Acrodermatitis chronica atrophicans natural history, complications and prognosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Raviteja Guddeti, M.B.B.S. [3]
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Overview
The course of acrodermatitis chronica atrophicans is chronic and could lasts for several years and it can progress slowly overtime. It has been estimated that mean duration of acrodermatitis chronica atrophicans before diagnosis is approximately 12 months, based on a study. It usually start on one extremity and can spread and involve extensor surfaces of the acral regions of limbs. Acrodermatitis chronica atrophicans has a biphasic manner. In first phase (the inflammatory phase) skin changes appear as blue and red discoloration with boggy infiltration. These inflammatory skin lesions can become atrophic without treatment (atrophic phase). Based on two studies, 55% and 66% of patients with acrodermatitis chronica atrophicans have at least one history of tick bite, while others may never remember such an accident. One fifth of patients in a study experienced erythema migrans 6 months to 8 years before acrodermatitis chronica atrophicans development. Superimposed bacterial infection, sclerotic skin changes, malignancies, arthropathy and peripheral neuropathy are some of the common complications of acrodermatitis chronica atrophicansis. In contrast to other skin manifestations of borrelia infection, acrodermatitis chronica atrophicans doesn't heal without treatment and can lead to extensive atrophy of skin and limitations of upper and lower limb joint mobility. The general pognosis is good with proper and rapid treatment in acute inflammatory stage of acrodermatitis chronica atrophicans. Nevertheless late treatment can cause some irreversible changes.
Natural History, Complications, and Prognosis
Natural History
- The course of acrodermatitis chronica atrophicans is chronic and could lasts for several years.[1]
- Mean duration of the disease before diagnosis was approximately 12 months among 693 patients.[2]
- It can progress slowly overtime.[1]
- It usually start on one extremity and can spread and involve extensor surfaces of the acral regions of limbs.[1][3][4]
- Skin changes first appear as blue and red discoloration with boggy infiltration (inflammatory phase). These inflammatory skin lesions can become atrophic later without treatment (atrophic phase), which resembles the biphasic manner of the disease.[3]
- Based on two studies, 55% and 66% of patients with acrodermatitis chronica atrophicans have at least one history of tick bite, while others may never remember such an accident. Since there could be several years between the tick bite and development of skin lesions, absence of tick bite in patients' history is not meaningful alone.[5]
- One fifth of patients in a study experienced erythema migrans 6 months to 8 years before acrodermatitis chronica atrophicans development.[5][6][4]
- Some of patients reported previous neurological or rheumatological symptoms. Sensory polyneuropathy is the common form of neuropathy in these patients.[2][7]
- Although symptoms of acrodermatitis chronica atrophicansis commonly present as a tertiary manifestation of lyme disease, it could be the first presentation of it in some cases.[8]
Complications
- Common complications of acrodermatitis chronica atrophicansis include:[1][2][9][4][10]
- Superimposed bacterial infection
- Sclerotic skin changes
- Malignancy
- Peripheral neuropathy
- May occur at the site of skin involvement or even at other sites.
- The most common form of peripheral neuropathy reported in these patients was sensory polyneuropathy.
- Based on a study done on 47 patients, the recommended antibiotic treatments for acrodermatitis chronica atrophicans are not effective against neuropathy.
- Arthropathy
- May occur at the site of skin involvement or even at other sites.
Prognosis
- Acrodermatitis chronica atrophicans can lead to extensive atrophy of skin and, in some patients it can cause limitation of upper and lower limb joint mobility.[4]
- In contrast to other skin manifestations of borrelia infection, acrodermatitis chronica atrophicans doesn't heal without treatment and is capable of becoming chronic.[11][12]
- The inflammatory phase can last for years and the atrophic phase can last for decades Without appropriate treatment.
- The general pognosis is good with proper and rapid treatment in acute inflammatory stage of acrodermatitis chronica atrophicans.[4]
- The therapeutic outcome is difficult to assess in patients with the chronic atrophic phase because most changes are only partially reversible. For instance there are numerous evidences on irreversibility of peripheral neuropathy in acrodermatitis chronica atrophicans patients with antibiotic treatments.[4]
References
- ↑ 1.0 1.1 1.2 1.3 Khalili M, Wong RJ (2018). "Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net". Dig Dis Sci. 63 (12): 3250–3252. doi:10.1007/s10620-018-5316-9. PMC 6436636. PMID 30311153.
- ↑ 2.0 2.1 2.2 Ogrinc K, Maraspin V, Lusa L, Cerar Kišek T, Ružić-Sabljić E, Strle F (2021). "Acrodermatitis chronica atrophicans: clinical and microbiological characteristics of a cohort of 693 Slovenian patients". J Intern Med. doi:10.1111/joim.13266. PMID 33550695 Check
|pmid=value (help). - ↑ 3.0 3.1 Nadal, D; Gundelfinger, R; Flueler, U; Boltshauser, E (1988). "Acrodermatitis chronica atrophicans". Archives of Disease in Childhood. 63 (1): 72–74. doi:10.1136/adc63.1.72. ISSN 0003-9888.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 "StatPearls". 2021. PMID 33085436 Check
|pmid=value (help). - ↑ 5.0 5.1 Asbrink E, Hovmark A, Olsson I (1986). "Clinical manifestations of acrodermatitis chronica atrophicans in 50 Swedish patients". Zentralbl Bakteriol Mikrobiol Hyg A. 263 (1–2): 253–61. doi:10.1016/s0176-6724(86)80128-6. PMID 3577484.
- ↑ Asbrink E, Hovmark A, Hederstedt B (1984). "The spirochetal etiology of acrodermatitis chronica atrophicans Herxheimer". Acta Derm Venereol. 64 (6): 506–12. PMID 6084922.
- ↑ Hopf, H C (1975). "Peripheral neuropathy in acrodermatitis chronica atrophicans (Herxheimer)". Journal of Neurology, Neurosurgery & Psychiatry. 38 (5): 452–458. doi:10.1136/jnnp.38.5.452. ISSN 0022-3050.
- ↑ Scott JD (2020). "Presentation of Acrodermatitis Chronica Atrophicans Rashes on Lyme Disease Patients in Canada". Healthcare (Basel). 8 (2). doi:10.3390/healthcare8020157. PMC 7349802 Check
|pmc=value (help). PMID 32512846 Check|pmid=value (help). - ↑ Kindstrand, E.; Nilsson, B. Y.; Hovmark, A.; Pirskanen, R.; Åsbrink, E. (2002). "Peripheral neuropathy in acrodermatitis chronica atrophicans - effect of treatment". Acta Neurologica Scandinavica. 106 (5): 253–257. doi:10.1034/j.1600-0404.2002.01336.x. ISSN 0001-6314.
- ↑ Leverkus M, Finner AM, Pokrywka A, Franke I, Gollnick H (2008). "Metastatic squamous cell carcinoma of the ankle in long-standing untreated acrodermatitis chronica atrophicans". Dermatology. 217 (3): 215–8. doi:10.1159/000142946. PMID 18607109.
- ↑ Asbrink E (1993). "Acrodermatitis chronica atrophicans". Clin Dermatol. 11 (3): 369–75. doi:10.1016/0738-081x(93)90092-q. PMID 8221518.
- ↑ Picken RN, Strle F, Picken MM, Ruzic-Sabljic E, Maraspin V, Lotric-Furlan S; et al. (1998). "Identification of three species of Borrelia burgdorferi sensu lato (B. burgdorferi sensu stricto, B. garinii, and B. afzelii) among isolates from acrodermatitis chronica atrophicans lesions". J Invest Dermatol. 110 (3): 211–4. doi:10.1046/j.1523-1747.1998.00130.x. PMID 9506437.