Acrodermatitis chronica atrophicans laboratory findings: Difference between revisions

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==Overview==
==Overview==
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [[acrodermatitis chronica atrophicans]].
High anti-[[Spirochaete|spirochetal]] [[antibody]] levels (such as [[Immunoglobulin G|IgG]], [[Immunoglobulin G|IgM]] and [[Immunoglobulin A|IgA]]) has been detected at indirect [[immunofluorescence]] and [[enzyme linked immunosorbent assay (ELISA)]]. Among various [[antigens]] in [[borrelia burgdorferi]], [[flagellum]] [[antigen]] is one of the recommended [[serology|serologic evaluation]] in [[Acrodermatitis chronica atrophicans|acrodermatitis chronica atrophicans]] [[patients]]. [[Diagnosis]] of [[Acrodermatitis chronica atrophicans|acrodermatitis chronica atrophicans]] can be excluded if the [[serology|serologic]] evaluataion is negative. [[Borrelia]] itself has been found in some of the [[skin]] samples. When clinical presentations are not clear enough, [[biopsy]] and [[histology|histological]] evaluation can assist. Findings such as [[Plasma cell|plasma cells]], [[histiocytes]] and [[Lymphocyte|lymphocytic infiltration]] plus [[telangiectasia]] and thinning of [[dermis]] and [[epidermis]] are commonly found in [[skin]] [[biopsy|biopsies]].


==Laboratory Findings==
==Laboratory Findings==
*[[Physicians]] can use [[serology|serologic]] and [[histology|histologic]] examination to confirm the [[diagnosis]] of [[acrodermatitis chronica atrophicans]].
*Since [[diagnosis]] of [[acrodermatitis chronica atrophicans]] could be dificult due to various presentations, [[physicians]] can use [[serology|serologic]] and [[histology|histologic]] examination to confirm it.<ref name="pmid33550695">{{cite journal| author=Ogrinc K, Maraspin V, Lusa L, Cerar Kišek T, Ružić-Sabljić E, Strle F| title=Acrodermatitis chronica atrophicans: clinical and microbiological characteristics of a cohort of 693 Slovenian patients. | journal=J Intern Med | year= 2021 | volume=  | issue=  | pages=  | pmid=33550695 | doi=10.1111/joim.13266 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33550695  }} </ref><ref name="Muller2012">{{cite journal|last1=Muller|first1=Kurt E.|title=Damage of Collagen and Elastic Fibres by Borrelia Burgdorferi – Known and New Clinical and Histopathological Aspects|journal=The Open Neurology Journal|volume=6|issue=1|year=2012|pages=179–186|issn=1874205X|doi=10.2174/1874205X01206010179}}</ref>
*High anti-[[Spirochaete|spirochetal]] [[antibody]] levels (both [[Immunoglobulin G|IgG]] and [[Immunoglobulin G|IgM]]) has been detected at indirect [[immunofluorescence]] and [[enzyme linked immunosorbent assay (ELISA)]].<ref name="pmid3577484">{{cite journal| author=Asbrink E, Hovmark A, Olsson I| title=Clinical manifestations of acrodermatitis chronica atrophicans in 50 Swedish patients. | journal=Zentralbl Bakteriol Mikrobiol Hyg A | year= 1986 | volume= 263 | issue= 1-2 | pages= 253-61 | pmid=3577484 | doi=10.1016/s0176-6724(86)80128-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3577484  }} </ref><ref name="pmid2715325">{{cite journal| author=Hansen K, Asbrink E| title=Serodiagnosis of erythema migrans and acrodermatitis chronica atrophicans by the Borrelia burgdorferi flagellum enzyme-linked immunosorbent assay. | journal=J Clin Microbiol | year= 1989 | volume= 27 | issue= 3 | pages= 545-51 | pmid=2715325 | doi=10.1128/jcm.27.3.545-551.1989 | pmc=267355 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2715325 }} </ref>
*High anti-[[Spirochaete|spirochetal]] [[antibody]] levels (such as [[Immunoglobulin G|IgG]], [[Immunoglobulin G|IgM]] and [[Immunoglobulin A|IgA]]) has been detected at indirect [[immunofluorescence]] and [[enzyme linked immunosorbent assay (ELISA)]].<ref name="pmid3577484">{{cite journal| author=Asbrink E, Hovmark A, Olsson I| title=Clinical manifestations of acrodermatitis chronica atrophicans in 50 Swedish patients. | journal=Zentralbl Bakteriol Mikrobiol Hyg A | year= 1986 | volume= 263 | issue= 1-2 | pages= 253-61 | pmid=3577484 | doi=10.1016/s0176-6724(86)80128-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3577484 }} </ref><ref name="pmid2715325">{{cite journal| author=Hansen K, Asbrink E| title=Serodiagnosis of erythema migrans and acrodermatitis chronica atrophicans by the Borrelia burgdorferi flagellum enzyme-linked immunosorbent assay. | journal=J Clin Microbiol | year= 1989 | volume= 27 | issue= 3 | pages= 545-51 | pmid=2715325 | doi=10.1128/jcm.27.3.545-551.1989 | pmc=267355 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2715325  }} </ref><ref name="pmid33550695">{{cite journal| author=Ogrinc K, Maraspin V, Lusa L, Cerar Kišek T, Ružić-Sabljić E, Strle F| title=Acrodermatitis chronica atrophicans: clinical and microbiological characteristics of a cohort of 693 Slovenian patients. | journal=J Intern Med | year= 2021 | volume= | issue=  | pages= | pmid=33550695 | doi=10.1111/joim.13266 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33550695 }} </ref><ref name="pmid6394553">{{cite journal| author=Weber K, Schierz G, Wilske B, Preac-Mursic V| title=[Clinical aspects and etiology of acrodermatitis chronica atrophicans]. | journal=Hautarzt | year= 1984 | volume= 35 | issue= 11 | pages= 571-7 | pmid=6394553 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6394553  }} </ref>
*Among various [[antigens]] in [[borrelia burgdorferi]], [[flagellum]] [[antigen]] is one of the recommended [[serology|serologic evaluation]] in [[acrodermatitis chronica atrophicans]] [[patients]]. Moreover checking [[Immunoglobulin G|IgG]] against [[borrelia burgdorferi|borrelia]] are more specific compared to [[Immunoglobulin M|IgM]].<ref name="pmid2715325">{{cite journal| author=Hansen K, Asbrink E| title=Serodiagnosis of erythema migrans and acrodermatitis chronica atrophicans by the Borrelia burgdorferi flagellum enzyme-linked immunosorbent assay. | journal=J Clin Microbiol | year= 1989 | volume= 27 | issue= 3 | pages= 545-51 | pmid=2715325 | doi=10.1128/jcm.27.3.545-551.1989 | pmc=267355 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2715325  }} </ref>
*Among various [[antigens]] in [[borrelia burgdorferi]], [[flagellum]] [[antigen]] is one of the recommended [[serology|serologic evaluation]] in [[Acrodermatitis chronica atrophicans|acrodermatitis chronica atrophicans]] [[patients]]. Moreover checking [[Immunoglobulin G|IgG]] against [[borrelia burgdorferi|borrelia]] are more specific compared to [[Immunoglobulin M|IgM]].<ref name="pmid2715325">{{cite journal| author=Hansen K, Asbrink E| title=Serodiagnosis of erythema migrans and acrodermatitis chronica atrophicans by the Borrelia burgdorferi flagellum enzyme-linked immunosorbent assay. | journal=J Clin Microbiol | year= 1989 | volume= 27 | issue= 3 | pages= 545-51 | pmid=2715325 | doi=10.1128/jcm.27.3.545-551.1989 | pmc=267355 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2715325  }} </ref>
*A study done on [[patients]] with [[acrodermatitis chronica atrophicans]] revealed [[rheumatoid factor]] in 32% of [[patients]].<ref name="pmid2715325">{{cite journal| author=Hansen K, Asbrink E| title=Serodiagnosis of erythema migrans and acrodermatitis chronica atrophicans by the Borrelia burgdorferi flagellum enzyme-linked immunosorbent assay. | journal=J Clin Microbiol | year= 1989 | volume= 27 | issue= 3 | pages= 545-51 | pmid=2715325 | doi=10.1128/jcm.27.3.545-551.1989 | pmc=267355 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2715325 }} </ref>
*[[Diagnosis]] of [[Acrodermatitis chronica atrophicans|acrodermatitis chronica atrophicans]] can be excluded if the [[serology|serologic]] evaluataion is negative.<ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=33085436 | doi= | pmc= | url= }} </ref><ref name="StanekFingerle2011">{{cite journal|last1=Stanek|first1=G.|last2=Fingerle|first2=V.|last3=Hunfeld|first3=K.-P.|last4=Jaulhac|first4=B.|last5=Kaiser|first5=R.|last6=Krause|first6=A.|last7=Kristoferitsch|first7=W.|last8=O'Connell|first8=S.|last9=Ornstein|first9=K.|last10=Strle|first10=F.|last11=Gray|first11=J.|title=Lyme borreliosis: Clinical case definitions for diagnosis and management in Europe|journal=Clinical Microbiology and Infection|volume=17|issue=1|year=2011|pages=69–79|issn=1198743X|doi=10.1111/j.1469-0691.2010.03175.x}}</ref>
*[[Biopsy]] shows [[inflammation#Chronic inflammation|chronic inflammatory]] signs in [[Chronic (medical)|chronic cases]]. Other histological finding are listed below: <ref name="pmid22153213">{{cite journal |author=Rosenlund S, Bækgaard N, Menné T |title=[Acrodermatitis chronica atrophicans can be difficult to diagnose] |language=Danish |journal=Ugeskr. Laeg. |volume=173 |issue=50 |pages=3272–3 |year=2011 |month=December |pmid=22153213 |doi= |url=}}</ref><ref name="pmid3577484">{{cite journal| author=Asbrink E, Hovmark A, Olsson I| title=Clinical manifestations of acrodermatitis chronica atrophicans in 50 Swedish patients. | journal=Zentralbl Bakteriol Mikrobiol Hyg A | year= 1986 | volume= 263 | issue= 1-2 | pages= 253-61 | pmid=3577484 | doi=10.1016/s0176-6724(86)80128-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3577484  }} </ref>
*Based on various studied cases there is no relation between anti-[[Spirochaete|spirochetal]] [[Immunoglobulin G|IgG]] and [[inflammation|inflammatory]] [[Cell (biology)|cell]] concentration (such as [[plasma cell]] concentration).
**[[Lymphocyte|Lymphocytic infiltration]]
*[[Borrelia]] itself has been found in some of the [[skin]] samples. In a study done on 693 [[patients]] suffering from [[Acrodermatitis chronica atrophicans|acrodermatitis chronica atrophicans]], 30.1% of samples were positive for [[borrelia]]. <ref name="pmid33550695">{{cite journal| author=Ogrinc K, Maraspin V, Lusa L, Cerar Kišek T, Ružić-Sabljić E, Strle F| title=Acrodermatitis chronica atrophicans: clinical and microbiological characteristics of a cohort of 693 Slovenian patients. | journal=J Intern Med | year= 2021 | volume=  | issue=  | pages=  | pmid=33550695 | doi=10.1111/joim.13266 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33550695  }} </ref><ref name="pmid11864084">{{cite journal| author=Rijpkema SG, Tazelaar DJ, Molkenboer MJ, Noordhoek GT, Plantinga G, Schouls LM | display-authors=etal| title=Detection of Borrelia afzelii, Borrelia burgdorferi sensu stricto, Borrelia garinii and group VS116 by PCR in skin biopsies of patients with erythema migrans and acrodermatitis chronica atrophicans. | journal=Clin Microbiol Infect | year= 1997 | volume= 3 | issue= 1 | pages= 109-116 | pmid=11864084 | doi=10.1111/j.1469-0691.1997.tb00259.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11864084  }} </ref>
*[[Borrelia]] can grew in [[skin]] [[culture]] even after 10 years of active [[disease]], which is an evidence of [[borrelia]] ability to survive for a long period.<ref name="ÅsbrinkHovmark2009">{{cite journal|last1=Åsbrink|first1=Eva|last2=Hovmark|first2=Anders|title=Successful Cultivation of Spirochetes from Skin Lesions of Patients With Erythema Chronicum Migrans Afzelius and Acrodermatitis Chronica Atrophicans|journal=Acta Pathologica Microbiologica Scandinavica Series B: Microbiology|volume=93B|issue=1-6|year=2009|pages=161–163|issn=01080180|doi=10.1111/j.1699-0463.1985.tb02870.x}}</ref>
*Negative [[skin]] [[Tissue culture|culture]] for [[borrelia]] doesn't exclude the [[diagnosis]], however detection of [[borrelia]] [[DNA]] can certainly confirm the [[diagnosis]].<ref name="NadalGundelfinger1988">{{cite journal|last1=Nadal|first1=D|last2=Gundelfinger|first2=R|last3=Flueler|first3=U|last4=Boltshauser|first4=E|title=Acrodermatitis chronica atrophicans.|journal=Archives of Disease in Childhood|volume=63|issue=1|year=1988|pages=72–74|issn=0003-9888|doi=10.1136/adc.63.1.72}}</ref><ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=33085436 | doi= | pmc= | url= }} </ref>
*A study done on [[patients]] with [[Acrodermatitis chronica atrophicans|acrodermatitis chronica atrophicans]] revealed [[rheumatoid factor]] in 32% of [[patients]].<ref name="pmid2715325">{{cite journal| author=Hansen K, Asbrink E| title=Serodiagnosis of erythema migrans and acrodermatitis chronica atrophicans by the Borrelia burgdorferi flagellum enzyme-linked immunosorbent assay. | journal=J Clin Microbiol | year= 1989 | volume= 27 | issue= 3 | pages= 545-51 | pmid=2715325 | doi=10.1128/jcm.27.3.545-551.1989 | pmc=267355 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2715325  }} </ref>
*Elevated levels of [[Erythrocyte sedimentation rate|ESR]] could be seen in these [[patients]].<ref name="NadalGundelfinger1988">{{cite journal|last1=Nadal|first1=D|last2=Gundelfinger|first2=R|last3=Flueler|first3=U|last4=Boltshauser|first4=E|title=Acrodermatitis chronica atrophicans.|journal=Archives of Disease in Childhood|volume=63|issue=1|year=1988|pages=72–74|issn=0003-9888|doi=10.1136/adc.63.1.72}}</ref>
*Based on a study done on [[acrodermatitis chronica atrophicans]] [[patients]], expression of [[inflammation|pro-inflammatory]] [[cytokine|cytokines]] (such as [[tumor necrosis factor alpha]] and [[interleukin-4]]) have been detected in [[skin]] [[biopsy|biopsies]].<ref name="pmid11121150">{{cite journal| author=Müllegger RR, McHugh G, Ruthazer R, Binder B, Kerl H, Steere AC| title=Differential expression of cytokine mRNA in skin specimens from patients with erythema migrans or acrodermatitis chronica atrophicans. | journal=J Invest Dermatol | year= 2000 | volume= 115 | issue= 6 | pages= 1115-23 | pmid=11121150 | doi=10.1046/j.1523-1747.2000.00198.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11121150  }} </ref>
*When clinical presentations are not clear enough, [[biopsy]] and [[histology|histological]] evaluation can assist.<ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=33085436 | doi= | pmc= | url= }} </ref>
*[[Biopsy]] shows [[inflammation#Chronic inflammation|chronic inflammatory]] [[Medical sign|signs]] in [[Chronic (medical)|chronic cases]]. Other [[Histology|histological]] finding are listed below: <ref name="pmid22153213">{{cite journal |author=Rosenlund S, Bækgaard N, Menné T |title=[Acrodermatitis chronica atrophicans can be difficult to diagnose] |language=Danish |journal=Ugeskr. Laeg. |volume=173 |issue=50 |pages=3272–3 |year=2011 |month=December |pmid=22153213 |doi= |url=}}</ref><ref name="pmid3577484">{{cite journal| author=Asbrink E, Hovmark A, Olsson I| title=Clinical manifestations of acrodermatitis chronica atrophicans in 50 Swedish patients. | journal=Zentralbl Bakteriol Mikrobiol Hyg A | year= 1986 | volume= 263 | issue= 1-2 | pages= 253-61 | pmid=3577484 | doi=10.1016/s0176-6724(86)80128-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3577484  }} </ref><ref name="NadalGundelfinger1988">{{cite journal|last1=Nadal|first1=D|last2=Gundelfinger|first2=R|last3=Flueler|first3=U|last4=Boltshauser|first4=E|title=Acrodermatitis chronica atrophicans.|journal=Archives of Disease in Childhood|volume=63|issue=1|year=1988|pages=72–74|issn=0003-9888|doi=10.1136/adc.63.1.72}}</ref>
**Perivascular [[Lymphocyte|lymphocytic infiltration]]
**[[Plasma cell|Plasma cells]]
**[[Plasma cell|Plasma cells]]
**[[Histiocytes]]
**[[Telangiectasia]]
**[[Telangiectasia]]
**[[Pigment|Pigmented]] [[stratum germinativum]]
**[[Dermis]] and [[epidermis]] thinning


==References==
==References==

Latest revision as of 11:21, 17 June 2021

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

High anti-spirochetal antibody levels (such as IgG, IgM and IgA) has been detected at indirect immunofluorescence and enzyme linked immunosorbent assay (ELISA). Among various antigens in borrelia burgdorferi, flagellum antigen is one of the recommended serologic evaluation in acrodermatitis chronica atrophicans patients. Diagnosis of acrodermatitis chronica atrophicans can be excluded if the serologic evaluataion is negative. Borrelia itself has been found in some of the skin samples. When clinical presentations are not clear enough, biopsy and histological evaluation can assist. Findings such as plasma cells, histiocytes and lymphocytic infiltration plus telangiectasia and thinning of dermis and epidermis are commonly found in skin biopsies.

Laboratory Findings

References

  1. ↑ 1.0 1.1 1.2 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).
  2. ↑ Muller, Kurt E. (2012). "Damage of Collagen and Elastic Fibres by Borrelia Burgdorferi – Known and New Clinical and Histopathological Aspects". The Open Neurology Journal. 6 (1): 179–186. doi:10.2174/1874205X01206010179. ISSN 1874-205X.
  3. ↑ 3.0 3.1 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.
  4. ↑ 4.0 4.1 4.2 Hansen K, Asbrink E (1989). "Serodiagnosis of erythema migrans and acrodermatitis chronica atrophicans by the Borrelia burgdorferi flagellum enzyme-linked immunosorbent assay". J Clin Microbiol. 27 (3): 545–51. doi:10.1128/jcm.27.3.545-551.1989. PMC 267355. PMID 2715325.
  5. ↑ Weber K, Schierz G, Wilske B, Preac-Mursic V (1984). "[Clinical aspects and etiology of acrodermatitis chronica atrophicans]". Hautarzt. 35 (11): 571–7. PMID 6394553.
  6. ↑ 6.0 6.1 6.2 "StatPearls". 2021. PMID 33085436 Check |pmid= value (help).
  7. ↑ Stanek, G.; Fingerle, V.; Hunfeld, K.-P.; Jaulhac, B.; Kaiser, R.; Krause, A.; Kristoferitsch, W.; O'Connell, S.; Ornstein, K.; Strle, F.; Gray, J. (2011). "Lyme borreliosis: Clinical case definitions for diagnosis and management in Europe". Clinical Microbiology and Infection. 17 (1): 69–79. doi:10.1111/j.1469-0691.2010.03175.x. ISSN 1198-743X.
  8. ↑ Rijpkema SG, Tazelaar DJ, Molkenboer MJ, Noordhoek GT, Plantinga G, Schouls LM; et al. (1997). "Detection of Borrelia afzelii, Borrelia burgdorferi sensu stricto, Borrelia garinii and group VS116 by PCR in skin biopsies of patients with erythema migrans and acrodermatitis chronica atrophicans". Clin Microbiol Infect. 3 (1): 109–116. doi:10.1111/j.1469-0691.1997.tb00259.x. PMID 11864084.
  9. ↑ Åsbrink, Eva; Hovmark, Anders (2009). "Successful Cultivation of Spirochetes from Skin Lesions of Patients With Erythema Chronicum Migrans Afzelius and Acrodermatitis Chronica Atrophicans". Acta Pathologica Microbiologica Scandinavica Series B: Microbiology. 93B (1–6): 161–163. doi:10.1111/j.1699-0463.1985.tb02870.x. ISSN 0108-0180.
  10. ↑ 10.0 10.1 10.2 Nadal, D; Gundelfinger, R; Flueler, U; Boltshauser, E (1988). "Acrodermatitis chronica atrophicans". Archives of Disease in Childhood. 63 (1): 72–74. doi:10.1136/adc.63.1.72. ISSN 0003-9888.
  11. ↑ Müllegger RR, McHugh G, Ruthazer R, Binder B, Kerl H, Steere AC (2000). "Differential expression of cytokine mRNA in skin specimens from patients with erythema migrans or acrodermatitis chronica atrophicans". J Invest Dermatol. 115 (6): 1115–23. doi:10.1046/j.1523-1747.2000.00198.x. PMID 11121150.
  12. ↑ Rosenlund S, Bækgaard N, Menné T (2011). "[Acrodermatitis chronica atrophicans can be difficult to diagnose]". Ugeskr. Laeg. (in Danish). 173 (50): 3272–3. PMID 22153213. Unknown parameter |month= ignored (help)

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