Acrodermatitis chronica atrophicans
Acrodermatitis chronica atrophicans (ACA) is a skin rash indicative of the third or late stage of European Lyme borreliosis.
The rash caused by ACA is most evident on the extremities. It begins with an inflammatory stage with bluish red discoloration and cutaneous swelling, and concludes several months or years later with an atrophic phase. Sclerotic skin plaques may also develop.[citation needed] As ACA progresses the skin begins to wrinkle (atrophy).
Generally a two-step approach is followed. First, a screening test involving IgM and IgG ELISA. If the ELISA screening has a positive or equivocal result, then the second step is to perform a Western Blot as a confirmatory test. Other methods include microscopy and culture (in modified Kelly's medium) of skin biopsy or blood samples.
Antibiotics is recommended in treatment of ACA. Doxycycline is often used. Resolution may take several months. Skin damage and nerve damage may persist after treatment.
The first record of ACA was made in 1883 in Breslau, Germany, where a physician named Alfred Buchwald first delineated it.[citation needed]Herxheimer and Hartmann described it in 1902 as a "tissue paper like" cutaneous atrophy.
