Acrodermatitis chronica atrophicans (ACA) also known as Pick-Herxheimer disease. ACA is not limited to any one nationality or race. It is much more frequent in whites than in other races, probably because of a far higher exposure to ticks transmitting B afzelii. 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. About 5-10% of patients with ACA develop sclerodermalike plaques. Anetodermalike skin lesions can be seen concomitant with ACA.ACA in its early inflammatory edematous stage shows a dense, patchy perivascular and periappendiceal dermal infiltrate of lymphocytes, histiocytes, and plasma cells. Collagen bundles become swollen and homogeneous and are split by mucinous deposition. Early stages of the disease show superficial and deep inflammatory cellular infiltrate in the dermis. ACA shows atrophy of collagen and elastic tissue as well as hypertrophic basophilic elastic tissue; whereas in morphea, sclerosis and polarizing elastic tissue are prominent. 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. Acrodermatitis Chronica - Prevention and Treatment Tips 1. Antibiotics including doxycycline and penicillin for up to four weeks in the acute case. 2. Burgdorferi flagellum a needed reference antigen for growing routine serology in Lyme borreliosis. 3. Leukocytoclastic vasculitis or vessel occlusion may be seen in some cases.
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