Acrodermatitis chronica atrophicans history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2] Raviteja Guddeti, M.B.B.S. [3]

History of tick bite, erythema migrans or other symptoms of lyme disease, and rheumatological symptoms have been presented in patients with acrodermatitis chronica atrophicans. Since there could be several years between the tick bite and development of skin lesions, absence of tick bite in patients‘ history never exclude the diagnosis. Symptoms and different forms of skin involvement in acrodermatitis chronica atrophicans are dependent to duration of the disease. Symptoms, such as sclerotic skin changes, pain and burning, edema and constitutional symptoms have been observed in acrodermatitis chronica atrophicans. Half of patients with acrodermatitis chronica atrophicans experience symptoms of peripheral neuropathy, such as paresthesia and hypesthesia. Symptoms of peripheral neuropathy can occure at the exact site of acrodermatitis chronica atrophicans‘s lesion or at other sites. Involvement of lower limb is more common compared to the upper limb. In some cases episodic knee joint effusion has been observed.

The following are some of the common findings in patients‘ history:^[1][2][3][4]

• Tick bite
  • Since there could be several years between the tick bite and development of skin lesions, absence of tick bite in patients‘ history never exclude the diagnosis.
  • Based on a study done on 693 patients with acrodermatitis chronica atrophicans approximately 85% remembered a tick bite.
• Erythema migrans
  • Some of the patients in a study experienced erythema migrans 6 months to 8 years before acrodermatitis chronica atrophicansis development.
• Neurological symptoms
• Rheumatological symptoms

• Symptoms and different forms of skin involvement in acrodermatitis chronica atrophicans are dependent to duration of the disease.^[3]
• It usually involves extensor surfaces of the acral regions of limbs beginning with an inflammatory stage (bluish red discoloration and edema followed by an atrophic phase).
• Sclerotic skin plaques may also develop.
• Acrodermatitis chronica atrophicans can progress and cause wrinkle.
• The following are symptoms have been observed in acrodermatitis chronica atrophicans:^{[1][3][5][6][7]}
  • Sclerotic skin lesions
  • Pain and burning
  • Edema
  • Wrinkles
  • Peripheral neuropathy (develop in half of patients)
    • Such as paresthesia and hypesthesia
    • Some patients develop symptoms related to peripheral neuropathy at the exact site of acrodermatitis chronica atrophicans‘s lesion, nevertheless there are other patients that experienced these symptoms at other sites.
    • Most of the times it presents as asymmetric distal sensory disturbance, which could be painful or painless.
  • Arthropathy
  • Constitutional symptoms (such as fever and fatigue)
  • Joint deformities
  • Band-like induration on extremities
• Based on a study done on 693 patients suffering from acrodermatitis chronica atrophicans:^[3]
  • Involvement of lower limb (70%) has been more common compared to upper limb (45.2%).
  • In 42.4% of cases acral involvement occurred bilaterally.
  • Only 2 among 693 patients had skin involvement on areas other than extremities.
  • Less than 3% of studied patients had symptoms such as nodule, arthritis, itching, muscle atrophy, joint deformities and paresis.
  • Small fraction of patients didn’t experience any skin discoloration and their main presentations were edema and atrophic changes.
• In some cases episodic knee joint effusion has been observed.^[7]
• In some cases symptoms such as personality changes have been reported due to involvement of central nervous system.^[7]

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