Atrophic Acrodermatitis Chronic - Causes, Symptoms, Treatment
- 25 Jun 12:30
- Disease Of The Skin
Chronic atrophic acrodermmatitis( in the literature, this disease is often referred to as the acronym HAD) is a late stage of Lyme's disease, characterized by skin lesions, with the formation of atrophy sites.
Chronic acrodermatitis has been studied long before the discovery and description ofLyme disease, which is provoked by tick bites and insect bites. Symptoms and the course of HAD have been described more than hundred years ago. The first known description of HAD is the work of the researcher Buchwald, published in 1883.
The chronic course of acrodermmatitis often affects the elderly, mostly women.
- 1 Causes of development of
- 2 Clinical picture of
- 3 Diagnosis of
- 4 Treatment of
- 5 Forecast and prevention of
Causes of development of
The researchers failed to determine with certainty the causes of HAD development. At present, the theory that acrodermatitis has an infectious nature appears to be most likely. The link between the development of HAD and the bite of the tick species Ixodes ricinus is admissible.
However, other reasons for the development of HAD are not excluded. It is possible that acrodermatitis develops on the background of lesions of the endocrine and nervous systems. There is a theory that the cause of the autointoxication of the body, caused by infection with syphilis, malaria, tuberculosis. The impact of injuries, overcooling and other factors can not be ruled out.
Clinical picture of
A chronic acrodermathetious disease lasts throughout the course of the disease that distinguishes three stages and several substates.
Period of initial atrophy, which, in turn, distinguishes:
- Erythematous stage;
- Infiltration-edema stage.
Progression period, subdivided into:
- Infiltration-Atrophic stage;
- The stage of occurrence of dermatosclerosis phenomena.
Period of residual events, in which there are phenomena of atrophy, dermatosclerosis, changes in pigmentation.
The majority of patients with the onset of HAD have general symptoms:
- Reduced skin sensitivity;
- Appearance of pain or cry on areas of the body, which subsequently appear eruptions.
Rash are localized at HAD, most often on the limbs skin - in the joints, on the skin of the hands. As the HAD develops, rash areas can expand, often capturing the entire surface of the skin of the legs and arms. The skin on the trunk is rarely affected, and even less often, with the HAD, the skin of the face and the buttocks is drawn into the process. In a small number of patients, acrodermmatitis extends to the skin of palms and soles.
Acrodermatitis cells are usually formed suddenly. A limited or diffuse hyperemia develops, which at the initial stage is red, and later becomes cyanotic or brown.
The skin in the lesions of the lumbar region is swollen, with the formation of areas of dense infiltration.
After several weeks, the inflammatory phenomena in the skin subsided, gradually undergo exudative phenomena, regress infiltration. HAD goes into the atrophy stage.
At this stage of acrodermathetic development, the skin becomes dry, loses its normal elasticity, thins, and wrinkles. Through thin skin it is clearly visible a network of vessels, sometimes even tendons appear. Often on the skin formed telangiectasia, zones with impaired pigmentation.
In many cases, dyskromias of the skin develops under HAD.In this case, areas of diffuse or spotted pigmentation that alternate with areas of hypo-pigmentation and areas of fully depigmented skin are formed.
As the HAD develops, disorders of the functioning of the secretory function are becoming more and more apparent. First of all, sharply decreases, and often completely ceases the development of sebum. In many patients, the sweat separation is greatly reduced. At the initial stages of HAD in the process, the muscles of the skin are detected, which is manifested mainly in reducing their ability to contract.
At the same time as skin lesions at HAD, cannon hair and nails are affected. The hair thins, loses its color and falls out. Nails thicken or vice versa, become very thin.
At HAD there are significant impairments in the sensitivity of the skin, and the tactile sensitivity is reduced, and pain and temperature sensitivity, on the contrary, increases.
Subjective sensations in HAD are diverse. Patients often complain of itching, a feeling of heat in the affected area, on various paresthesias. However, in some patients there are no subjective complaints, nor a violation of sensitivity.
Less commonly observed is the atypical course of HAD, in which the property of the skin is marked, which is expressed in conjugation with the subordinate tissues, and its excessive tension. The coloration of the skin under the unusual course of HAD may be unusual - white with a yellow tinge or brown.
In some patients with HAD, the formation of subcutaneous nodes, which are localized in the region of the knees or elbows, is observed. Rarely formed nodes on the skin of the hands or feet. The number of nodes in HAD varies widely, individual education may develop, but often there are multiple nodes arranged in groups.
Hedge assemblies have very dense consistency, sharp boundaries and rounded outlines. The magnitude ranges from 5 to 30 mm. Moreover, small nodes, as a rule, are flat, and large ones have a semi-spherical shape.
Acrodermatitis is sometimes accompanied by the formation of chronic ulcers. Often ulcers are formed after injury to the skin. Ulcers differ in the stability of the current and are extremely poorly treated. Some patients had malignancy of the ulcers with transformations in the basal, or carcinoma. There is information about the occurrence of acrodermatitis in patients with sarcomas, located outside the foci of HAD.
When diagnosing, it is necessary to take into account the clinical and histological picture. When studying a specimen of tissues with HAD, the picture depends on the stage of the disease.
At the first stage, there are phenomena of atrophy of the epidermis, the presence of pareceratosis, diffuse infiltration in the papillary layer. At the last stages of acrodermatitis, atrophy of all layers of the skin, including the sweat and sebaceous glands, is detected. Elastic fibers are completely absent.
In the initial stage of acrodermatitis, treatment with penicillin or other antibiotics( tetracycline, chloromycetin, etc.) is effective. In addition to antibiotics, patients with HAD prescribe vitamin therapy, iron supplements.
In the event that the HAD develops against an abnormality of the functioning of the endocrine glands or nervous system, appropriate corrective treatment is prescribed.
Patients with acrodermatitis are prescribed physiotherapy:
- UHF therapy;
It is recommended to have a spa treatment - sulfur, mud baths, wraps. Locally conducted ozokerite or paraffin wraps.
Patients with HAD are important to carefully protect the skin from injury and overcooling, as with negative effects on the affected skin formed badly healing ulcers.
Forecast and prevention of
The primary prophylaxis of HAD development has not been developed, since the causes that cause this illness are not clear. Secondary prophylaxis is to exclude the trauma of a sick skin.
Forecast for life is favorable. The success of treatment depends on the stage in which the therapy is started.