Acrodermatitis Chronic Atrophicans: A Chronic T-cell-mediated Immune Reaction Against Borrelia Burgdorferi? Clinical, Histologic, and Immunohistochemical Study of Five Cases

J Am Acad Dermatol. 1993 Mar;28(3):399-405. doi: 10.1016/0190-9622(93)70058-2.


Background: Acrodermatitis chronica atrophicans (ACA) is a late manifestation of infection caused by Borrelia burgdorferi.

Objective: Our purpose was to study the clinical, histopathologic, and immunohistochemical findings in patients with ACA to understand better the pathogenesis of the disease.

Methods: Five patients were studied. Skin biopsy specimens were obtained from active lesions for histologic and immunohistochemical studies.

Results: Clinical lesions included an initial erythematous discoloration in one patient and violaceous infiltrated plaques and nodules in four patients, three of whom also had late atrophic lesions. Biopsy specimens showed a dermal perivascular and interstitial lymphocytic infiltrate with plasma cells. There was a predominance of CD3+, CD4+ T cells in the dermal infiltrate. B cells were present in three patients. The dermal infiltrate showed an intense expression of lymphocyte function-associated antigen. The intercellular adhesion molecule type 1 was expressed on endothelial cells, perivascular mononuclear cells, and focally on basal keratinocytes.

Conclusion: Our findings suggest that a chronic, T-cell-mediated immune reaction against B. burgdorferi is involved in the pathogenesis of ACA.

MeSH terms

  • Acrodermatitis / immunology*
  • Acrodermatitis / microbiology
  • Acrodermatitis / pathology
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Bacterial / analysis
  • Antigens, CD / analysis
  • Atrophy
  • Borrelia burgdorferi Group / immunology*
  • Cell Adhesion Molecules / analysis
  • Chronic Disease
  • Female
  • HLA-DR Antigens / analysis
  • Humans
  • Immunity, Cellular
  • Immunohistochemistry
  • Intercellular Adhesion Molecule-1
  • Keratinocytes / immunology
  • Langerhans Cells / immunology
  • Lyme Disease / complications
  • Male
  • Middle Aged
  • Skin / immunology
  • Skin / pathology
  • T-Lymphocytes / immunology*


  • Antibodies, Bacterial
  • Antigens, CD
  • Cell Adhesion Molecules
  • HLA-DR Antigens
  • Intercellular Adhesion Molecule-1