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.

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.