A 56-year-old woman was referred to our department for an
eruption on the front side of the left thigh present for 6 months,
accompanied more recently by arthralgia and localized subjective
neurological symptoms.
The eruption started a few days after an insect bite by a red papule which secondarily enlarged.
The erythema was of variable intensity. Clinical examination revealed
peripilar red papules of the thigh from the groin to the knee( fig. 1 ).
The patient had no remarkable contralateral keratosis pilaris.

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Lyme serology was positive for both IgG and IgM (ELISA, Enzygnost
Borreliosis , Siemens, Dade Behring, Germany, and blot,
Euroline WB , Euroimmun, Germany). A punch biopsy of a papule showed a dermal perifollicular ( fig. 2 ) – and occasionnally perineural – infiltrate of lymphocytes and plasma cells, consistent with a borrelial infection. Borrelia burgdorferi DNA was amplified from fresh tissue obtained from a skin biopsy performed on a peripilar papule, using a specific real-time PCR according to Mäkinen et al. [1] (culture not performed). The erythema resolved after a 3-week doxycycline treatment whereas arthralgia and dysesthesia persisted.