Acrodermatitis chronica atrophicans

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
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Yvonne
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Re: Acrodermatitis chronica atrophicans

Post by Yvonne » Wed 11 Aug 2010 19:41

Acta Neurol Scand. 2002 Nov;106(5):253-7.

Peripheral neuropathy in acrodermatitis chronica atrophicans - effect of treatment.

Kindstrand E, Nilsson BY, Hovmark A, Pirskanen R, Asbrink E.

Karolinska Institute, Department of Neurology, Huddinge University Hospital, Stockholm, Sweden.

Abstract
Forty-seven patients with the late borrelial manifestation acrodermatitis chronica atrophicans (ACA) and with objective neurological and/or neurophysiological findings were followed up after antibiotic treatment with dermatological, serological, neurological and neurophysiological controls. Despite a good therapeutic effect on ACA lesions, specific antibody values and symptoms of irritative nerve lesions, the objective neurological and neurophysiological findings of nerve deficit remained unchanged. There was no progress of neuropathy findings during the follow-up time. Our interpretation of the results is that the remaining neuropathy signs after treatment of ACA are neurological sequelae and not manifestations of persisting Borrelia infection.

PMID: 12371917
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X-member
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Re: Acrodermatitis chronica atrophicans

Post by X-member » Wed 11 Aug 2010 20:50

http://www.ncbi.nlm.nih.gov/pubmed/3056202
Ann N Y Acad Sci. 1988;539:324-45.

Antibiotic therapy of early European Lyme borreliosis and acrodermatitis chronica atrophicans.
Weber K, Preac-Mursic V, Neubert U, Thurmayr R, Herzer P, Wilske B, Schierz G, Marget W.

Department of Microbiology, University of Munich, Federal Republic of Germany.

Abstract
In a study on 121 consecutive patients with erythema migrans, 65 patients obtained oral penicillin, 36 tetracyclines, and 20 amoxicillin-clavulanic-acid. Follow-up was carried out for a median of 29, 17, and 7 months, respectively. In another limited trial on 29 patients with acrodermatitis chronica atrophicans (ACA), 14 patients received oral penicillin, 9 parenteral penicillin, and 6 tetracyclines. There was no statistically significant difference among treatment groups in both therapeutic trials, with the exception of different follow-ups due to the nonrandomized study design and different occurrence of the Jarisch-Herxheimer reaction in patients with erythema migrans. Later extracutaneous manifestations developed in 27% of the patients with erythema migrans and in 47% of the patients with ACA despite antibiotic therapy. We could not prove the superiority of any antibiotic tested in either early or late European Lyme borreliosis.

PMID: 3056202 [PubMed - indexed for MEDLINE]

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Re: Acrodermatitis chronica atrophicans

Post by X-member » Thu 12 Aug 2010 0:39

http://www.springerlink.com/content/q6272k4140463144/
Success and failure in the treatment of acrodermatitis chronica atrophicans
Elisabeth Aberer, F. Breier, G. Stanek and B. Schmidt

Abstract

To determine the most effective treatment for acrodermatitis chronica atrophicans, several clinical trials were undertaken in recent years to evaluate whether a 2-week course of ceftriaxone would be superior to oral antibiotics. Of the 46 patients suffering from acrodermatitis chronica atrophicans, 14 were treated with ceftriaxone 2g for 15 days. The remaining patients received either oral penicillin V 1.5 million IU t.i.d. or doxycycline 100 mg b.i.d. for 20 to 30 days. Patients were followed up for at least 1 year. Of the 14 ceftriax-one-treated patients four showed incomplete regression of the inflammatory skin changes after 6 to 12 months. Two out of five patients who were monitored for Borrelia burgdorferi DNA excretion were still positive after 12 months as compared to none of six patients who were treated orally for 20–30 days. Six out of 11 patients treated orally for only 20 days needed retreatment after 6 months because of continuing skin manifestations, neuropathy or arthralgia. A 30-day duration of treatment with oral antibiotics and not the chosen antibiotic is crucial for curing acrodermatitis chronica atrophicans. The duration of treatment with ceftriaxone needed for eradication of Borrelia in acrodermatitis chronica atrophicans has yet to be determined in future studies.

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Re: Acrodermatitis chronica atrophicans

Post by X-member » Thu 12 Aug 2010 0:46

http://www.centuryinter.net/tjs11/bug/blot1.htm#n6
Patients with ACA shed Bb DNA post treatment: Aberer E, et al. Success and Failure in the treatment of Acrodermatitis Chronica Atrophicans (ACA) skin rash. Infection 24(1):85-87 1996.

ACA is a late stage skin rash usually attributed to Borrelia afzelii, it is sometimes mistaken for scleroderma.

Forty-six patients with ACA were treated with either 14 days of IV Rocephin or thirty days of oral penicillin or doxycycline and followed up for one year. Of those treated with IV, 28% had no improvement, and 40% still shed Bb antigen in their urine. Of the oral group, 70% required retreatment. Conclusion: Proper length of treatment for ACA has yet to be determined.

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Yvonne
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Re: Acrodermatitis chronica atrophicans

Post by Yvonne » Fri 13 Aug 2010 12:03

Ned Tijdschr Geneeskd. 2010;154(30):A2012.

Acrodermatitis chronica atrophicans: late manifestation of Lyme borreliosis.

[Article in Dutch]

Krol CG, van der Geer S, Thio HB, Janssen MJ, Jonkers GP.

Rijnland ziekenhuis, Leiderdorp.

Abstract
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.

PMID: 20699042
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sibila
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Re: Acrodermatitis chronica atrophicans

Post by sibila » Sun 4 Sep 2011 18:07

Hello!

I am 19 years old, and when i was about 7 years old my parents first noticed a skin disorder on front part of my right tigh. I was treated with basic hidrating losions and that is it. Later, when I hit puberty I noticed that my rught tigh is thinner than the left one, for about 3 cm. Later the shape of the upper part of my leg changed and it was obvious that some parts were simply missing. The skin in that area was/is almost transparent. Later on I started feeling tingling in my lower part of my right leg, below the knee and I lost sensation in that area. Same thing later happened on my right arm, but it is not as serious as my leg.
Doctors were never sure wat was the cause or the exact name of the disease. I was treated with physical terapy, but it didn't prove very helpfull.

I did tests for blodwork, something with those neeedles, and they said that the results were ok.
About the musle loss, they said that my muscles were atrophic, but that I also have no fat in that area and that the only way to compensate that fat is by plastic surgery, but I refused that option.
I went to physical therapy for years, and the only sign of improvement was a little muscle ''comeback'' in the middle of the front part of my thighs. After that the doctor said that there might be a slight chance of replacing the missing fat with muscles, but that never happened since after my doctor found out that the problem is not that much in mucles as in the fat, said that the ph. therapy is not that necesery.

I should also mention that my reflects are a mess. When my doctor tried to do the test with the little rubber hammer( i don't know what it is called) my leg barely moved after many tries.

Could this be related to Acrodermatitis chronica atrophicans? But I should mention that the affected area isn't reddish now, but my mom says that at first it had a brownish colour.

RitaA
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Re: Acrodermatitis chronica atrophicans

Post by RitaA » Fri 18 Sep 2015 16:35

I realize this thread hasn't been active since September 2011, however I thought it might be worthwhile mentioning that research into ACA is still taking place in Austria and Germany, as well as other European countries:

http://www.ncbi.nlm.nih.gov/pubmed/23147352
Am J Dermatopathol. 2013 May;35(3):338-42. doi: 10.1097/DAD.0b013e31826b7487.

Acrodermatitis chronica atrophicans with pseudolymphomatous infiltrates.

Tee SI1, Martínez-Escanamé M, Zuriel D, Fried I, Wolf I, Massone C, Cerroni L.

Author information

1 Research Unit of Dermatopathology, Department of Dermatology, Medical University of Graz, Graz, Austria.

Abstract

In this study, we describe the clinicopathologic features of pseudolymphomatous infiltrates found within lesions of acrodermatitis chronica atrophicans (ACA). We studied 11 patients (10 females, 1 male, age range 60-88 years). The diagnosis of ACA in all cases was confirmed by clinicopathologic correlation and positive serology for Borrelia. Histopathologic examination revealed prominent, pseudolymphomatous inflammatory cell infiltrates in all cases, with 2 distinct patterns. Eight of 11 cases showed a band-like lymphocytic infiltrate, exocytosis of lymphocytes and a fibrotic papillary dermis, similar to features seen in mycosis fungoides. The other 3 cases showed dense, nodular-diffuse dermal infiltrates with many plasma cells and without germinal centers. The plasma cells expressed both kappa and lambda immunoglobulin light chains with a polyclonal pattern in all 3 cases. In conclusion, ACA may present with pseudolymphomatous infiltrates showing both a T-cell and, less frequently, a B-cell pattern. These lesions need to be distinguished from a cutaneous lymphoma. In the context of the knowledge of Borrelia-associated cutaneous lymphomas, follow-up seems advisable in these cases.

PMID: 23147352 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/26156537
J Cutan Pathol. 2015 Jul 8. doi: 10.1111/cup.12550. [Epub ahead of print]

Histopathology and immunophenotype of acrodermatitis chronica atrophicans correlated with ospA and ospC genotypes of Borrelia species.

Brandt FC1, Ertas B2, Falk TM2, Metze D1, Böer-Auer A2.

Author information

1 Department of Dermatology, Munster University, Münster, Germany.
2 Dermatologikum Hamburg, Hamburg, Germany.

Abstract

BACKGROUND: Chronic cutaneous borreliosis (acrodermatitis chronica atrophicans, ACA) is a relatively rare manifestation of borreliosis attributed mainly to Borrelia afzelii. Chronic borreliosis has been associated with ospA and ospC genotypes. Literature on molecular investigations of Borrelia in lesions of ACA is scant.

METHODS: Histopathological and immmunohistochemical features in 22 biopsies of ACA (16 patients) were examined. Paraffin-embedded biopsies were analyzed with polymerase chain reaction (PCR) assays targeting ospA and ospC genes, sequencing and phylogenetic analysis.

RESULTS:Genotyping of ospA identified B. afzelii, serotype 2, in 12 of 16 patients. ospC-PCR was positive in seven patients revealing genotypes Af5 (n = 4), Af2 (n = 2) and Af6 (n = 1). Histopathologically, interstitial granulomatous infiltrates (CD68 positive) were common, combined with thickened collagen bundles and band-like infiltrates of CD4 positive T lymphocytes. Plasma cells were sparse/absent in 9 of 22 specimens even on staining with CD138. On CD34-staining, interstitial fibroblasts were often reduced akin to the situation in morphea.

CONCLUSIONS: With assays targeting ospA and ospC genes we confirmed from paraffin-embedded biopsies that B. afzelii, serotype 2, osp C groups Af5, Af2 and Af6 is the main cause of ACA. Specimens commonly showed a combination of band-like T-cell-rich infiltrates with interstitial granulomatous features, a pattern previously under-recognized in ACA. This finding was particularly typical for lesions infected with ospC genotype Af5.

© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

KEYWORDS:Lyme borreliosis; acrodermatitis chronica atrophicans; granuloma; ospA; ospC

PMID: 26156537 [PubMed - as supplied by publisher]
http://www.ncbi.nlm.nih.gov/pubmed/25230062
Acta Dermatovenerol Croat. 2014;22(3):205-8.

Acrodermatitis chronica atrophicans of the face: a case report and a brief review of the literature.

Stinco G1, Trevisan G, Martina Patriarca M, Ruscio M, Di Meo N, Patrone P.

Author information

1 Giuseppe Stinco, MD, Institute of Dermatology , University of Udine, Ospedale "San Michele" , Piazza Rodolone 1, 33013 Gemona del Friuli (Udine), Italy ; giuseppe.stinco@uniud.it.

Abstract

Acrodermatitis chronica atrophicans is a rare late manifestation of tick-borne Borrelia burgdorferi infection, manifesting as inflammatory and atrophic lesions on acral skin. We describe the case of a 73-year-old woman with skin changes progressed to marked atrophy on her left hand and an edematous inflammatory involvement of the face. The diagnosis of acrodermatitis chronica atrophicans was made on the basis of clinical appearance, serological and histopathological findings, and the lesional detection of B. burgdorferi-specific gene segments by polymerase chain reaction. This unusual case illustrates that acrodermatitis chronica atrophicans affects not only the extremities but also the face. The clinical and histological finding of the lesions occurring on acral skin showed a prominent atrophic appearance, while the ones occurring on the face showed a prominent inflammatory appearance.

PMID: 25230062 [PubMed - in process]

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