Causes and risk factors
Active infection with the spirochete Borrelia afzelii which is transmitted by ticks is the cause of acrodermatitis chronica atrophicans.
Clinical presentation
Commonly affected parts in ACA are foot, lower legs, hands, forearm, and olecranon area. Other sites include proximal areas of arms, shoulder, thighs, and buttocks. It is seen in 3rd stage of borreliosis. Patient presents with inflammation, erythema, rash, cutaneous swelling. There are skin plaques, atrophy of skin. Limitation to limb movements is seen. Sensory polyneuropathy is seen. Exaggerated response to pain is observed (progressive allodynia). Bluish red discoloration with swelling of the skin and ulceration of skin occurs. Lymphadenopathy may be present. Multiple fibrotic nodules located linearly near the joints are commonly seen. Gradually, atrophy of skin starts occurring. Skin becomes thin, atrophied, wrinkled, dry, and translucent. There is loss of hair, sebaceous glands, and sweat glands. Minor trauma causes ulceration of skin. ACA is accompanied by peripheral neuropathy, musculoskeletal pains, and joint damage.
Investigation
Medical history by the patient and clinical examination by the dermatologist helps in diagnosis. Histopathologic examination is done. Skin biopsy is obtained. Serologic testing is required.
Treatment
Treatment depends upon the site involved. Treatment involves administration of antibiotics. Expert advice by rheumatologist and ophthalmologist is required. Neurologist’s opinion is sought for diagnosis of peripheral neuropathy. Vaccine is available in some countries.
Other Modes of treatment
The other modes of treatment can also be effective in treating acrodermatitis chronica atrophicans. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates is also found to be effective in treating acrodermatitis chronica atrophicans.
