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{{Infobox_Disease
__NOTOC__
| Name          = {{PAGENAME}}
'''For patient information, click [[Acrodermatitis chronica atrophicans (patient information)|here]]'''
| Image          =
{{ACA}}
| Caption        =
{{CMG}}; {{AE}} {{Anahita}} {{RT}}
| DiseasesDB    = 32940
| ICD10          = {{ICD10|L|90|4|l|80}}
| ICD9          = {{ICD9|701.8}}
| ICDO          =
| OMIM          =
| MedlinePlus    =
| eMedicineSubj  = derm
| eMedicineTopic = 4
| MeshID        =
}}
{{SI}}
{{CMG}}


{{Editor Help}}
{{SK}} Pick-Herxheimer disease; Herxheimer disease; primary diffuse atrophy; ACA


'''Acrodermatitis chronica atrophicans''' (ACA) also known as Pick-Herxheimer disease, is a [[skin rash]] indicative of the third or late stage of European [[Lyme Disease|Lyme borreliosis]].
==[[Acrodermatitis chronica atrophicans overview|Overview]]==
==[[Acrodermatitis chronica atrophicans historical perspective|Historical Perspective]]==
==[[Acrodermatitis chronica atrophicans pathophysiology|Pathophysiology]]==
==[[Acrodermatitis chronica atrophicans causes|Causes]]==
==[[Acrodermatitis chronica atrophicans differential diagnosis|Differentiating Acrodermatitis chronica atrophicans from other Diseases]]==
==[[Acrodermatitis chronica atrophicans epidemiology and demographics|Epidemiology and Demographics]]==
==[[Acrodermatitis chronica atrophicans risk factors|Risk Factors]]==
==[[Acrodermatitis_chronica_atrophicans_natural_history,_complications_and_prognosis|Natural History, Complications and Prognosis]]==


ACA is a [[dermatology|dermatological]] condition that takes a chronically progressive course and finally leads to a widespread [[atrophy]] of the skin. Involvement of the [[peripheral nervous system]] is often observed, specifically [[polyneuropathy]].
==Diagnosis==
[[Acrodermatitis chronica atrophicans history and symptoms|History and Symptoms]] | [[Acrodermatitis chronica atrophicans physical examination|Physical Examination]] | [[Acrodermatitis chronica atrophicans laboratory findings|Laboratory Findings]] | [[Acrodermatitis chronica atrophicans other diagnostic studies|Other Diagnostic Studies]]
==Treatment==
[[Acrodermatitis chronica atrophicans medical therapy|Medical Therapy]] | [[Acrodermatitis chronica atrophicans primary prevention|Primary Prevention]] | [[Acrodermatitis chronica atrophicans secondary prevention|Secondary Prevention]] | [[Acrodermatitis chronica atrophicans cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Acrodermatitis chronica atrophicans future or investigational therapies|Future or Investigational Therapies]]


This progressive skin process is due to the effect of continuing active infection with the [[spirochete]] [[Lyme disease microbiology|Borrelia afzelii]]. B afzelii is the predominant pathophysiology, but may not be the exclusive, [[etiology|etiologic]] agent of ACA. Borrelia garinii, has also been detected.
==Case Studies==
[[Acrodermatitis chronica atrophicans case study one|Case #1]]


==History==
==Related Chapters==
The first record of ACA was made in 1883 in Breslau, Germany, where a physician named Alfred Buchwald first delineated it.
 
[[Herxheimer reaction|Herxheimer]] and Hartmann described it in 1902 as a "tissue paper" like [[cutaneous]] atrophy.
 
==Presentation==
 
The rash caused by ACA is most evident on the extremities or limbs beginning with an [[inflammatory]] stage with bluish red discoloration and cutaneous [[swelling]] and concluding several months or years later with an atrophic phase. [[Sclerosis|Sclerotic]] skin plaques may also develop.
 
As ACA progresses the skin begins to [[wrinkle]].
 
==Prognosis and Treatment==
 
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.     
 
The outlook is good if the 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.
 
Physicians should use [[serology|serologic]] and [[histology|histologic]] examination to confirm the diagnosis of ACA.  Treatment consists of antibiotics including [[doxycycline]] and [[penicillin]] for up to four weeks in the acute case.
 
==See also==
*[[Lyme Disease]]
*[[Lyme Disease]]
*[[erythema migrans|Erythema Migrans]]
*[[erythema migrans|Erythema Migrans]]


==External links==
==References==
*[http://www.dermis.net/dermisroot/en/35111/diagnose.htm DermIs.net Picture of Acrodermatitis chronica atrophicans rashes]
{{reflist|2}}


{{Diseases of the skin and subcutaneous tissue}}
{{Diseases of the skin and subcutaneous tissue}}
{{SIB}}


[[Category:Disease]]
[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Symptoms]]
[[Category:Insect-borne diseases]]
[[Category:Insect-borne diseases]]
[[Category:Lyme disease]]
[[Category:Lyme disease]]
[[Category:Zoonoses]]
[[Category:Zoonoses]]
[[Category:Spirochaetes]]
[[Category:Spirochaetes]]
[[Category:Infectious disease|*]]
[[Category:Ddx]]
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Latest revision as of 07:54, 4 August 2022

For patient information, click here

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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]

Synonyms and keywords: Pick-Herxheimer disease; Herxheimer disease; primary diffuse atrophy; ACA

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Acrodermatitis chronica atrophicans from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

References

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