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Acrodermatitis chronica atrophicans

Acrodermatitis chronica atrophicans (ACA) or Herxheimer disease (according to its discoverer Karl Herxheimer) is one of the possible long-term consequences of a tick bite or a Lyme disease infection and describes progressive damage (lesions) to the skin, which can even lead to the death of tissue with others Consequential complaints are enough.

Acrodermatitis - symptoms

Acrodermatitis is a late skin manifestation of Lyme disease and is most common in women over 40 years of age. Up to three percent of all people infected with Lyme disease in Germany develop Acrodermatitis chronica atrophicans as a late consequence. The skin damage occurs several years after the initial infection and mostly the extended side of a leg or arm is affected first. The first symptoms can also be seen on the outside of the hand and the top of the foot. In the further course, other parts of the body such as the soles of the feet and very rarely also the trunk or face can be affected.

The first signs of acrodermatitis are slight bluish-reddish discoloration of the skin and edematous swelling with accompanying inflammation. In the further course of the so-called plasma-cellular skin inflammation, the skin is increasingly damaged superficially but also subcutaneously (for example in subcutaneous fatty tissue), which results in tissue loss (atrophy) with degeneration of the sweat glands and hair follicles and a decrease in collagen and elastic fibers. Also noticeable are so-called ulnar stripes (strip-like reddening on the forearm) or the thickening of the Achilles tendon or widening of the heel on the lower leg. The formation of nodules and hardening can also be noticed from time to time, and over time the loss of connective tissue creates a so-called “parchment skin” (lack of elasticity; extremely thin).

About two thirds of those affected also develop peripheral neuropathy in the corresponding extremity, which manifests itself as numbness or tingling in the limbs. There is also an accompanying Lyme arthritis with symptoms such as joint pain or swelling in the area of ​​the joints.

Diagnosis of acrodermatitis

If you suspect acrodermatitis, the medical diagnosis is relatively reliable. However, a connection must first be established between the skin complaints and a possible Lyme disease, which can be difficult in practice and can lead to considerable delays in the diagnosis. The diagnosis is usually made by detecting the pathogen, with blood tests for antibodies against Lyme disease playing a particularly important role. Tissue samples from the skin can also be used for histological examinations to confirm the diagnosis.

Acrodermatitis treatment

Antibiotics are the means of choice for the late effects of Lyme disease in order to eliminate the pathogens and thus relieve the symptoms. In the case of acrodermatitis without neurological involvement, for example, doxycycline therapy over 30 days can be used, and with additional neurological symptoms, intravenous therapy with ceftriaxone is possible. The exact steps of the therapy must be selected by your doctor or your doctor depending on the extent of the symptoms. (fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters


  • Elfie Fust, tick bites: clinical pictures and treatment options; Basics and Practice; Edition: 2nd, adult (July 8, 2009)
  • Gary P. Wormser: Lyme Disease; in Goldman's Cecil Medicine (Twenty Fourth Edition), Volume 2, 2012, pages 1930-1935; (2012)
  • L.H. Sigal: Lyme borreliosis; in Reference Module in Biomedical Sciences, Elsevier (2014),
  • German Dermatological Society: Cutaneous Manifestations of Lyme Disease; in the guideline of the German Dermatological Society Working Group for Dermatological Infectiology (accessed 08.09.2019),

ICD codes for this disease: L90.4ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

Video: Acrodermatitis enteropathica - Medical Definition (July 2022).


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