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.