Acrodermatitis chronica atrophicans in the United States: clinical and histopathologic features of six cases.
Authors:DiCaudo DJ, Su WP, Marshall WF, Malawista SE, Barthold S, Persing DH Source:Cutis 1994 Aug;54(2):81-4
Organization:Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905.
Abstract:
Acrodermatitis chronica atrophicans is a chronic cutaneous disease caused by the Lyme disease spirochete Borrelia burgdorferi. Acrodermatitis chronica atrophicans is endemic in some regions of Europe but is only rarely seen in the United States. This report describes the clinical and histopathologic findings in six cases of acrodermatitis chronica atrophicans seen at the Mayo Clinic between 1912 and 1961. Histologic differences between early and late phases of the disease were observed, and multisystemic symptoms consistent with chronic Lyme disease were documented in a subset of the patients..... Our data
suggest that some of the first patients with Lyme disease in the United States came to the Mayo Clinic earlier in this century.

Keywords:
Acrodermatitis, EPIDEMIOLOGY, ETIOLOGY, PATHOLOGY, Adult, Chronic Disease, Europe, ETHNOLOGY, Female, Human, Lyme Disease, COMPLICATIONS, Male, Middle Age, Support, Non-U.S. Gov't, Support, U.S. Gov't, P.H.S., United States, EPIDEMIOLOGY

Language: Eng

Unique ID: 95044406

"Acrodermatitis Chronica
Atrophicans: Historical and Clinical Overview," by Rudolph J.
Scrimenti, Associate Clinical Professor of
Dermatology, Medical College of Wisconsin, Milwaukee. Remarks added
are in parenthesis.

Montgomery and Sullivan from the Mayo Clinic reviewed 45 cases of ACA
in 1945......
(ACA has two stages): early infiltration and/or inflammation and,
later atrophy.

ACA is an outstanding example of prolonged latency and chronic
infection......"


from: Annals of Internal Medicine--Vol. 114--Number 6--March 15, 1991 pg. 490-498
title: Diagnosis of Lyme Disease Based on Dermatologic Manifestations
authors: Malane, MD, et al

Acrodermatitis Chronica Atrophicans
"Acrodermatitis Chronica Atrophicans is a unique late complication of Lyme disease, which was first recognized in 1883 (54) . .......It has been reported as the first manifestation of Lyme disease; for example, one asymptomatic patient, on screening had a high serum titer of B. burgdorferi antibodies and he developed acrodermatitis chronica atophicans 4 years later (13, 54, 56)....Classically, there is an intial erythematous or violaceous discoloration in doughy and swollen skin, appearing as plaques or nodules (13, 54). ....The lesion expands and may have a waxing and waning course ((13, 58). This stage will continue for weeks to years before becoming atrophic......There may be hypopigmentation or hyperpignmentation as well as scaling (54, 57). The lesion may be associated with pain, pruritis,"(itching)" hyperesthesias, or paresthesias (55, 57)." (esthesia--from Taber's Cyclopedic Medical Dictionary-- 1. Perception ; feeling; sensation 2. Any disease that affects sensations and perceptions.----para is a prefix meaning near, beside, past, opposite, abnormal, irregular, two like parts-----hyper is a prefix meaning above, excessive or beyond) "Regional lymphadenopathy," (a disease of the lymph nodes---pathy is a combining form indicating disease.---While I was looking this up I noticed that Taber's 18 th edition has a computer glossary included.) " as well as neurological and musculoskeletal signs or symptoms, may be localized to the same extremity as the acrodermatitis chronica atrophicans lesion (13, 57). An associated sclerotic or fibrotic lesion may be found in patients with acrodermatitis chronica atrophicans (13, 28, 57). The differential diagnosis includes thrombophlebitis, venous insufficiency, eczematous dermatitis, cold injury or aging......"

LATE CUTANEOUS LYME DISEASE: ACRODERMATITIS CHRONICA ATROPHICANS.
Authors: Kaufman LD Gruber BL Phillips ME Benach JL
Source: Am J Med 1989 Jun;86(6 Pt 2):828-30

".....Observations from our patients indicate that the cutaneous lesions of ACA may be more common than was previously recognized. Alternatively, there may be an increase in incidence related to the rapidly rising number of Lyme disease cases in endemic areas throughout this couontry. We have confirmed the spirochetal etiology of this
lesion as demonstrated in European specimens using a specific monoclonal antibody against B. burgdorferi . This therefore establishes ACA as a part of the natural history as well as a late manifestation of untreated cutaneous Lyme disease in the United States.....A heightened awareness of this manifestation of Lyme diseae may lead to the more frequent recognition of its occurrence, avoidance of a delay in diagnosis, and the development of appropriate therapeutic intervention." _________________________________________________________

Title: Acrodermatitis Atrophicans Chronica
Authors: Hamilton Montgomery and Ralph Sullivan
Source: Archives of Dermatology and Syphilology 51:32-47 1945
Organization: Mayo Foundation Rochester, Minn.

"Summary and Conclusions-
There is no known treatment for acrodermatitis chronica atrophicans (Lyme disease) is a chronic dermatosis of unknown cause usually involving the extremities, especially the extensor surfaces in the vicinity of the knees, ankles, elbows and wrists. The disease, however, may be generalized and appear as erythoderma" (abnormal redness of the skin-Taber's) "with poikiloderma-like changes."
(poikiloderma- A skin disorder characterized by pigmentation, telangiectasia, purpura, pruritus, and atrophy.-Taber's)
"At times it may be unilateral. IT IS NOT LIMITED TO ONE NATIONALITY OR CONTINENT, AND IT OCCURS FAIRLY FREQUENTLY AMONG NATIVE BORN AMERICANS. It is usually a disease of the later decades of life, predominating in women who are more than 40 years of age. ......The average histopathologist has much difficulty in differentiating the end stages of other cutaneous atrophies..."

here are several interesting references from the article- ( there are 47 references)

author: Director, W., and Bluefarb, S.M.: Familial Occurrence of Acrodermatitis Atrophicans Chronica. Report of Two Cases, Archives of Dermat. and Syph. 46:480-482 (Oct.) 1942 (families have genes in common but they also have hikes in the woods, picnics, and other outdoor activities in common)

author: Andrews
title: Acrodermatitis Chronica Atrophicans and Hodgkin's Disease, Arch. Dermat and Syph. 16:4(Oct.) 1927

author: Pardo-Castello, V.
title : Leprosy Associated with Dermatitis Atrophicans Diffusa et Progressiva, Arch. of Dermat. and Syph. 33:12-20 (Jan.) 1936

author: Pack, et al
source: JAMA 118:879-884 (March 14) 1942.
title: The Development of Cancer in Acrodermatitis Chronica Atrophicans (Lyme disease)

author: Wise, F.
title: Acrodermatitis Chronica Atrophicans with Healed Squamous Cell Epithelioma
source: Archives of Dermat. and Syph. 15:230-231 (Feb.) 1927


__OLD Posts about ACA-Acrodermatitis Chronica Atrophicans-late Lyme disease____________________________
source: Everything You Need to Know About Lyme Disease
author: Karen Vanderhoof-Forschner
pg. 165
1945 "Mayo Clinic researchers present additional cases of ACA. Although some of the patients had arthralgias, arthritis and heart problems prior to ACA the researchers conclude they are unrelated to the skin disease. source: Montgomery and Sullivan (1945) "Acrodermatitis atrophicans chronica." Arch Dermatol, 51:32-47. Referenced in Weber/Burgdorfer (1993). chapter by Weber/Pfister.
1883 "German physcician Alfred Buchwald describes a degenerative skin condition lasting 16 years in one patient which he names diffuse idiopathic skin atrophy. This is the first record of what we know as acrodermatitis chronica atrophicans (ACA), which is a late Lyme disease skin condition......" "source: Buchwald 1883...... ...referenced in Weber/Burgdorfer (1993), chapter by Weber/Pfister."
_____________________________________________


".....The results not only show that borrelial lymphocytoma
can be caused by B. afzelii but also
demonstrate an association with another genomic group of B.
burgdorferi sensu lato that is present in
North America as well..."
LYMPHOCYTOMA OF EAR LOBE IS FOUND IN THE UNITED STATES:

- JOURNAL ARTICLE LA - Eng SO - J Wildl Dis 1996 Jul;32(3):560-2 UI
- 97134735 AU - Picken RN
AU - Strle F AU -Ruzic-Sabljic E AU - Maraspin V AU - Lotric-Furlan S
AU - Cimperman J AU - Cheng Y
AU - Picken MM TI - Molecular subtyping of Borrelia burgdorferi sensu
lato isolates from five patients
with solitary lymphocytoma. AD - Section of Infectious Disease, Rush- Presbyterian-St. Luke's Medical
Center, Chicago, Illinois, USA. AB - Solitary lymphocytoma is a rare
cutaneous manifestation of Lyme
borreliosis that has been reported almost exclusively from Europe.
This suggests that its etiologic agent
may be absent or extremely rare on the North American continent. All
three species of B. burgdorferi
sensu lato known to be associated with human Lyme borreliosis (B.
burgdorferi sensu stricto, B. garinii,
and B. afzelii have been isolated in Europe, whereas only B.
burgdorferi sensu stricto has been found in
North America. This suggests that either B. garinii or B. afzelii
might be the etiologic agent of borrel
al lymphocytoma. To investigate this hypothesis we characterized five
strains of B. burgdorferi sensu
lato isolated from lymphocytoma lesions of patients residing in
Slovenia. The methods used included:
large restriction fragment pattern analysis of restriction enzyme luI-
digested genomic DNA, plasmid
profiling, protein profiling, ribotyping using 5S, 16S, and 23S rDNA
probes, and polymerase chain
reaction amplification of the rrf (5S)-rrl (23S) intergenic spacer
region. Molecular subtyping showed that
four of the five isolates belonged to the species B. afzelii; however,
this species is the predominant
patient isolate in Slovenia and, therefore, may not represent a
preferential association with
lymphocytoma. The fifth isolate appeared to be most closely related
to the DN127 genomic group of
organisms. Further characterization of the isolate revealed that it
possessed a unique molecular
"fingerprint." The results not only show that borrelial lymphocytoma
can be caused by B. afzelii but also
demonstrate an association with another genomic group of B.
burgdorferi sensu lato that is present in
North America as well.
_____________________

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