Acrodermatitis chronica atrophicans in prolonged borrelia infection

Tidsskr Nor Laegeforen. 2021 Nov 8;141(16). doi: 10.4045/tidsskr.21.0201. Print 2021 Nov 9.
[Article in English, Norwegian]


Background: Acrodermatitis chronica atrophicans (ACA) is a late manifestation of Borrelia infection and is easily overlooked, especially in elderly patients.

Case presentation: A woman in her fifties presented with dizziness, general muscle stiffness, chills, nausea and a feeling of transient shock in her head during dosage reduction of escitalopram. The symptoms were therefore initially misinterpreted as related to her psychiatric disorder. Four months after the first symptoms presented, she complained that her right foot had become one shoe size larger than her left. Skin manifestations were found to be consistent with acrodermatitis chronica atrophicans.

Interpretation: Acrodermatitis chronica atrophicans is uncommon and affects women more than men. The skin changes mostly occur on the dorsal side of the extremities, often the feet or hands. The diagnosis is confirmed by positive serum antibodies (high level of IgG, and IgM can also be present), and a positive Borrelia PCR skin test.

Publication types

  • Case Reports

MeSH terms

  • Acrodermatitis* / diagnosis
  • Acrodermatitis* / drug therapy
  • Aged
  • Escitalopram
  • Female
  • Hand
  • Humans
  • Lyme Disease* / complications
  • Lyme Disease* / diagnosis
  • Lyme Disease* / drug therapy
  • Male
  • Skin


  • Escitalopram