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{{SK}}  Pick-Herxheimer disease; ACA
{{SK}}  Pick-Herxheimer disease; ACA


==Overview==
==[[Acrodermatitis chronica atrophicans overview|Overview]]==
Acrodermatitis chronica atrophicans is a [[skin rash]] indicative of the third or late stage of European [[Lyme Disease|Lyme borreliosis]].
==[[Acrodermatitis chronica atrophicans historical perspective|Historical Perspective]]==
 
==[[Acrodermatitis chronica atrophicans classification|Classification]]==
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]].
==[[Acrodermatitis chronica atrophicans pathophysiology|Pathophysiology]]==
 
==[[Acrodermatitis chronica atrophicans causes|Causes]]==
==Historical Perspective==
==[[Acrodermatitis chronica atrophicans differential diagnosis|Differentiating Acrodermatitis chronica atrophicans from other Disease]]==
* The first record of ACA was made in 1883 in Breslau, Germany, where a physician named Alfred Buchwald first delineated it.
==[[Acrodermatitis chronica atrophicans epidemiology and demographics|Epidemiology and Demographics]]==
* [[Herxheimer reaction|Herxheimer]] and Hartmann described it in 1902 as a "tissue paper" like [[cutaneous]] atrophy.
==[[Acrodermatitis chronica atrophicans risk factors|Risk Factors]]==
 
==[[Acrodermatitis chronica atrophicans screening|Screening]]==
==Pathophysiology==
==[[Acrodermatitis_chronica_atrophicans_natural_history,_complications_and_prognosis|Natural History, Complications, and Prognosis]]==
* 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.
 
===Microscopic Pathology===
* Light and electron microscopic study of the [[skin biopsy]] shows degeneration of the elastica and collagen fibers.<ref name="pmid7751475">{{cite journal |author=de Koning J, Tazelaar DJ, Hoogkamp-Korstanje JA, Elema JD |title=Acrodermatitis chronica atrophicans: a light and electron microscopic study |journal=J. Cutan. Pathol. |volume=22 |issue=1 |pages=23–32 |year=1995 |month=February |pmid=7751475 |doi= |url=}}</ref>
 
==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.     
 
* 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.
 
==Diagnosis==
==Diagnosis==
===History===
* A history of a recent [[tick bite]] should be inquired about.
===Symptoms===
* 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]].
===Laboratory Findings===
* Physicians should use [[serology|serologic]] and [[histology|histologic]] examination to confirm the diagnosis of ACA.
* '''Biopsy''' shows chronic inflammatory signs in long standing cases. <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>


==Treatment==
=Related Chapters=
* 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]]
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[[Category:Spirochaetes]]
[[Category:Spirochaetes]]
[[Category:Infectious disease|*]]
[[Category:Infectious disease|*]]
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Revision as of 14:39, 31 October 2012

Acrodermatitis chronica atrophicans
ICD-10 L90.4
ICD-9 701.8
DiseasesDB 32940

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]

Synonyms and keywords: Pick-Herxheimer disease; ACA

Overview

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