jwissmille

LATE CUTANEOUS LYME DISEASE: ACRODERMATITIS CHRONICA ATROPHICANS. Authors:
Kaufman LD Gruber BL Phillips ME Benach JL
Source: Am J Med 1989 Jun;86(6 Pt 2):828-30
*
".....Observations from our patients indicate that the cutaneous lesions of ACA
may be more common than was previously recognized.* Alternatively,* there may
be an increase in incidence related to the rapidly rising number of Lyme
disease cases in endemic areas throughout this couontry.* We have confirmed the
spirochetal etiology of this
lesion as demonstrated in European specimens using a specific monoclonal
antibody against B. burgdorferi .* This therefore establishes ACA as a part of
the natural history as well as a late manifestation of untreated* cutaneous
Lyme disease in the United States.....A heightened awareness of this
manifestation of Lyme diseae may lead to the more frequent recognition of its
occurrence, avoidance of a delay in diagnosis, and the development of
appropriate therapeutic intervention."
__________________________________________________ ________

Title: Acrodermatitis Atrophicans Chronica
Authors: Hamilton* Montgomery and Ralph Sullivan
Source:* Archives of Dermatology and Syphilology 51:32-47* 1945 Organization:*
Mayo Foundation Rochester, Minn.

"Summary and Conclusions-
* * There is no known treatment for acrodermatitis chronica atrophicans (Lyme
disease) is a chronic dermatosis of unknown cause usually involving the
extremities, especially the extensor surfaces in the vicinity of the knees,
ankles, elbows and wrists.* The disease, however, may be generalized and appear
as erythoderma" (abnormal redness of the skin-Taber's) "with poikiloderma-like
changes."
(poikiloderma-* A skin disorder characterized by pigmentation, telangiectasia,
purpura, pruritus, and atrophy.-Taber's)
"At times it may be unilateral.* IT IS NOT LIMITED TO ONE NATIONALITY OR
CONTINENT, AND IT OCCURS FAIRLY FREQUENTLY AMONG NATIVE BORN AMERICANS.* It is
usually a disease of the later decades of life, predominating in women who are
more than 40 years of age. ......The average histopathologist has much
difficulty in differentiating the end stages of other cutaneous atrophies..."
*
________________________________________
Title:Successful cultivation of spirochetes from skin lesions of patients with
erythema chronicum migrans Afzelius and acrodermatitis chronica atrophicans.
Authors:Asbrink E, Hovmark A
Source:Acta Pathol Microbiol Immunol Scand [b] 1985 Apr;93(2):161-3

Abstract:
Spirochetes could be cultivated from 9 out of 13 skin biopsies from patients
with erythema chronicum migrans Afzelius (ECMA) and from 2 out of 5 biopsies
from patients with acrodermatitis chronica atrophicans (ACA) by using a newly
modified serumless Kelly's medium. The different spirochete strains grew best
at a low oxygen tension. Attempts to grow spirochetes from blood and
cerebrospinal fluid failed. The cultivation of spirochetes from secondary ECMA
lesions favours the presumption that a spirochetemia may occur in ECMA. The
isolation of spirochetes from an ACA patient who had a disease duration of
greater than 10 years proves that the spirochetes may survive in the human body
for a considerable time.

Keywords:


Language: Eng

Unique ID: 85247578
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Title:The spirochetal etiology of acrodermatitis chronica atrophicans
Herxheimer.
Authors:Asbrink E, Hovmark A, Hederstedt B
Source:Acta Derm Venereol 1984;64(6):506-12
Organization:

Abstract:
Spirochetes were recovered from the skin lesion of 1 out of 10 acrodermatitis
chronica atrophicans patients (ACA).
Spirochetes from this skin isolate and from Ixodes (I.) ricinus and I. dammini
spirochetes were used as antigens in indirect
immunofluorescence tests. All sera from 17 ACA patients showed high antibody
titers to the three antigens. Seven of the 17
sera which had the highest titers had crossreactive antibodies to treponemal
antigen detectable in the FTA-ABS test. The
results indicate that spirochetes are of importance for ACA and probably the\0
causative agent of this disease. The connection
between ACA and tick bites and the relationship to erythema chronicum migrans
Afzelius (ECMA) and Lyme disease are
discussed. The results are consistent with the hypothesis that ECMA and ACA are
different manifestations of the same
spirochete, with ACA as a late manifestation.

Keywords:
Acrodermatitis/complications/*etiology/microbiology, Adult, Aged, Biopsy,
*Bites and Stings, Erythema/complications/etiology, Female, Fluorescent
Antibody Technique, Human, Lyme Disease/etiology, Male, Middle Age,
Skin/microbiology, Spirochaetales/isolation & purification, *Spirochaetales
Infections, Support, Non-U.S. Gov't, *Ticks

Language: Eng

Unique ID: 85144858
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Why is Chronic Lyme Borreliosis Chronic?
Authors:Aberer E; Koszik; Silberer M
Conference:9th Annual International Scientific Conference on Lyme Disease &
Other Tick-Borne Disorders, Westin Copley Plaza Hotel, Boston, MA, April 19-20,
1996
Presenter:Elizabeth Aberer, M.D.
Department of Dermatology
University of Graz

Abstract:
In spite of marked cellular and humoral immune responses in acrodematitis
chronica atrophicans (ACA) B. burgdorferi (Bb) can be isolated from
long-standing skin lesions. Recently, it was shown that the most important cell
for antigen presentation, the epidermal Langerhans cell (LC), is heavily
damaged in erythema migrans (EM). To evaluate whether the immune response and
the number or function of LC is altered we studied the immunophenotype of
cutaneous leukocytes in ACA. Lesional skin biopsies from 19 patients with ACA
and 9 patients with EM were investigated by immunoperoxidase single labeling or
double-labeling procedures. In EM the total number of CD1a+ cells reduced in
the epidermis of ACA skin semi-automatic image analysis revealed a density of
811(+336 SD) CD1a+ but only 13(+143 SD) HLA-DR+ dendritic cells while in normal
skin most of the epidermal CD1a+ cells are HLA-DR+. The majority of cells in
the dermis of ACA were composed of CD68+ macrophages and CD45+ memory T-cells
with a predominance of helper/inducer cells. About 75% of the cells were
further activated expressing HLA-DR and CD54 and its receptor CD18. In this
study, the most prominent immunohistochemical changes were seen on the
epidermal dendritic cell population. Our data suggest that MHC class II
molecules are strongly down regulated on LC not only in the early but also in
the late stage skin manifestation of LB. This phenomenon [of?] antigen
presenting cells might be a protective mechanism against the presentation of
cellular auto antigens and might be the cause for the impaired capacity of LC
to eliminate Bb antigens.

Unique ID: 96LDF008
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Peripheral neuropathy in acrodermatitis chronica atrophicans - a late Borrelia
manifestation.
Authors:Kindstrand E, Nilsson BY, Hovmark A, Pirskanen R, Asbrink E
Source:Acta Neurol Scand 1997 Jun;95(6):338-45
Organization:Karolinska Institute, Department of Neurology, Stockholm Soder
Hospital, Sweden.

Abstract:
Clinical and/or neurophysiological signs of peripheral neuropathy were found in
64% of 63 consecutive untreated patients with the late borrelial manifestation
acrodermatitis chronica atrophicans (ACA). The neuropathy frequency was
significantly higher in the patients than in 30 age- and sex-matched control
persons of whom 27% had neuropathy findings. The most common neuropathy in ACA
was a symmetric distal sensory polyneuropathy. In a subgroup of patients with
localized or asymmetric neuropathy, the changes were found more often in
extremities with than without visible ACA lesions. Neuropathy symptoms, most
often pain and/or paresthesia, were present in 64% of the patients, compared to
in 13% of the control persons. Thus, both symptoms and signs of neuropathy were
significantly more frequent in patients with untreated ACA than in control
subjects.

Keywords:
Acrodermatitis, EPIDEMIOLOGY, MICROBIOLOGY, PATHOLOGY, Adult, Age Factors,
Aged, Borrelia burgdorferi, ISOLATION & PURIF, Case-Control Studies, Chi-Square
Distribution, Comorbidity, Extremities, PATHOLOGY, PHYSIOPATHOLOGY, Female,
Human, Hyperalgesia, PATHOLOGY, PHYSIOPATHOLOGY, Hypesthesia, PATHOLOGY,
PHYSIOPATHOLOGY, Lyme Disease, COMPLICATIONS, Male, Middle Age, Pain,
CLASSIFICATION, PATHOLOGY, PHYSIOPATHOLOGY, Paresthesia, PATHOLOGY,
PHYSIOPATHOLOGY, Peripheral Nervous System Diseases, EPIDEMIOLOGY, ETIOLOGY,
PATHOLOGY, PHYSIOPATHOLOGY, Prevalence, Prospective Studies, Risk Factors, Sex
Factors, Sweden, EPIDEMIOLOGY

Language: Eng

Unique ID: 97372003

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A clinical, histological, and immunohistochemical comparison of acrodermatitis
chronica atrophicans and morphea.
Authors:Aberer E, Klade H, Hobisch G
Source:Am J Dermatopathol 1991 Aug;13(4):334-41
Organizationepartment of Dermatology II, University of Vienna, Austria.

Abstract:
We compared 19 patients with acrodermatitis chronica atrophicans (ACA), a
dermatosis caused by Borrelia burgdorferi infection, and 40 patients with
morphea, a disease of heterogeneous origin where a borrelia etiology has been
suggested in some cases, both clinically and histologically to define the
differences between these two dermatoses. Clinically, ACA involves acral body
sites with lower temperatures, is seen mostly in elderly persons, and presents
as a livid discoloration that is not sharply demarcated. Morphea can be
localized in embryonal structures, affects any age and body site, and exhibits
extension at the periphery of the lesions. Histologically, ACA shows atrophy of
collagen and elastic tissue as well as hypertrophic basophilic elastic tissue;
whereas in morphea, sclerosis and polarizing elastic tissue are prominent.
Graft-versus-host-like reactions may be present in both dermatoses.
Immunohistochemical testing with different lymphocyte markers showed
differences only in the expression of HLA-DR antigens. These conditions can be
distinguished from each other on a clinical and histological basis in most
cases. In 17% of morphea biopsy specimens, however, histological
differentiation from ACA was not possible. Moreover, the histological pattern
of morphea was not associated with a positive borrelia serology.

Keywords:
Acrodermatitis, IMMUNOLOGY, MICROBIOLOGY, PATHOLOGY, Adult, Aged, Atrophy,
Borrelia burgdorferi, Borrelia Infections, PATHOLOGY, Chronic Disease,
Comparative Study, Female, Human, Immunohistochemistry, Male, Middle Age,
Scleroderma, Circumscribed, IMMUNOLOGY, MICROBIOLOGY, PATHOLOGY, Skin,
IMMUNOLOGY, PATHOLOGY, Support, Non-U.S. Gov't

Language: Eng

Unique ID: 92026765
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Acrodermatitis chronic atrophicans: a chronic T-cell-mediated immune reaction
against Borrelia burgdorferi? Clinical, histologic, and immunohistochemical
study of five cases.
Authors:Buechner SA, Rufli T, Erb P
Source:J Am Acad Dermatol 1993 Mar;28(3):399-405
Organizationepartment of Dermatology, University of Basel, Switzerland.

Abstract:
BACKGROUND: Acrodermatitis chronica atrophicans (ACA) is a late manifestation
of infection caused by Borrelia burgdorferi. OBJECTIVE: Our purpose was to
study the clinical, histopathologic, and immunohistochemical findings in
patients with ACA to understand better the pathogenesis of the disease.
METHODS: Five patients were studied. Skin biopsy specimens were obtained from
active lesions for histologic and immunohistochemical studies. RESULTS:
Clinical lesions included an initial erythematous discoloration in one patient
and violaceous infiltrated plaques and nodules in four patients, three of whom
also had late atrophic lesions. Biopsy specimens showed dermal perivascular
and interstitial lymphocytic infiltrate with plasma cells. There was a
predominance of CD3+, CD4+ T cells in the dermal infiltrate. B cells were
present in three patients. The dermal infiltrate showed an intense expression
of lymphocyte function-associated antigen. The intercellular adhesion molecule
type 1 was expressed on endothelial cells, perivascular mononuclear cells, and
focally on basal keratinocytes. CONCLUSION: Our findings suggest that a
chronic, T-cell-mediated immune reaction against B. burgdorferi is involved in
the pathogenesis of ACA.

Keywords:
Acrodermatitis, IMMUNOLOGY, MICROBIOLOGY, PATHOLOGY, Adult, Aged, Aged, 80 and
over, Antibodies, Bacterial, ANALYSIS, Antigens, CD, ANALYSIS, Atrophy,
Borrelia burgdorferi, IMMUNOLOGY, Cell Adhesion Molecules, ANALYSIS, Chronic
Disease, Female, Human, HLA-DR Antigens, ANALYSIS, Immunity, Cellular,
Immunohistochemistry, Keratinocytes, IMMUNOLOGY, Langerhans Cells, IMMUNOLOGY,
Lyme Disease, COMPLICATIONS, Male, Middle Age, Skin, IMMUNOLOGY, PATHOLOGY,
T-Lymphocytes, IMMUNOLOGY

Language: Eng

Unique ID: 93187047
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Acrodermatitis chronica atrophicans: Historical and clinical overview
Authors:Scrimenti RJ
Source:JSTD 1995; 2:97-100
JSTD Home Page: http://www.slackinc.com/general/jstd/jstdhome.htm
Organization:

Abstract:
Acrodermatitis chronica atrophicans (ACA), a late manifestation of Lyme
borreliosis, is an excellent example of chronic and latent spirochetosis.
Indeed, it may serve as a model for investigation of chronic bacterial
infection. Cases of ACA are extremely rare in the United States, despite the
fact that they have been recognized in this country for at least a century. In
Europe, where it is much more frequently encountered, its clinical features
have been delineated carefully.

ACA consists of an early infiltrative and inflammatory stage and a late
atrophic stage. It does not spontaneously abate. The histologic features are a
lymphohistiocytic and sometimes plasmacytic dermal and subcutaneous
infiltration and telangiectasia of blood and lymphatic vessels with lymphedema.
Eventually, dermal and subcutaneous atrophy and disruption of collagen and,
especially, elastic fibers ensue. Borrelia burgdorferi, the causative organism,
may be cultured from even decade-old skin esions. The skin eruption is
characteristically accompanied by fibrotic bands, juxta articular nodules, a
distinctive arthropathy and a peripheral neuropathy. Occasionally,
pseudosclerodermoid skin changes appear. Marked differences in clinical
manifestations are noted in recently reported cases from the United States.
Perhaps this is due to genospecific and organotropic differences between
spirochetes on either side of the Atlantic.

Early skin changes usually respond to antibiotic treatment. Later changes,
especially severe atrophy, may resist therapy. Elevated serologic titers of
antibodies to Borrelia burgdorferi, a characteristic finding in virtually all
European cases, may remain positive indefinitely, even after adequate
treatment.


Language: Eng

Unique ID: 950000AO
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Periarticular fibrous nodules in Lyme borreliosis.
Authors:Espa:na A, Torrelo A, Guerrero A, Su:arez J, Rocamora A, Ledo A
Source:Br J Dermatol 1991 Jul;125(1):68-70
Organizationepartment of Dermatology, Hospital Ramn y Cajal, Madrid, Spain.

Abstract:
Periarticular fibrous nodules have been described in patients with late-phase
acrodermatitis chronica atrophicans (ACA) in the setting of Lyme borreliosis.
We report the clinical and histopathological study of two patients with
periarticular fibrous nodules and with Lyme borreliosis and discuss the
relationship between these nodules and ACA.

Keywords:
Acrodermatitis, PATHOLOGY, Aged, Case Report, Fingers, PATHOLOGY, Human, Lyme
Disease, PATHOLOGY, Male, Middle Age, Skin, PATHOLOGY

Language: Eng

Unique ID: 91337890
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[Chronic atrophic acrodermatitis; a deceptive form of Lyme borreliosis]
Authors:Tazelaar DJ, Velders AJ, de Koning J, Hoogkamp-Korstanje JA
Source:Ned Tijdschr Geneeskd 1991 Jul 27;135(30):1358-63
Organization:Algemeen Ziekenhuis de Tjongerschans, afd. Dermatologie,
Heerenveen.

Abstract:
Acrodermatitis chronica atrophicans (ACA) was diagnosed in 15 patients from the
southern and eastern part of Friesland (the Netherlands). Twelve patients had
one leg affected; three had more than one extremity involved. Frequent
complaints were fatigue, paraesthesia, swelling and blue discoloration. The
symptoms persisted for many years in most cases. The inflammatory stage was
observed most frequently (13/15): violet-blue erythema, oedema, firm swelling
and nodules. Atrophy (4/15) was observed once in the form of a scleroderma-like
lesion. Neuropathy was found in five patients. Histological investigation
showed infiltration with lymphocytes and plasma cells (13/15) and atrophy
(2/15). Spirochaetes were demonstrated in biopsies of 13 patients. Specific
antibodies against Borrelia burgdorferi were found in all patients. ACA appears
to be not infrequent and must be distinguished from other inflammatory and
vascular diseases, such as chronic venous insufficiency.

Keywords:
Acrodermatitis, ETIOLOGY, PATHOLOGY, Adult, Aged, Antibodies, Bacterial,
ISOLATION & PURIF, Atrophy, Borrelia burgdorferi, IMMUNOLOGY, ISOLATION &
PURIF, English Abstract, Female, Human, Lyme Disease, COMPLICATIONS, DIAGNOSIS,
Male, Middle Age, Skin, MICROBIOLOGY, PATHOLOGY

Language: Dut

Unique ID: 91326144
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Cutaneous fibroses induced by Borrelia burgdorferi.
Authors:Marsch WC, Mayet A, Wolter M
Source:Br J Dermatol 1993 Jun;128(6):674-8
Organizationepartment of Dermatology, Johann Wolfgang Goethe-Universit:at,
Frankfurt am Main, Germany.

Abstract:
Three cases of chronic infection with Borrelia burgdorferi are described. The
patients presented with nodular or discoid fibrosis, partly in conjunction with
acrodermatitis chronica atrophicans (ACA). Juxta-articular fibrotic nodules may
develop within a few months of the onset of ACA. Nodular, discoid
morphoea-like, and widespread cutaneous fibroses in chronic Borrelia infection
may be provoked by trauma, surgery or electromagnetic radiation. They respond
well to antibiotic therapy. These lesions offer an in vivo model for studying
the evolution of immunologically induced fibrosis.

Keywords:
Adult, Borrelia burgdorferi, Case Report, Female, Fibrosis, Human, IgG,
ANALYSIS, Lyme Disease, DRUG THERAPY, IMMUNOLOGY, PATHOLOGY, Male, Middle Age,
Oxytetracycline, THERAPEUTIC USE, Penicillin G, Procaine, THERAPEUTIC USE,
Penicillin V, ANALOGS & DERIVATIVES, THERAPEUTIC USE, Skin Diseases,
Infectious, PATHOLOGY

Language: Eng

Unique ID: 93332818
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Acrodermatitis chronica atrophicans in the United States: clinical and
histopathologic features of six cases.
AuthorsiCaudo DJ, Su WP, Marshall WF, Malawista SE, Barthold S, Persing DH
Source:Cutis 1994 Aug;54(2):81-4
Organizationepartment of Dermatology, Mayo Clinic, Rochester, Minnesota
55905.

Abstract:
Acrodermatitis chronica atrophicans is a chronic cutaneous disease caused by
the Lyme disease spirochete Borrelia burgdorferi. Acrodermatitis chronica
atrophicans is endemic in some regions of Europe but is only rarely seen in the
United States. This report describes the clinical and histopathologic findings
in six cases of acrodermatitis chronica atrophicans seen at the Mayo Clinic
between 1912 and 1961. Histologic differences between early and late phases of
the disease were observed, and multisystemic symptoms consistent with chronic
Lyme disease were documented in a subset of the patients. All five patients
from whom biographical data were available were European immigrants. Our data
suggest that some of the first patients with Lyme disease in the United States
came to the Mayo Clinic earlier in this century.

Keywords:
Acrodermatitis, EPIDEMIOLOGY, ETIOLOGY, PATHOLOGY, Adult, Chronic Disease,
Europe, ETHNOLOGY, Female, Human, Lyme Disease, COMPLICATIONS, Male, Middle
Age, Support, Non-U.S. Gov't, Support, U.S. Gov't, P.H.S., United States,
EPIDEMIOLOGY

Language: Eng

Unique ID: 95044406

______________________________________

Lyme disease: the evolution of erythema chronicum migrans into acrodermatitis
chronica atrophicans.
Authors:Patmas MA
Source:Cutis 1993 Sep;52(3):169-70
Organization:Community Medical Center, Toms River, New Jersey.

Abstract:
Erythema chronicum migrans and acrodermatitis chronica atrophicans are both
recognized to be lesions associated with Lyme disease, although they are
thought to be distinct entities. In this paper, the clear evolution of erythema
chronicum migrans into acrodermatitis chronica atrophicans is demonstrated.

Keywords:
Acrodermatitis, ETIOLOGY, PATHOLOGY, Atrophy, Case Report, Chronic Disease,
Erythema Chronicum Migrans, COMPLICATIONS, DRUG THERAPY, PATHOLOGY, Female,
Human, Lyme Disease, COMPLICATIONS, DIAGNOSIS, DRUG THERAPY, Middle Age, Skin,
PATHOLOGY, Time Factors

Language: Eng

Unique ID: 94062378
_________________________________

Acrodermatitis chronica atrophicans in an 11-year-old girl.
Authors:Muellegger RR, Schluepen EM, Millner MM, Soyer HP, Volkenandt M, Kerl H
Source:Br J Dermatol 1996 Oct;135(4):609-12
Organizationepartment of Dermatology, Karl Franzens University, Graz,
Austria.

Abstract:
We report a case of acrodermatitis chronica atrophicans in an 11-year-old girl
living in an area endemic for Lyme borreliosis. The diagnosis was first made on
the basis of clinical, histopathological and serological findings. Moreover,
Borrelia burgdorferi-specific DNA was amplified from lesional skin by
polymerase chain reaction. Intravenous treatment with ceftriaxone (2 g once
daily) for 2 weeks was initiated. The skin changes clearly responded to the
therapy, and Borrelia burgdorferi-specific gene segments were no longer
detectable by polymerase chain reaction. This is the first report of
molecular-proven acrodermatitis chronica atrophicans in childhood. The
occurrence of this late skin manifestation of Lyme borreliosis in children is
reviewed.

Keywords:
Acrodermatitis, MICROBIOLOGY, PATHOLOGY, Borrelia burgdorferi, ISOLATION &
PURIF, Case Report, Child, DNA, Bacterial, ANALYSIS, Female, Human, Lyme
Disease, DIAGNOSIS, PATHOLOGY, Skin Diseases, Bacterial, DIAGNOSIS, PATHOLOGY

Language: Eng

Unique ID: 97072391
_____________________________________

Joint and bone involvement in Dutch patients with Lyme borreliosis presenting
with acrodermatitis chronica atrophicans.
Authors:Houtman PM, Tazelaar DJ
Source:Neth J Med 1999 Jan;54(1):5-9
Organizationepartment of Rheumatology, Tjongerschans Hospital Heerenveen, The
Netherlands.

Abstract:
We report on the radiological abnormalities of bones and joints in Dutch
patients suffering from Lyme borreliosis presenting with acrodermatitis
chronica atrophicans (A.C.A.). In a highly endemic area of the Netherlands
rheumatic complaints were mentioned by 26 out of 60 patients suffering from a
late stage of Lyme disease. Radiological findings in our group of patients were
subluxation of the toe joint and periostitis of the bones of the lower limb.

Keywords:
Acrodermatitis, ETIOLOGY, RADIOGRAPHY, Adult, Aged, Aged, 80 and over,
Antibiotics, ADMINISTRATION & DOSAGE, Arthrography, Borrelia burgdorferi,
PATHOGENICITY, Female, Human, Joint Diseases, ETIOLOGY, RADIOGRAPHY, Lyme
Disease, COMPLICATIONS, DIAGNOSIS, THERAPY, Male, Middle Age, Periostitis,
ETIOLOGY, RADIOGRAPHY, Retrospective Studies, Toe Joint, RADIOGRAPHY

Language: Eng

Unique ID: 99157849
_____________________________________