Abstract
ABSTRACT
Background
Lichen sclerosus (LSc) is a chronic inflammatory dermatosis that primarily affects the genitalia. Growing evidence supports chronic occlusive urine exposure as the principal pathogenic driver, though other mechanisms, including mechanical irritation, hormonal influences, autoimmunity, and infection, have been proposed. Borrelia burgdorferi has been implicated based on clinical and histopathological similarities between LSc and acrodermatitis chronica atrophicans, as well as reports of Borrelia detection in some LSc cases.
Objectives
To systematically evaluate the evidence linking Borrelia to LSc and determine whether Borrelia represents a credible aetiological factor.
Methods
A comprehensive search of MEDLINE, Embase, and PubMed was conducted from inception to December 2024 using all relevant synonyms and misspellings of ‘Borrelia’ and ‘lichen sclerosus’. Citation tracking of prior reviews was also performed. All English‐language studies addressing LSc in the context of Borrelia were included. Chi‐squared analyses compared Borrelia detection rates in LSc versus other dermatoses.
Results
Thirty‐six studies met inclusion criteria: 22 reported an association, while 14 found none. ELISA (
n
= 18), PCR (
n
= 17), and immunohistochemistry (IHC;
n
= 12) were the most frequently used methods. No significant differences in Borrelia detection were found between LSc and comparator dermatoses using ELISA, PCR, culture, or light microscopy. A single significant difference identified by IHC was considered an outlier.
Conclusions
The current evidence does not support Borrelia as a consistent or credible aetiological factor in LSc.
Trial Registration:
PROSPERO ID: CRD420250631635.