Acrodermatitis chronica atrophicans: clinical and microbiological characteristics of a cohort of 693 Slovenian patients

J Intern Med. 2021 Feb 7. doi: 10.1111/joim.13266. Online ahead of print.

Abstract

Background: Information on large groups of patients with acrodermatitis chronica atrophicans (ACA) is limited.

Methods: We assessed clinical and microbiological characteristics of patients with ACA diagnosed at a single medical centre and compared findings in periods 1991-2004 vs. 2005-2018. The cohort is representative of Slovenian ACA patients.

Results: We assessed 693 patients: 461 females, 232 males; median age 64. Median duration of ACA before diagnosis was 12 months. In all but 2 patients the skin lesions were located on extremities, more often on the lower (70.0%) than the upper (45.2%), bilaterally in 42.4%. Reddish-blue discoloration, swelling, thinning, and wrinkling of skin were present in 95.2%, 28.1%, 46.4%, and 20.5% of patients, respectively. Overall, 64.4% of patients reported constitutional symptoms, 23.1% had local symptoms, and 20.8% had symptoms/signs of peripheral neuropathy. Nodules, arthritis, joint deformity, muscle atrophy, and paresis were rare (<3%). Borreliae were isolated from 200/664 (30.1%) skin samples; 92.8% were Borrelia afzelii. B. garinii and B. burgdorferi s.s. were more often isolated from the skin of male patients (OR=4.17) and from those with arthropathy (OR=11.74). Patients included in the more recent period were older, complained less often of constitutional symptoms but more often of local symptoms, and more often had local swelling but less often skin atrophy and bilateral involvement, probably as a consequence of earlier diagnosis.

Conclusions: ACA, typically caused by B. afzelii, usually affects older women. Clinical presentation depends on the duration of illness and probably on the Borrelia species causing the disease.

Keywords: Borrelia afzelii; Borrelia burgdorferi sensu lato; acrodermatitis chronica atrophicans; late Lyme borreliosis.