Acrodermatitis chronica atrophicans pathophysiology: Difference between revisions
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*[[Borrelia]] is capable of attaching to the [[extracellular matrix]] proteins (such as [[glycosaminoglycan]], [[fibronectin]] and [[decorin]] proteoglycan) which eventually leads to [[Metalloproteinases (MMPs)|metalloproteases]] activation. When [[Metalloproteinases (MMPs)|metalloproteases]] activate they degrade [[extracellular matrix]].<ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume= | issue= | pages= | pmid=33085436 | doi= | pmc= | url= }} </ref><ref name="GuoNorris1995">{{cite journal|last1=Guo|first1=B P|last2=Norris|first2=S J|last3=Rosenberg|first3=L C|last4=Höök|first4=M|title=Adherence of Borrelia burgdorferi to the proteoglycan decorin|journal=Infection and Immunity|volume=63|issue=9|year=1995|pages=3467–3472|issn=0019-9567|doi=10.1128/iai.63.9.3467-3472.1995}}</ref> | *[[Borrelia]] is capable of attaching to the [[extracellular matrix]] proteins (such as [[glycosaminoglycan]], [[fibronectin]] and [[decorin]] proteoglycan) which eventually leads to [[Metalloproteinases (MMPs)|metalloproteases]] activation. When [[Metalloproteinases (MMPs)|metalloproteases]] activate they degrade [[extracellular matrix]].<ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume= | issue= | pages= | pmid=33085436 | doi= | pmc= | url= }} </ref><ref name="GuoNorris1995">{{cite journal|last1=Guo|first1=B P|last2=Norris|first2=S J|last3=Rosenberg|first3=L C|last4=Höök|first4=M|title=Adherence of Borrelia burgdorferi to the proteoglycan decorin|journal=Infection and Immunity|volume=63|issue=9|year=1995|pages=3467–3472|issn=0019-9567|doi=10.1128/iai.63.9.3467-3472.1995}}</ref> | ||
*High affinity of [[borrelia]] to [[Collagen|collagen fibers]] explains how damage of [[connective tissue]], [[fibrosis]] and [[dermis|dermal]] [[atrophy]] occur.<ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume= | issue= | pages= | pmid=33085436 | doi= | pmc= | url= }} </ref><ref name="KoningTazelaar1995">{{cite journal|last1=Koning|first1=J.|last2=Tazelaar|first2=D. J.|last3=Hoogkamp-Korstanje|first3=J. A. A.|last4=Elema|first4=J. D.|title=Acrodermatitis chronica atrophicans: A light and electron microscopic study|journal=Journal of Cutaneous Pathology|volume=22|issue=1|year=1995|pages=23–32|issn=0303-6987|doi=10.1111/j.1600-0560.1995.tb00735.x}}</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 affinity of [[borrelia]] to [[Collagen|collagen fibers]] explains how damage of [[connective tissue]], [[fibrosis]] and [[dermis|dermal]] [[atrophy]] occur.<ref name="pmid33085436">{{cite journal| author=| title=StatPearls | journal= | year= 2021 | volume= | issue= | pages= | pmid=33085436 | doi= | pmc= | url= }} </ref><ref name="KoningTazelaar1995">{{cite journal|last1=Koning|first1=J.|last2=Tazelaar|first2=D. J.|last3=Hoogkamp-Korstanje|first3=J. A. A.|last4=Elema|first4=J. D.|title=Acrodermatitis chronica atrophicans: A light and electron microscopic study|journal=Journal of Cutaneous Pathology|volume=22|issue=1|year=1995|pages=23–32|issn=0303-6987|doi=10.1111/j.1600-0560.1995.tb00735.x}}</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> | ||
*[[Fibrosis]] and [[collagen]] accumulation lead to formation of band-like hardness on [[Limb (anatomy)|extremities]] and may cause [[joint]] movement reduction as a consequent.<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> | |||
==Genetics== | ==Genetics== | ||
Revision as of 01:42, 11 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
Pathophysiology
Pathogenesis
- Acrodermatitis chronica atrophicans is one of the tertiary presentations of European lyme borreliosis.[1][2]
- This progressive skin process is due to the effect of chronic infection with the spirochete borrelia burgdorferi. Borrelia afzelii is the predominant pathophysiology, but may not be the exclusive, etiology of acrodermatitis chronica atrophicans. [3][4][5][1][2]
- Borrelia garinii, borrelia afzelii and borrelia burgdorferi (B. burgdorferi sensu lato), are all responsible and have been detected in acrodermatitis chronica atrophicans patients.[6]
- Based on a study, majority of skin biopsies from acrodermatitis chronica atrophicans patients demonstrated borrelia afzelii.[6]
- Transmission of this infection probably occur via ixodes tick, mosquito and horsefly bite. These vectors themselves get infected by feeding on an infected animal reservoir.[7]
- Acrodermatitis chronica atrophicans development is the result of chronic T cell mediated reaction of immune system against borrelia. This immune reaction leads to infiltration of CD3+ and CD4+ cells in the dermis.[7]
- Borrelia is capable of attaching to the extracellular matrix proteins (such as glycosaminoglycan, fibronectin and decorin proteoglycan) which eventually leads to metalloproteases activation. When metalloproteases activate they degrade extracellular matrix.[7][8]
- High affinity of borrelia to collagen fibers explains how damage of connective tissue, fibrosis and dermal atrophy occur.[7][9][10]
- Fibrosis and collagen accumulation lead to formation of band-like hardness on extremities and may cause joint movement reduction as a consequent.[10]
Genetics
Associated Conditions
Conditions associated with acrodermatitis chronica atrophicans include:[11][3][12]
- Lymphocytic meningoradiculitis:
- Also known as bannwarth syndrome.
- Lymphocytic meningoradiculitis is a neurological disease which is also due to Borrelia burgdorferi infection and subsequent lyme disease.
- Symptoms such as radicular pain in cervical or lumbar regions and cranial nerve palsy (such as facial palsy) are common among patients.
- Lichen sclerosus et atrophicus
- Also called Lichen sclerosus.
- It appears as scleroderma-like skin lesions.
- It has been reported in 12% patients of a study done on 50 patients with acrodermatitis chronica atrophicans.
Gross Pathology
- In the atrophy phase of the acrodermatitis chronica atrophicans skin appears transparent with easily seen veins on gross pathology.[6][13]
- The following list are some of the findings on gross pathology:[2]
Microscopic Pathology
- Light and electron microscopic study of the skin biopsy shows degeneration of the elastica and collagen fibers.[14]
- Findings from biopsies exhibit leukocytic infiltrations, plasma cells, histiocytes and telangiectasia. [15][3][7]
- Thinning of skin layers such as dermis and epidermis has been seen in atrophic phase. [6][15][7]
- Pigmented stratum germinativum also has been reported in some biopsies.[15]
- The following are list of pathognomonic microscopic findings when atrophic phase starts:[15][7]
- Epidermal atrophy
- Elastin and collagen damage
- Dermal blood vessels dilation
- Perivascular plasma cell infiltration
References
- ↑ 1.0 1.1 Smetanick MT, Zellis SL, Ermolovich T (2010). "Acrodermatitis chronica atrophicans: a case report and review of the literature". Cutis. 85 (5): 247–52. PMID 20540415.
- ↑ 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 3.2 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.
- ↑ 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.
- ↑ Rudenko N, Golovchenko M (2021). "Sexual Transmission of Lyme Borreliosis? The Question That Calls for an Answer". Trop Med Infect Dis. 6 (2). doi:10.3390/tropicalmed6020087. PMID 34074046 Check
|pmid=value (help). - ↑ 6.0 6.1 6.2 6.3 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.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 "StatPearls". 2021. PMID 33085436 Check
|pmid=value (help). - ↑ Guo, B P; Norris, S J; Rosenberg, L C; Höök, M (1995). "Adherence of Borrelia burgdorferi to the proteoglycan decorin". Infection and Immunity. 63 (9): 3467–3472. doi:10.1128/iai.63.9.3467-3472.1995. ISSN 0019-9567.
- ↑ Koning, J.; Tazelaar, D. J.; Hoogkamp-Korstanje, J. A. A.; Elema, J. D. (1995). "Acrodermatitis chronica atrophicans: A light and electron microscopic study". Journal of Cutaneous Pathology. 22 (1): 23–32. doi:10.1111/j.1600-0560.1995.tb00735.x. ISSN 0303-6987.
- ↑ 10.0 10.1 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.
- ↑ 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.
- ↑ Kim, MyungHwa; Choi, MiSoo; Seong, GiHyun; Park, MyeongJin; Park, Minkee; Hong, SeungPhil; Park, ByungCheol (2020). "Rapidly progressing generalized morphea with high lyme disease titer". Indian Journal of Dermatology. 65 (5): 432. doi:10.4103/ijd.IJD_279_18. ISSN 0019-5154.
- ↑ Abele DC, Anders KH (1990). "The many faces and phases of borreliosis II". J Am Acad Dermatol. 23 (3 Pt 1): 401–10. doi:10.1016/0190-9622(90)70233-8. PMID 2212138.
- ↑ de Koning J, Tazelaar DJ, Hoogkamp-Korstanje JA, Elema JD (1995). "Acrodermatitis chronica atrophicans: a light and electron microscopic study". J. Cutan. Pathol. 22 (1): 23–32. PMID 7751475. Unknown parameter
|month=ignored (help) - ↑ 15.0 15.1 15.2 15.3 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.
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