title: Expanding the clinicopathological spectrum of late cutaneous Lyme borreliosis (acrodermatitis chronica atrophicans [ACA]): A prospective study of 20 culture- and/or polymerase chain reaction (PCR)-documented cases.
abstract: BACKGROUND
  The diagnosis of acrodermatitis chronica atrophicans (ACA), the late cutaneous manifestation of Lyme borreliosis, can be challenging. Histologic changes in ACA have been described in a few studies from endemic countries, relying on cases documented by serology only.
  
  
  OBJECTIVE
  We sought to reassess the clinicopathological spectrum of ACA in a series of thoroughly documented cases.
  
  
  METHODS
  Patients prospectively included in a national prospective study were selected on the basis of positive culture and/or polymerase chain reaction of a skin biopsy sample. The diagnosis of ACA was confirmed by reviewing the clinical and serologic data. Histopathological samples were carefully reviewed.
  
  
  RESULTS
  Twenty patients were included. Unusual clinical features (ie, numerous small violaceous patches and equidistant small spinous papules with background faint erythema) were observed in 2 patients. Histopathological examination revealed a classic plasma cell-rich perivascular and interstitial pattern with telangiectases in 16 of 25 samples, whereas strikingly prominent granuloma annulare-like or lichenoid features were observed in 4 and 2 of 25 cases, respectively, and discrete nonspecific minor changes in 3 of 25 cases.
  
  
  CONCLUSIONS
  The small number of patients was a limitation.
  
  
  CONCLUSIONS
  Genuine culture- and/or polymerase chain reaction-proven ACA can rarely present as numerous violaceous patches or cluster of spinous papules clinically, and as a granuloma annulare-like or lichenoid dermatosis histologically.
authors.affiliation: Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Lenormand
authors.affiliation: EA (Equipe d'Accueil) 7290 Virulence bactérienne précoce and Centre National de Référence des Borrelia, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Jaulhac
authors.affiliation: Service de Dermatologie at Centre Hospitalier Lyon Sud, Pierre Bénite, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Debarbieux
authors.affiliation: Service de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dupin
authors.affiliation: Service de Dermatologie, Hôpitaux de Brabois, Centre Hospitalier Universitaire de Nancy, Nancy, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Granel-Brocard
authors.affiliation: Service de Dermatologie, Hôpital Universitaire Pontchaillou, Rennes, France.
authors.forename: Henri
authors.initials: H
authors.lastname: Adamski
authors.affiliation: EA (Equipe d'Accueil) 7290 Virulence bactérienne précoce and Centre National de Référence des Borrelia, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.
authors.forename: Cathy
authors.initials: C
authors.lastname: Barthel
authors.affiliation: Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine, Université de Strasbourg, Strasbourg, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Cribier
authors.affiliation: Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Faculté de Médecine, Université de Strasbourg, Strasbourg, France. Electronic address: dan.lipsker@chru-strasbourg.fr.
authors.forename: Dan
authors.initials: D
authors.lastname: Lipsker
mesh_terms: D000169:Acrodermatitis / Q000175:diagnosis* / Q000382:microbiology; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D015331:Cohort Studies; D004269:DNA, Bacterial / Q000032:analysis; D015787:Erythema Chronicum Migrans / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D008193:Lyme Disease / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution
chemical_list: D004269:DNA, Bacterial
keywords: Borrelia burgdorferi; acrodermatitis chronica atrophicans; borreliosis; granuloma annulare; lichenoid dermatitis; plasma cells