By Gary M. White, MD
Acrodermatitis chronic atrophicans represents the late state of infection of the skin by the spirochete Borrelia afzelii. Elderly women in Europe are most commonly affected.
Initially during the inflammatory phase, the skin is swollen and reddish-blue in discoloration. Later, the skin becomes wrinkled, dry, atrophic, and lacking in hair. Fibrotic nodules overlying joints are also typical. Nerve involvement may cause pain and dysethesias. Less common presentations include violaceous patches or spinous papules on an erythematous background [JAAD 2016;74;685].
The appropriate clinical and histologic picture may be sufficient. High titers of IgG anti-Borrelia antibodies strongly supports the diagnosis.
The treatment of the patient depends upon the overall status of the Lyme disease. Consultation with an infectious disease expert is recommended.
See Figure 4 of Clinical Features of 705 Borrelia burgdorferi Seropositive Patients in an Endemic Area of Northern Italy Scientific World Journal
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