Acrodermatitis chronica atrophicans natural history, complications and prognosis
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
Natural History, Complications, and Prognosis
Natural History
- The course of acrodermatitis chronica atrophicans is chronic and could lasts for several years. [1]
- Mean duration of the disease before diagnosis was approximately 12 months among 693 patients.[2]
- It can progress slowly overtime. [1]
- It usually involves extensor surfaces of the acral regions of limbs.[1]
- Skin changes first appear as blue and red discoloration with boggy infiltration (inflammatory phase). These inflammatory skin lesions can become atrophic later without treatment (atrophic phase).
- Based on two studies, 55% and 66% of patients with acrodermatitis chronica atrophicans have at least one history of tick bite, while others may never remember such an accident. Since there could be several years between the tick bite and development of skin lesions, absence of tick bite in patients' history is not meaningful alone.[3]
- One fifth of the patients in a study experienced erythema migrans 6 months to 8 years before acrodermatitis chronica atrophicans development.[3][4]
- Some of patients reported previous neurological or rheumatological symptoms.[2]
Complications
- Common complications of acrodermatitis chronica atrophicansis include:[1]
- Sclerotic skin changes
Prognosis
- Acrodermatitis chronica atrophicans can lead to extensive atrophy of skin and, in some patients it can cause limitation of upper and lower limb joint mobility.
- In contrast to other skin manifestations of borrelia infection, acrodermatitis chronica atrophicans doesn't heal without treatment and is capable of becoming chronic. [5][6]
- The inflammatory phase can last for years and the atrophic phase can last for decades Without appropriate treatment.
- The general pognosis is good with proper and rapid treatment in acute inflammatory stage of acrodermatitis chronica atrophicans.
- The therapeutic outcome is difficult to assess in patients with the chronic atrophic phase because most changes are only partially reversible.
References
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ 2.0 2.1 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 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.
- ↑ Asbrink E, Hovmark A, Hederstedt B (1984). "The spirochetal etiology of acrodermatitis chronica atrophicans Herxheimer". Acta Derm Venereol. 64 (6): 506–12. PMID 6084922.
- ↑ Asbrink E (1993). "Acrodermatitis chronica atrophicans". Clin Dermatol. 11 (3): 369–75. doi:10.1016/0738-081x(93)90092-q. PMID 8221518.
- ↑ 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.