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16-September-2008 16:15:14 - Acrodermatitis chronica atrophicans Acrodermatitis chronica atrophicans Classification and external resources ICD-10 L90.4 ICD-9 701.8 DiseasesDB 32940 eMedicine derm/4 Acrodermatitis chronica atrophicans ACA also known as Pick-Herxheimer disease, is a skin rash indicative of the third or late stage of European Lyme borreliosis. ACA is a 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. This progressive skin process is due to the effect of continuing active infection with the spirochete Borrelia afzelii. B afzelii is the predominant pathophysiology, but may not be the exclusive, etiologic agent of ACA. Borrelia garinii, has also been detected. Contents 1 History 2 Presentation 3 Prognosis and Treatment 4 See also 5 External links History The first record of ACA was made in 1883 in Breslau, Germany, where a physician named Alfred Buchwald first delineated it. Herxheimer and Hartmann described it in 1902 as a tissue paper like cutaneous atrophy. Presentation 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. Sclerotic skin plaques may also develop. As ACA progresses the skin begins to wrinkle. Prognosis and Treatment 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. Physicians should use serologic and histologic examination to confirm the diagnosis of ACA. Treatment consists of antibiotics including doxycycline and penicillin for up to four weeks in the acute case. See also Lyme Disease Erythema Migrans External links DermIs.net Picture of Acrodermatitis chronica atrophicans rashes v d e Diseases of the skin and subcutaneous tissue integumentary system L, 680-709 Infections Staphylococcus Staphylococcal scalded skin syndrome, Impetigo, Boil, Carbuncle - Cellulitis Paronychia - Acute lymphadenitis - Pilonidal cyst - Corynebacterium Erythrasma Bullous disorders acantholysis Pemphigus, Transient acantholytic dermatosis - Pemphigoid Bullous pemphigoid, Mucous membrane pemphigoid - Dermatitis herpetiformis Inflammatory Dermatitis and eczema Atopic dermatitis - Seborrhoeic dermatitis Dandruff, Cradle cap - Contact dermatitis Diaper rash, Urushiol-induced contact dermatitis - Erythroderma - Lichen simplex chronicus/Prurigo nodularis - Itch Pruritus ani - Nummular dermatitis - Dyshidrosis - Pityriasis alba Papulosquamous disorders Psoriasis Psoriatic arthritis - Parapsoriasis Pityriasis lichenoides et varioliformis acuta, Pityriasis lichenoides chronica, Lymphomatoid papulosis - other pityriasis Pityriasis rosea, Pityriasis rubra pilaris - other lichenoid Lichen planus, Lichen nitidus Urticaria and erythema Urticaria Dermatographic urticaria, Cholinergic urticaria Erythema Erythema multiforme, Stevens-Johnson syndrome, Toxic epidermal necrolysis, Erythema nodosum, Erythema annulare centrifugum, Erythema marginatum Radiation-related disorders Sunburn - Actinic keratosis - Polymorphous light eruption - Radiodermatitis - Erythema ab igne Pigmentation disorder hypopigmentation Albinism, Vitiligo - hyperpigmentation Melasma, Freckle, Café au lait spot, Lentigo/Liver spot, Acanthosis nigricans Other keratosis Seborrheic keratosis, Callus - other epidermal thickening Ichthyosis acquisita, Palmoplantar keratoderma skin ulcer Pyoderma gangrenosum, Bedsore atrophic Lichen sclerosus, Acrodermatitis chronica atrophicans necrobiosis Granuloma annulare, Necrobiosis lipoidica - other granuloma Granuloma faciale, Pyogenic granuloma vasculitis Livedoid vasculitis, Erythema elevatum diutinum Keloid - Systemic lupus erythematosus - Morphea - Calcinosis cutis - Sclerodactyly - Ainhum Disorders of skin appendages Nail Ingrown nail - Onychogryposis - Beau's lines - Yellow nail syndrome - Leukonychia Hair hair loss: Alopecia areata Alopecia totalis, Alopecia universalis, Ophiasis - Androgenic alopecia - Hypotrichosis - Telogen effluvium - Traction alopecia - Lichen planopilaris - Trichorrhexis nodosa other follicular disorders: Hypertrichosis Hirsutism - Acne vulgaris - Rosacea Perioral dermatitis, Rhinophyma - follicular cysts Epidermoid cyst, Sebaceous cyst, Steatocystoma multiplex - Pseudofolliculitis barbae - Hidradenitis suppurativa - Folliculitis Sweat glands eccrine Miliaria, Anhidrosis - apocrine Body odor, Chromhidrosis, Fox-Fordyce disease see also congenital, neoplasia Retrieved from http://en..org/wiki/Acrodermatitis_chronica_atrophicans Categories: Dermatology | Symptoms | Insect-borne diseases | Lyme disease | Zoonoses | Spirochaetes | Infectious diseases Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch This page was last modified on 23 January 2008, at 07:31
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