Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct;35(5):490-494.
doi: 10.5114/ada.2018.77240. Epub 2018 Jul 19.

Acrodermatitis chronica atrophicans: various faces of the late form of Lyme borreliosis

Anna Moniuszko-Malinowska  1 , Piotr Czupryna  1 , Justyna Dunaj  1 , Sławomir Pancewicz  1 , Adam Garkowski  1 , Maciej Kondrusik  1 , Sambor Grygorczuk  1 , Joanna Zajkowska  1
Affiliations

Acrodermatitis chronica atrophicans: various faces of the late form of Lyme borreliosis

Anna Moniuszko-Malinowska et al. Postepy Dermatol Alergol. 2018 Oct.

Abstract

Introduction: Acrodermatitis chronica atrophicans (ACA) is probably the most common late and chronic manifestation of the Lyme borreliosis seen in European patients.

Aim: To analyze epidemiological data, and to investigate the effects of treatment of patients with ACA.

Material and methods: Nine patients were included in the study. All patients had serological examinations (ELISA and Western blot) and histopathological examination of the skin lesions performed. Eight patients had PCR in the skin biopsy performed.

Results: The duration of symptoms ranged from 2 months to 2 years. In 7 patients, skin lesions were located on lower limbs, in 2 patients - in a non-typical body area - abdomen. In 1 patient, scleroderma and in 3 patients, diabetes mellitus was diagnosed. Borrelia burgdorferi DNA was detected in 25% of the skin biopsy specimens. IgG anti-B. burgdorferi specific antibodies were present in serum of all patients (confirmed by Western blot). In all cases, the diagnosis was confirmed by histopathological examination. The response to ceftriaxone therapy varied. In 5 cases, the lesions resolved completely, in others they faded.

Conclusions: Despite raising awareness of Lyme borreliosis, late forms of the disease such as ACA are still observed. Acrodermatitis chronica atrophicans skin lesions may be located in non-characteristic areas, e.g. abdominal skin. Symptoms are not irritating or painful, therefore patients do not seek medical help. The effect of antibiotic treatment varies.

Keywords: Lyme borreliosis; acrodermatitis chronica atrophicans.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Patient 2. Lesions typical of ACA on the left thigh
Figure 2
Figure 2
Patient 3. Lesions typical of ACA on the right palm
Figure 3
Figure 3
Patient 4. Lesions typical of ACA in the left knee area
Figure 4
Figure 4
Patient 7. Lesions typical of ACA on the left shank
Figure 5
Figure 5
Patient 8. Lesions typical of ACA on the whole right lower limb
Figure 6
Figure 6
Patient 9. ACA lesions on abdomen
See this image and copyright information in PMC

References

    1. Stanek G, Strle F. Lyme disease – European perspective. Infect Dis Clin N Am. 2008;22:327–39. - PubMed
    1. Letrilliart L, Ragon B, Hanslik T, Flahault A. Lyme disease in France: a primary care-based prospective study. Epidemiol Infect. 2005;133:935–42. - PMC - PubMed
    1. Rizzoli A, Hauffe H, Carpi G, et al. Lyme borreliosis in Europe. Euro Surveill. 2011;7:16. - PubMed
    1. Stanek G, Fingerle V, Hunfeld KP, et al. Lyme borreliosis: clinical case definitions for diagnosis and management in Europe. Clin Microbiol Infect. 2011;17:69–79. - PubMed
    1. Christova I, Komitova R. Clinical and epidemiological features of Lyme borreliosis in Bulgaria. Wien Klin Wochenschr. 2004;116:42–6. - PubMed