Acrodermatitis chronica atrophicans, (quite a mouthful huh?), or ACA, is a skin rash that is indicative of chronic Lyme. It was thought of to be an “only European” dermatological condition in relation to Lyme, but I will explain further exactly why it is very well in the United States. It can lead to widespread atrophy in the skin and can also cause many issues in the peripheral nervous system in more serious cases. ACA is the only form of Lyme in which no spontaneous remission occurs, and its pathology is not yet fully understood, according to one source.
Do you remember my feet? Dr J took a look at it and immediately knew what it was. ACA. It is also known as “the herx rash” or “herxheimer disease”, as it generally shows during or right after antibiotic treatment. In my case, as soon as I stopped antibiotics, this is what happened to my feet, with exception of the red sore on top of my foot, which happened while I was on this past month’s treatment. Let me refresh you….
It is common among your feet, lower legs, hands and forearms, although can be found on other parts of your body, generally upper arms, shoulders, and thighs. ACA generally begins with an inflammatory stage with blue or reddish discoloration, and turns to a tissue paper like texture. The skin can end up being wrinkled, dry, or translucent. Slow healing ulcerations, or scleroderma-like plaques can occur. Later on, ACA can become atrophic.
The first findings of this phenomenon begins with a physician, Alfred Buchwald of Germany, in 1883. Later, Herxhiemer and Hartmann described it in 1902 in studies related to syphilis. This skin condition is known to be from European decent, as research shows that a particular strain of the Lyme spirochete, Borrelia afzelii, which is only found in Europe, is the main known strain that can cause ACA. More strains are now being recognized to cause this skin condition.
Interesting facts of ACA:
– ACA only occurs in patients with an active infection of Lyme… if you have ACA, then you are definitely not in remission.
– ACA is considered extremely uncommon, with only about 10% of cases reported in Europe. In fact, the annual reportings of ACA in Europe per 100,000 people, were only 146 cases. An even smaller amount has been reported in the United States, predominately in the New England region.
– It is most common for people that have developed ACA to have had the following manifestations during their Lyme journey: Bells Palsy, aseptic meningitis, peripheral neuropathy, and cognitive disfunction.
– 2/3 of patients with ACA are female.
– Although the disease can occur in any age group, it is most frequently found in adults, usually in their 40’s or 50’s.
– Babesia is also known to cause this ACA rash! I am thinking since this past month was my first Babesia treatment, it just might have had something to do with it!
Prognosis? This condition can be a short term reaction when herxing or can be very long standing, from a few to several years and can eventually lead to limitation of limb and joint mobility. Once ACA gets to this stage, it is only partially reversible. Some patients with ACA on occasion develop B-cell lymphoma, basal cell and squamous carcinoma.
I was reading and did not think that it could be true that the cases of ACA are so low, since there are a lot of people suffering from chronic Lyme. The reasons that I found were very, very high amounts of misdiagnoses.
In the U.S., this condition is simply not recognized, as you know many doctors are not Lyme literate, but it is also misdiagnosed by many LLMD’s. Doctors or dermatologists are just plain not trained to know anything about ACA. Like I mentioned before, it is considered extremely rare. Many are misdiagnosed with other skin conditions such as scleroderma, loved, venous insufficiency, Reynaud’s syndrome, edema, eczema, Lupus, or even part of the aging process.
So folks, if you are in a chronic state of Lyme disease and develop a rash similar to these, you could possibly have ACA. Ask your doctor and see if they have any knowledge about this skin manifestation of Lyme. As I said before, it is highly misdiagnosed, but you can always try to educate your doctor, especially if they are a good LLMD, as the best doctors are the ones who listen! 🙂
Things to make you feel more comfortable in the meantime are Benadryl, other antihistamines, soothing creams or lotions, and ibuprofen, if it is causing you pain and discomfort. The only true fix, however, is to kill the buggers!