All Posts Tagged With: "acrodermatitis chronica atrophicans"

Excerpt:

A 71-year-old man was referred to our outpatient clinic because of arthralgia and swelling of his right hand. He also showed a subcutaneous nodule on his left knee. A second patient, a 57-year-old woman, was referred because of painful skin of her legs. Dermatologic examination revealed erythemateous livid discoloration on both feet and legs. There were reticular varices, corona flebectatia paraplantaris medialis and minimal pitting oedema. Serology tested positive in both patients for Borrelia and they both recalled tick bites. A third patient, a 73-year-old woman, was referred because of erythema and maculae located at her lower legs and positive Borrelia serology. Pathologic examination was typical for acrodermatitis chronica atrophicans, a late skin manifestation of Lyme borreliosis. In all patients, symptoms improved after treatment with doxycycline for four weeks. A lack of familiarity with this skin condition may lead to unnecessary vascular investigations and considerable delay in adequate treatment.

Full article: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20699042&retmode=ref&cmd=prlinks

Excerpt:

A 71-year-old man was referred to our outpatient clinic because
of arthralgia and swelling of his right hand. He also showed a
subcutaneous nodule on his left knee. A second patient, a
57-year-old woman, was referred because of painful skin of her
legs. Dermatologic examination revealed erythemateous livid
discoloration on both feet and legs. There were reticular
varices, corona flebectatia paraplantaris medialis and minimal
pitting oedema. Serology tested positive in both patients for
Borrelia and they both recalled tick bites. A third patient, a
73-year-old woman, was referred because of erythema and maculae
located at her lower legs and positive Borrelia serology.
Pathologic examination was typical for acrodermatitis chronica
atrophicans, a late skin manifestation of Lyme borreliosis. In
all patients, symptoms improved after treatment with doxycycline
for four weeks. A lack of familiarity with this skin condition
may lead to unnecessary vascular investigations and considerable
delay in adequate treatment.

Full article: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20540415&retmode=ref&cmd=prlinks

Excerpt:

Acrodermatitis chronica atrophicans (ACA) is a rare tertiary
manifestation of Lyme borreliosis, manifesting as inflammatory
and atrophic lesions on acral skin. Although ACA rarely has been
reported in the United States, it may be seen in approximately
10% of European cases of Lyme borreliosis, most commonly
associated with the genospecies Borrelia afzelii. We report a
presumptive case of ACA involving an American woman from
Pennsylvania with convincing clinical, histopathologic, and
serologic findings. We also provide an overview of the history,
epidemiology, pathogenesis, clinical and histopathologic
presentation, and treatment of ACA.

Excerpt:

The known spectrum of skin manifestations in cutaneous Lyme disease is continuously expanding and can not be regarded as completed. Besides the classical manifestations of cutaneous borreliosis like erythema (chronicum) migrans, borrelial lymphocytoma and acrodermatitis chronica atrophicans evidence is growing that at least in part also other skin manifestations, especially morphea, lichen sclerosus and cases of cutaneous B-cell lymphoma are causally related to infections with Borrelia. Also granuloma annulare and interstitial granulomatous dermatitis might be partly caused by Borrelia burgdorferi or similar strains. There are also single reports of other skin manifestations to be associated with borrelial infections like cutaneous sarcoidosis, necrobiosis lipoidica and necrobiotic xanthogranuloma. In addition, as the modern chameleon of dermatology, cutaneous borreliosis, especially borrelial lymphocytoma, mimics other skin conditions, as has been shown for erythema annulare centrifugum or lymphocytic infiltration (Jessner Kanof) of the skin.

Full article: http://www.emedicine.com/derm/topic4.htm

Excerpt:

Acrodermatitis chronica atrophicans (ACA) is the third or late stage of European Lyme borreliosis (LB). This unusual, progressive, fibrosing skin process is due to the effect of continuing active infection with Borrelia afzelii. Buchwald first delineated it in 1883; Herxheimer and Hartmann described it in 1902 as a tissue paper–like cutaneous atrophy. It is evident on the extremities, particularly on the extensor surfaces, beginning with an inflammatory stage with bluish red discoloration and cutaneous swelling and concluding several months or years later with an atrophic phase. Sclerotic skin plaques may also develop. Physicians should use serologic and histologic examination to confirm this diagnosis.

Pathophysiology: B afzelii is the predominant, but may not be the exclusive, etiologic agent of ACA. Another genospecies of the Borrelia burgdorferi sensu lato complex, Borrelia garinii, has also been detected.

ACA is the only form of LB in which no spontaneous remission occurs. Its pathophysiology is not yet fully understood. ACA appears to be associated with long-term persistence of Borrelia organisms in the skin; several nonspecific reactions together with a specific immune response may contribute to its manifestations.

The persistence of the spirochetes despite a marked cutaneous T-cell infiltration and high serum antibody titers may be connected with resistance of the pathogen to the complement system; the ability to escape to immunologically protected sites (eg, endothelial cells, fibroblasts); and the ability to change antigens, which may lead to an inappropriate immune response. Lack of protective antibodies, with a narrow antibody spectrum and a weak cellular response with down-regulation of major histocompatibility system class II molecules on Langerhans cells, has been observed in patients with LB.