Challenge ACA Pt. 2

Lyme Disease Education and Support Groups of America

Contact: Lucy Barnes


Acrodermatitis Chronica Atrophicans- (continued)

“Sometimes, the erythema is slight and swelling may dominate, or the signs are very subtle and may be overlooked by the patient or the physician.” 1

Additional reading: Danz B, Kreft B, Radant K, Marsch WCh, Fiedler E. Skin-coloured facial oedema as an initial manifestation of acrodermatitis chronica atrophicans. J Eur Acad Dermatol Venereol. 2008 Jun;22(6):751-3

“A 54-year-old patient complained about palpitations secondary to ventricular arrhythmias over a period of several years and severe fatigue for months. Later on arthralgia of the left shoulder and diffuse swelling of both hands and feet appeared. An elevated B. burgdorferi antibody titer and later on in the course the characteristic cutaneous aspect of acrodermatitis chronica atrophicans supported the diagnosis of Lyme-Borreliosis with affection of multiple organs.” 2

“… A 59-year old female patient was seen in the late phases of cutaneous borreliosis with histologically confirmed ACA. In addition, prominent livedo racemosa was seen on the legs, also showing tissue changes similar to those of ACA…” 3

“The later, atrophic phase of acrodermatitis chronica atrophicans is more characteristic clinically. The affected skin has a dark red or brownish red discoloration; focal hyperpigmentation; telangiectasias; and a thin, wrinkled, cigarette paper–like, translucent appearance.”[i]


1 Chodynicka, Bozena MD, Head, Professor, Department of Dermatology and Venereology, Medical University of Bialystok, Poland. Schwartz, RA, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Flisiak, Iwona, assistant, MD, Department of Dermatology and Venereology, Medical University of Bialystok, Poland. Acrodermatitis Chronica Atrophicans. Mar 23, 2009

2 Satz N, Loretan M, Hany A. [Arrhythmia and swelling of all extremities] Schweiz Rundsch Med Prax. 1992 Apr 7;81(15):485-8. German

3 Hautarzt. 2000 Aug;51(8):593-6. [Livedo racemosa: an unusual late manifestation of borreliosis?] Baumann M, Tebbe B, Arnold M, Krengel S, Goerdt S, Orfanos CE. Klinik und Poliklinik für Dermatologie, Universitätsklinikum Benjamin Franklin, Freie Universität Berli

· Permission granted for photograph use in this document- by chronically ill Lyme disease patients.

Additional reading:

Ned Tijdschr Geneeskd. 1991 Jul 27;135(30):1358-63. [Chronic atrophic acrodermatitis; a deceptive form of Lyme borreliosis]

Tazelaar DJ, Velders AJ, de Koning J, Hoogkamp-Korstanje JA.

Algemeen Ziekenhuis de Tjongerschans, afd. Dermatologie, Heerenveen.

… 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.

Additional Reading:

CORNBLEET T, SCHORR H, BAKER NL Livedo reticularis and acrodermatitis atrophicans chronica. .Arch Derm Syphilol. 1948 Apr;57(4):751.

Submitted by: Lucy Barnes, Lyme Disease Education and Support Groups of America