Late cutaneous lyme disease: Acrodermatitis chronica atrophicans

Abstract

Acrodermatitis chronica atrophicans (ACA) is a chronic skin disorder characterized in its initial stages by an edematous infiltration that progresses to an atrophic lesion resembling localized scleroderma in its more established form [l]. It has been recognized more commonly in Europe than in the United States for many years and is known to be linked epidemiologically with the tick Zxodes ricinus and the skin lesion erythema chronicum migrans [2,3]. Recent serologic studies from Sweden have demonstrated an association between ACA and the presence of antibodies against the Lyme disease spirochete Borrelia burgdorferi [3,43. This entity is seldom recognized in North America and there has been only one report of ACA as a late manifestation of Lyme disease in the United States [5]. We describe herein two patients who presented with ACA as their principal manifestation of B. burgdorferi infection in an endemic region of Lyme disease on eastern Long Island, New York. These patients represent the first reported cases of Lyme disease presenting with ACA in North America.