Author/Editor		Strle, Franc
Title		Acrodermatitis chronica atrophicans
Translated title		Acrodermatitis chronica atrophicans
Type		članek
Source		Med Razgl
Vol. and No.		Letnik 38, št. Suppl 1
Publication year		1999
Volume		str. 85-91
Language		slo
Abstract		Acrodermatitis chronica atrophicans is a relatively frequent sign of late Lyme borreliosis, often causing diagnostic difficulties. It affects predominately older people, especially women over 50 years of age, and in contrast to erythema migrans and borrelial lymphocytoma does not disappear spontaneously. It is usually caused by Borrelia afzelii. Pathogenesis has not been well delineated. The first clinical signs appear months to years after the inoculation of borreliae in the organism, however in some patients acrodermatitis chronica atrophicans is preceded by other manifestations of Lyme borreliosis. The onset is as a rule slow, hardly appreciated: bluish-red slowly expanding skin lesion appears, usually on the dorsal part of a hand, foot or in the region of knee. At the beginning it is as a rule unilateral, later it may become more or less symmetric. During the initial months or years the involved skin is oedematous but later on the affected areas gradually become atrophic with thin, wrinkled skin and prominent blood vessels. Sometimes sclerotic lesions and/or fibrotic bands or nodules develop. Peripheral neuropathy and joint involvement, usually located underneath skin lesions, are present in up to one half and one third of patients, respectively. THe diagnosis of acrodermatitis chronica atrophicans is based on clinical and serologic criteria (high titres of borrelial IgG antibody are regularly present); histological examination serves a confirmatory purpose. Treatment with antibiotics is successful particularly in the early (oedematous) phase of the illness.
Summary		Acrodermatitis chronica atrophicans je razmeroma pogost pozni znak lymske borelioze, ki praviloma povzroča mnogo diagnostičnih težav. Prizadene pretežno starejše ljudi, predvsem ženske po 50. letu sarosi, in nasprotju z erythema migrans in borelijskim limfocitomom ne izgine samodejno. Najbolj pogost povzročitelj je Borrelia afzelii. Patogeneza je slabo pojasnjena. prve spremembe se pojavilo mesece do leta po vnosu borelij v organizem. nekateri bolniki imajo pred pojavom acrodermatitis chronica atrophicans druge znake lymske borelioze, drugi pa ne. Začetek jeobičajno postopen, komaj zaznaven; pojavi se rdečemodrikasto obarvana koža (največkrat na hrbtišču ene od rok, na hrbtni strani stopala ali v predelu kolena), ki se zelo počasi širi. Sprva je praviloma enostranska, kasneje lahko bolj ali manj simetrična. prve mesece do leta je prizadeti predel običajno otekel. Kasneje začne oteklina izginjati, vse bolj pa stopa v ospredje atrofija. Koža postaja vse tanjša, se guba, skoznjo prosevajo žile. Včasih se pridužijo tudi sklerotične spremembe in/ali fibrozne zadebelitve v obliki trakov ali vozličev. V predelih s prizadeto kožo so pri približno tretjini bolnikov prizadeti sklepi in pri do polovici periferno živčevje. Za diagnozo acrodermatitis chronica atrophicans je treba klinični sum potrditi s prisotnosjo borelijskih protiteles (titri IgG-protitles so praviloma zeli vosoki). Potreben je tudi histološki pregled kože. Zdravljenje z antibiotoki je uspešno predvsem v zgodnjem )edematoznem) obdobju bolezni.
Descriptors		LYME DISEASE ACRODERMATITIS