\/00015555-2000","article-title":"Clinical spectrum of skin manifestations of Lyme borreliosis in 204 children in Austria","volume":"95","author":"Glatz","year":"2015","journal-title":"Acta Derm. Venereol."},{"key":"ref_26","first-page":"490","article-title":"Acrodermatitis chronica atrophicans: Various faces of the late form of Lyme borreliosis","volume":"35","author":"Czupryna","year":"2018","journal-title":"Post Derm. Alerg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"167","DOI":"10.4103\/0019-5154.110822","article-title":"Lyme borreliosis and skin","volume":"58","author":"Vasudevan","year":"2013","journal-title":"Indian J. Dermatol."},{"key":"ref_28","unstructured":"Gade, A., Matin, T., Rubenstein, R., and Robinson, C.A. (2022). Acrodermatitis chronica atrophicans. StatPearls, StatPearls Publishing."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.idc.2008.01.001","article-title":"Lyme disease: European perspective","volume":"22","author":"Stanek","year":"2008","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1093\/cid\/ciw417","article-title":"Borrelial lymphocytoma in adult patients","volume":"63","author":"Maraspin","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1097\/INF.0000000000000884","article-title":"Borrelial Lymphocytoma in Children","volume":"34","year":"2015","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Maraspin, V., and Strle, F. (Wien. Klin. Wochenschr., 2022). Borrelial lymphocytoma, Wien. Klin. Wochenschr., epub ahead of print.","DOI":"10.1007\/s00508-022-02064-5"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s15010-010-0062-8","article-title":"Isolation of Borrelia burgdorferi sensu lato from blood of adult patients with borrelial lymphocytoma, Lyme neuroborreliosis, Lyme arthritis and acrodermatitis chronica atrophicans","volume":"39","author":"Maraspin","year":"2011","journal-title":"Infection"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/BF02033059","article-title":"Solitary borrelial lymphocytoma: Report of 36 cases","volume":"20","author":"Strle","year":"1992","journal-title":"Infection"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1111\/j.1600-0560.1997.tb01318.x","article-title":"Infection by Borrelia burgdorferi and cutaneous B-cell lymphoma","volume":"24","author":"Cerroni","year":"1997","journal-title":"J. Cutan. Pathol."},{"key":"ref_36","first-page":"333","article-title":"Localized scleroderma (morphea). Diagnostic and therapeutic recommendations of the Polish Dermatological Society","volume":"106","author":"Krasowska","year":"2019","journal-title":"Przegl. Derm."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1590\/abd1806-4841.20176045","article-title":"Evaluation of mean platelet volume in localized scleroderma","volume":"92","author":"Bahali","year":"2017","journal-title":"An. Bras. Dermatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/DAD.0000000000001290","article-title":"Tick Bite-Associated Morphea: A Case Report","volume":"41","author":"George","year":"2019","journal-title":"Am. J. Dermatopathol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/1\/72\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:52:17Z","timestamp":1760147537000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/1\/72"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,27]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["life13010072"],"URL":"https:\/\/doi.org\/10.3390\/life13010072","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,27]]}}}