Acrodermatitis chronica atrophicans

This is a feature of Stage III Lyme disease.

It is characterised by involvement of mainly the extensor surface of the extremities. Initially there is a bluish-red discolouration of the skin with oedematous swelling. This progresses to skin atrophy with wrinkles.

• reported in 1-3% of Lyme borreliosis cases in Europe (1)
• characterized by high levels of borrelial IgG antibodies (2)
• very rarely develops in children
• may present several months to years after an untreated erythema migrans
• been postulated that does not resolve spontaneously, in contrast to most other manifestations of Lyme borreliosis
• concurrent peripheral neuropathy is common, and local joint involvement may occur

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Reference:

• Kullber BJ et al. Lyme borreliosis: diagnosis and management.BMJ 2020;369:m1041
• Maraspin V et al. Acrodermatitis Chronica Atrophicans in Children: Report on Two Cases and Review of the Literature. Ticks Tick borne dis. 2019 Jan;10(1):180-185