SUCCESS AND FAILURE IN THE TREATMENT OF ACRODERMATITIS CHRONICA ATROPHICANS

To determine the most effective treatment for acrodermatitis chronica atrophicans, several clinical trials were undertaken in recent years t o evaluate whether a 2-week course of ceftriaxone would be superior to oral antibiotics. Of the 46 patients suffering from acrodermatitis ch ronica atrophicans, 14 were treated with ceftriaxone 2g for 15 days. T he remaining patients received either oral penicillin V 1.5 million IU t,i,d, or doxycycline 100 mg b,i,d, for 20 to 30 days. Patients were followed up for at least 1 year. Of the 14 ceftriaxone-treated patient s four showed incomplete regression of the inflammatory skin changes a fter 6 to 12 months, Two out of five patients who were monitored for B orrelia burgdorferi DNA excretion were still positive after 12 months as compared to none of six patients who were treated orally for 20-30 days. Six out of 11 patients treated orally for only 20 days needed re treatment after 6 months because of continuing skin manifestations, ne uropathy or arthralgia. A 30-day duration of treatment with oral antib iotics and not the chosen antibiotic is crucial for curing acrodermati tis chronica atrophicans. The duration of treatment with ceftriaxone n eeded for eradication of Borrelia in acrodermatitis chronica atrophica ns has yet to be determined in future studies.