title: Acrodermatitis chronica atrophicans: a case report and review of the literature.
abstract: We report a 55-year-old woman with acrodermatitis chronica atrophicans (ACA) and a peripheral sensory neuropathy. ACA is an uncommon late cutaneous manifestation of Lyme disease, which follows disseminated Borrelia burgdorferi infection. This is the second published case from the U.K. since serological diagnosis has been available. In this patient the diagnosis was confirmed by serology using a sensitive enzyme-linked immunosorbent assay and immunoblotting techniques. B. burgdorferi DNA was demonstrated in the affected skin using the polymerase chain reaction, although staining and cultures for the organism were negative. Recommended treatment of ACA is with oral doxycycline 100 mg twice daily for 28 days, but our patient did not respond well to this regimen. She was therefore treated with ceftriaxone intravenously for 21 days, which resulted in a rapid symptomatic and clinical response.
authors.affiliation: Department of Dermatology, University College London Medical School, Middlesex Hospital, U.K.
authors.forename: T A
authors.initials: TA
authors.lastname: Leslie
authors.forename: N J
authors.initials: NJ
authors.lastname: Levell
authors.forename: S J
authors.initials: SJ
authors.lastname: Cutler
authors.forename: K J
authors.initials: KJ
authors.lastname: Cann
authors.forename: M E
authors.initials: ME
authors.lastname: Smith
authors.forename: D J
authors.initials: DJ
authors.lastname: Wright
authors.forename: J J
authors.initials: JJ
authors.lastname: Gilkes
authors.forename: T W
authors.initials: TW
authors.lastname: Robinson
mesh_terms: D000169:Acrodermatitis / Q000209:etiology* / Q000473:pathology; D001483:Base Sequence; D001898:Borrelia / Q000235:genetics; D004269:DNA, Bacterial / Q000032:analysis; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000150:complications* / Q000473:pathology; D008875:Middle Aged; D008969:Molecular Sequence Data; D013997:Time Factors
chemical_list: D004269:DNA, Bacterial