Acrodermatitis chronica atrophicans is a relatively frequent sign of late Lymeborreliosis, often causing diagnostic difficulties. It affects predominately older people, especially women over 50 years ...of age, and in contrast to erythema migrans and borrelial lymphocytoma does not disappear spontaneously. It is usually caused by Borrelia afzelii. Pathogenesis has not been well delineated. The first clinical signs appear months to years after the inoculation of borreliae in the organism, however in some patients acrodermatitis chronica atrophicans is preceded by other manifestations of Lyme borreliosis. The onset is as a rule slow, hardly appreciated: bluish-red slowly expanding skin lesion appears, usually on the dorsal part of a hand, foot or in the region of knee. At the beginning it is as a rule unilateral, later it may become more or less symmetric. During the initial months or yearsthe involved skin is oedematous but later on the affected areas graduallybecome atrophic with thin, wrinkled skin and prominent blood vessels.Sometimes sclerotic lesions and/or fibrotic bands or nodules develop. Peripheral neuropathy and joint involvement, usually located underneath skin lesions, are present in up to one half and one third of patients, respectively. THe diagnosis of acrodermatitis chronica atrophicans is based onclinical and serologic criteria (high titres of borrelial IgG antibody are regularly present); histological examination serves a confirmatory purpose. Treatment with antibiotics is successful particularly in the early (oedematous) phase of the illness.
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