Acrodermatitis chronica atrophicans (ACA) is a

skin rash A rash is a change of the human skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, cr ...

indicative of the third or late stage of European Lyme borreliosis. ACA is a

dermatological Dermatology is the branch of medicine dealing with the skin.''Random House Webster's Unabridged Dictionary.'' Random House, Inc. 2001. Page 537. . It is a speciality with both medical and surgical aspects. A dermatologist is a specialist medical ...

condition that takes a chronically progressive course and finally leads to a widespread atrophy of the skin. Involvement of the

peripheral nervous system The peripheral nervous system (PNS) is one of two components that make up the nervous system of bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia, which lie outside the brain ...

is often observed, specifically polyneuropathy. This progressive skin process is due to the effect of continuing active infection with the

spirochete A spirochaete () or spirochete is a member of the phylum Spirochaetota (), (synonym Spirochaetes) which contains distinctive diderm (double-membrane) gram-negative bacteria, most of which have long, helically coiled (corkscrew-shaped or s ...

Borrelia afzelii ''Borrelia afzelii'' is a species of '' Borrelia'' a bacterium that can infect various species of vertebrates and invertebrates. Among 30 ''Borrelia'' known species, it is one of four which are likely to infect humans causing a variant of Lyme d ...

'', which is the predominant pathophysiology. ''B. afzelii'' may not be the exclusive etiologic agent of ACA; ''Borrelia garinii'' has also been detected.

Presentation

The rash caused by ACA is most evident on the extremities. It begins with an inflammatory stage with bluish red discoloration and cutaneous swelling, and concludes several months or years later with an atrophic phase. Sclerotic skin plaques may also develop. As ACA progresses the skin begins to

wrinkle A wrinkle, also known as a rhytid, is a fold, ridge or crease in an otherwise smooth surface, such as on skin or fabric. Skin wrinkles typically appear as a result of ageing processes such as glycation, habitual sleeping positions, loss of ...

( atrophy).

Cause

Diagnosis

Generally a two-step approach is followed. First, a screening test involving IgM and IgG ELISA. If the ELISA screening has a positive or equivocal result, then the second step is to perform a Western Blot as a confirmatory test. Other methods include microscopy and culture (in modified Kelly's medium) of skin biopsy or blood samples.

Treatment

Antibiotics An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...

is recommended in treatment of ACA. Doxycycline is often used. Resolution may take several months. Skin damage and

nerve damage Nerve injury is an injury to nervous tissue. There is no single classification system that can describe all the many variations of nerve injuries. In 1941, Seddon introduced a classification of nerve injuries based on three main types of nerve f ...

may persist after treatment.

History

The first record of ACA was made in 1883 in Breslau,

Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...

, where a physician named

Alfred Buchwald Alfred may refer to: Arts and entertainment *''Alfred J. Kwak'', Dutch-German-Japanese anime television series * ''Alfred'' (Arne opera), a 1740 masque by Thomas Arne * ''Alfred'' (Dvořák), an 1870 opera by Antonín Dvořák *"Alfred (Interlu ...

first delineated it. Herxheimer and Hartmann described it in 1902 as a "tissue paper like"

cutaneous Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different d ...

atrophy.

References

Bibliography

* Stanek G & Strle F (2008) ''Lyme Disease—European Perspective'', Infectious Disease Clinics of North America , Volume 22 , Issue 2 , June 2008, Pages 327-33
Abstract

External links

{{DEFAULTSORT:Acrodermatitis Chronica Atrophicans Abnormalities of dermal fibrous and elastic tissue Lyme disease Spirochaetes Bacterium-related cutaneous conditions