ACRODERMATITIS CHRONICA ATROPHICANS - A CASE-REPORT AND REVIEW OF THELITERATURE

We report a 55-year-old woman with acrodermatitis chronica atrophicans (ACA) and a peripheral sensory neuropathy. ACA is an uncommon late cu taneous manifestation of Lyme disease, which follows disseminated Borr elia burgdorferi infection. This is the second published case from the U.K. since serological diagnosis has been available. In this patient the diagnosis was confirmed by serology using a sensitive enzyme-linke d immunosorbent assay and immunoblotting techniques. B. burgdorferi DN A was demonstrated in the affected skin using the polymerase chain rea ction, although staining and cultures for the organism were negative. Recommended treatment of ACA is with oral doxycycline 100 mg twice dai ly for 28 days, but our patient did not respond well to this regimen. She was therefore treated with ceftriaxone intravenously for 21 days, which resulted in a rapid symptomatic and clinical response.