NOTE: A version of this was originally published on bjjcaveman.com (here) on August 31, 2014
I was very excited by the title of this article, especially since it offered potential insight as to a specific infectious etiology to this rash!
This was published in the International Journal of Infectious Diseases, August 2013. This is a free article, so please feel free to read the whole thing yourself from the link provided.
The two organisms in the title, Borrelia garinii and Borrelia afzelii are spiral shaped bacteria that are associated with Lyme disease (LD).
This research group decided to approach the potential causes of this rash from a new angle:
The chronic and recurrent nature of PP is quite similar to the skin manifestations of LD infection, and together with the seasonal prevalence and effective treatment of both of these disorders with doxycyline, this may imply a possible correlation between PP and LD infection.
I thought this was a very refreshing and ‘out of the box’ way to look at this and want to applaud their efforts!
They found 14 cases of suspected PP, and skin biopsies were performed and analyzed for the bacterial DNA while blood samples were obtained to detect LD infections.
In skin specimens, they were able to isolate genetic material from Borrelia spirochetes in 3 of the 14 subjects, and the blood tests from these same individuals demonstrated a Lyme Disease infection.
This group had some interesting observations on the potential relationship between PP and LD:
It is interesting that the skin lesions of PP share some clinical and histopathological characteristics with acrodermatitis chronica atrophicans (ACA), which is a late cutaneous manifestation associated with LD infection.
The possible association of Borrelia spirochetes in the pathogenesis of ACA has been assumed by the isolation of Borrelia spirochetes from patients with ACA. In the present study, Borrelia spirochetes were isolated from skin specimens of patients with PP skin lesions and Borrelia species was also verified by a nested PCR targeting the 5S-23S intergenic spacer amplicon gene of B. Burgdorferi sensu lato. These results suggest that Borrelia spirochetes may play a role in the pathogenesis of PP in Taiwan.
After reading through the paper it does raise some interesting questions about a possible infectious cause for PP. Unfortunately this paper didn’t identify whether any of the subjects had been fasting or dieting prior to the onset of the rash.
The fact that the bacteria were found in only 3 out of 14 subjects doesn’t really say much either. If they had found it in 14 out of 14, then of course it would be convincing evidence that this particular strain of bacteria is the primary cause… but since they didn’t, the most we can conclude is that there may or may not be a relationship… which isn’t of much help to us at this point.
It could simply have been coincidence that these 3 subjects also had a lyme disease infection on top of whatever was going on already…
In any case, it does at least bear mentioning that if you suspect you have the PP rash and are demonstrating any of the following symptoms associated with Lyme Disease then you should at least get yourself checked out by your physician!
For everyone else, myself included, who can make this rash predictably come and go simply by varying carb consumption, I don’t think this helps us out.