Acrodermatitis chronica atrophicans

The acrodermatitis chronica atrophicans Herxheimer is a chronic progressive disease of the dermatological model of the third stage ( final stage ) of Lyme disease.

In the ICD -10 it is classified as L90.4 under " Atrophic skin diseases." It was named after Karl Herxheimer (1861-1942), a German dermatologist.

Synonyms

  • Herxheimer disease
  • Acrodermatitis chronica atrophicans
  • Dermatitis atrophicans chronica progressiva
  • Atrophy of the cutis idiopathic
  • Herxheimer 's disease (English )

Epidemiology

The disease occurs mainly in Europe but also in the U.S. and in Asia, and usually affects people in the young to middle adulthood and older women. In Europe and Asia the disease is also associated with Borrelia afzelii.

Symptoms

Months to years (weeks to decades) after the initial infection with the pathogen Borrelia burgdorferi - to the responsible tick bite thus remember a few patients - usually develops first on one of the legs ( the extensor surface of the distal extremities) an edematous, dunkellivide ( ie. bluish dark ) swelling of the skin that causes little discomfort. This infiltrative stage is replaced by months by a progressive decrease ( atrophy) of the subcutaneous adipose tissue ( subcutis ) and a decrease in skin thickness, so that the skin vessels durchzuschimmern begin. In addition, the skin over the joints can thicken fibromatous, therefore increase the fiber content of the connective tissue of the skin.

Associated symptoms are in many cases oligoarthritis ( monoarthritis ) of large joints (or a large joint, often the knee ); involvement of the nerves ( radiculoneuritis, axonal polyneuropathy, as a complication applies the emergence of a tertiary neuroborreliosis ).

Differential Diagnosis

  • Erysipelas Erysipeloid, erysipelas Carcinomatosum
  • Lymphoplasmozytoides immunocytoma
  • Acrocyanosis
  • Erythromelalgia
  • Eosinophilic Fasciitis
  • Linear morphea, Disseminated circumscribed scleroderma, progressive systemic sclerosis ( scleroderma see )
  • Scleroedema adultorum Buschke
  • Kortikoidwirkung
  • Cutis marmorata (marble skin)
  • Telangiectasia

Regarding the joint symptoms should be given to a

  • Gouty arthritis
  • Juvenile rheumatoid arthritis

Treatment

High doses of antibiotics (penicillin, cefotaxime ) as an infusion or oral antibiotics, such as tetracycline. In the atrophic stage, the disease is, however, as it " burned out " and no longer treatable with medication.

Treatment of the accompanying symptom arthritis: NSAIDs, corticosteroids only after pretreatment with antibiotics, synovectomy

Dermatology Erysipeloid of Rosenbach
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