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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 [[Limb (anatomy)|extremity]] and can spread and involve [[Extension (kinesiology)|extensor surfaces]] of the [[Limb (anatomy)|acral regions of limbs]]. [[Acrodermatitis chronica atrophicans]] has a biphasic manner. In first phase
([[inflammation|the inflammatory phase]]) [[skin]] changes appear as blue and red discoloration with boggy infiltration. These [[inflammation|inflammatory]] [[skin]] lesions can become [[atrophy|atrophic]] without [[treatment]] ([[atrophy|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 [[Lyme disease history and symptoms|erythema migrans]] 6 months to 8 years before [[acrodermatitis chronica atrophicans]] development. Superimposed [[Bacteria|bacterial]] [[infection]], sclerotic [[skin]] changes, [[Cancer|malignancies]], [[arthropathy]] and [[peripheral neuropathy]] are some of the common [[Complication (medicine)|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 limb|upper]] and [[Leg|lower limb]] [[joint]] mobility. The general [[pognosis]] is good with proper and rapid [[treatment]] in [[inflammation#Acute inflammation|acute inflammatory]] stage of [[acrodermatitis chronica atrophicans]]. Nevertheless late [[treatment]] can cause some irreversible changes.


==Natural History==
==Natural History, Complications, and Prognosis==
The course of ACA is long-standing, from a few to several years, and it leads to extensive [[atrophy]] of the skin and, in some patients, to the limitation of upper and lower limb [[joint]] mobility.


==Prognosis==
===Natural History===
The outlook is good if the [[inflammation#Acute inflammation|acute inflammatory]] stage of ACA is treated adequately. The therapeutic outcome is difficult to assess in patients with the chronic atrophic phase, in which many changes are only partially reversible.
*The course of [[acrodermatitis chronica atrophicans]] is chronic and could lasts for several years.<ref name="pmid30311153">{{cite journal| author=Khalili M, Wong RJ| title=Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net. | journal=Dig Dis Sci | year= 2018 | volume= 63 | issue= 12 | pages= 3250-3252 | pmid=30311153 | doi=10.1007/s10620-018-5316-9 | pmc=6436636 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30311153  }} </ref>
*[[Mean]] duration of the [[disease]] before [[diagnosis]] was approximately 12 months among 693 [[patients]].<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>
*It can progress slowly overtime.<ref name="pmid30311153">{{cite journal| author=Khalili M, Wong RJ| title=Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net. | journal=Dig Dis Sci | year= 2018 | volume= 63 | issue= 12 | pages= 3250-3252 | pmid=30311153 | doi=10.1007/s10620-018-5316-9 | pmc=6436636 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30311153  }} </ref>
*It usually start on one [[Limb (anatomy)|extremity]] and can spread and involve [[Extension (kinesiology)|extensor surfaces]] of the [[Limb (anatomy)|acral regions of limbs]].<ref name="pmid30311153">{{cite journal| author=Khalili M, Wong RJ| title=Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net. | journal=Dig Dis Sci | year= 2018 | volume= 63 | issue= 12 | pages= 3250-3252 | pmid=30311153 | doi=10.1007/s10620-018-5316-9 | pmc=6436636 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30311153  }} </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/adc63.1.72}}</ref><ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=33085436 | doi= | pmc= | url= }} </ref>
*[[Skin]] changes first appear as blue and red discoloration with boggy infiltration ([[inflammation|inflammatory phase]]). These [[inflammation|inflammatory]] [[skin]] lesions can become [[atrophy|atrophic]] later without [[treatment]] ([[atrophy|atrophic phase]]), which resembles the biphasic manner of the [[disease]].<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 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.<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>
*One fifth of [[patients]] in a study experienced [[Lyme disease history and symptoms|erythema migrans]] 6 months to 8 years before [[acrodermatitis chronica atrophicans]] development.<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="pmid6084922">{{cite journal| author=Asbrink E, Hovmark A, Hederstedt B| title=The spirochetal etiology of acrodermatitis chronica atrophicans Herxheimer. | journal=Acta Derm Venereol | year= 1984 | volume= 64 | issue= 6 | pages= 506-12 | pmid=6084922 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6084922  }} </ref><ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=33085436 | doi= | pmc= | url= }} </ref>
*Some of [[patients]] reported previous [[neurology|neurological]] or [[rheumatology|rheumatological]] [[symptoms]]. [[Neuropathy|Sensory polyneuropathy]] is the common form of [[neuropathy]] in these [[patients]].<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="Hopf1975">{{cite journal|last1=Hopf|first1=H C|title=Peripheral neuropathy in acrodermatitis chronica atrophicans (Herxheimer).|journal=Journal of Neurology, Neurosurgery & Psychiatry|volume=38|issue=5|year=1975|pages=452–458|issn=0022-3050|doi=10.1136/jnnp.38.5.452}}</ref>
*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.<ref name="pmid32512846">{{cite journal| author=Scott JD| title=Presentation of Acrodermatitis Chronica Atrophicans Rashes on Lyme Disease Patients in Canada. | journal=Healthcare (Basel) | year= 2020 | volume= 8 | issue= 2 | pages=  | pmid=32512846 | doi=10.3390/healthcare8020157 | pmc=7349802 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32512846  }} </ref>
 
===Complications===
*Common [[Complication (medicine)|complications]] of [[acrodermatitis chronica atrophicansis]] include:<ref name="pmid30311153">{{cite journal| author=Khalili M, Wong RJ| title=Underserved Does Not Mean Undeserved: Unfurling the HCV Care in the Safety Net. | journal=Dig Dis Sci | year= 2018 | volume= 63 | issue= 12 | pages= 3250-3252 | pmid=30311153 | doi=10.1007/s10620-018-5316-9 | pmc=6436636 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30311153  }} </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="KindstrandNilsson2002">{{cite journal|last1=Kindstrand|first1=E.|last2=Nilsson|first2=B. Y.|last3=Hovmark|first3=A.|last4=Pirskanen|first4=R.|last5=Åsbrink|first5=E.|title=Peripheral neuropathy in acrodermatitis chronica atrophicans - effect of treatment|journal=Acta Neurologica Scandinavica|volume=106|issue=5|year=2002|pages=253–257|issn=00016314|doi=10.1034/j.1600-0404.2002.01336.x}}</ref><ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=33085436 | doi= | pmc= | url= }} </ref><ref name="pmid18607109">{{cite journal| author=Leverkus M, Finner AM, Pokrywka A, Franke I, Gollnick H| title=Metastatic squamous cell carcinoma of the ankle in long-standing untreated acrodermatitis chronica atrophicans. | journal=Dermatology | year= 2008 | volume= 217 | issue= 3 | pages= 215-8 | pmid=18607109 | doi=10.1159/000142946 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18607109  }} </ref>
**Superimposed [[Bacteria|bacterial]] [[infection]]
**Sclerotic [[skin]] changes
**[[Cancer|Malignancy]]
***[[Basal cell carcinoma]]
***[[Squamous cell carcinoma]]
***[[B-cell lymphoma]]
**[[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 [[neuropathy|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 limb|upper]] and [[Leg|lower limb]] [[joint]] mobility.<ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=33085436 | doi= | pmc= | url= }} </ref>
*In contrast to other [[skin]] manifestations of [[borrelia]] [[infection]], [[acrodermatitis chronica atrophicans]] doesn't heal without [[treatment]] and is capable of becoming [[Chronic (medical)|chronic]].<ref name="pmid8221518">{{cite journal| author=Asbrink E| title=Acrodermatitis chronica atrophicans. | journal=Clin Dermatol | year= 1993 | volume= 11 | issue= 3 | pages= 369-75 | pmid=8221518 | doi=10.1016/0738-081x(93)90092-q | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8221518  }} </ref><ref name="pmid9506437">{{cite journal| author=Picken RN, Strle F, Picken MM, Ruzic-Sabljic E, Maraspin V, Lotric-Furlan S | display-authors=etal| title=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. | journal=J Invest Dermatol | year= 1998 | volume= 110 | issue= 3 | pages= 211-4 | pmid=9506437 | doi=10.1046/j.1523-1747.1998.00130.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9506437  }} </ref>
*The [[inflammation|inflammatory phase]] can last for years and the [[atrophy|atrophic phase]] can last for decades Without appropriate [[treatment]].
*The general [[pognosis]] is good with proper and rapid [[treatment]] in [[inflammation#Acute inflammation|acute inflammatory]] stage of [[acrodermatitis chronica atrophicans]].<ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=33085436 | doi= | pmc= | url= }} </ref>
*The [[Therapy|therapeutic]] outcome is difficult to assess in [[patients]] with the [[Chronic (medical)|chronic]] [[atrophy|atrophic phase]] because most changes are only partially reversible. For instance there are numerous evidences on irreversibility of [[nueropathy|peripheral neuropathy]] in [[acrodermatitis chronica atrophicans]] [[patients]] with [[antibiotic]] [[treatments]].<ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume=  | issue=  | pages=  | pmid=33085436 | doi= | pmc= | url= }} </ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Needs content]]
[[Category:Needs review]]
[[Category:Needs overview]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Dermatology]]

Latest revision as of 13:47, 16 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

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

Complications

Prognosis

References

  1. ↑ 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. ↑ 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. ↑ 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. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 "StatPearls". 2021. PMID 33085436 Check |pmid= value (help).
  5. ↑ 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.
  6. ↑ Asbrink E, Hovmark A, Hederstedt B (1984). "The spirochetal etiology of acrodermatitis chronica atrophicans Herxheimer". Acta Derm Venereol. 64 (6): 506–12. PMID 6084922.
  7. ↑ 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.
  8. ↑ 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).
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ Asbrink E (1993). "Acrodermatitis chronica atrophicans". Clin Dermatol. 11 (3): 369–75. doi:10.1016/0738-081x(93)90092-q. PMID 8221518.
  12. ↑ 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.

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