Acrodermatitis chronica atrophicans (ACA) is a skin rash indicative of the third or late stage of European

Lyme borreliosis Lyme or LYME may refer to: * Lyme disease, an infectious disease carried by ticks caused by bacteria of the genus ''Borrelia'' Places United Kingdom * Lyme, an alternative name of Lyme Handley, a civil parish in Cheshire ** Lyme Park, an estate ...

. ACA is a dermatological condition that takes a chronically progressive course and finally leads to a widespread

atrophy Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply ...

of the skin. Involvement of the peripheral nervous system is often observed, specifically polyneuropathy. This progressive skin process is due to the effect of continuing active infection with the spirochete '' Borrelia afzelii'', which is the predominant pathophysiology. ''B. afzelii'' may not be the exclusive

etiologic Cause, also known as etiology () and aetiology, is the reason or origination of something. The word ''etiology'' is derived from the Greek , ''aitiologia'', "giving a reason for" (, ''aitia'', "cause"; and , ''-logia''). Description In medicin ...

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 (

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 ...

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

History

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

Germany Germany, officially the Federal Republic of Germany (FRG),, is a country in Central Europe. It is the most populous member state of the European Union. Germany lies between the Baltic and North Sea to the north and the Alps to the sou ...

, where a physician named Alfred Buchwald first delineated it.

Herxheimer Karl Herxheimer (; 26 June 1861 – 6 December 1942) was a German-Jewish dermatologist who was a native of Wiesbaden. He studied medicine at the universities of University of Freiburg, Freiburg, University of Strasbourg, Strasbourg and Unive ...

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 ...

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