Acrodermatitis chronica atrophicans: a case report and review of the literature.

Acrodermatitis chronica atrophicans (ACA) is a rare tertiary manifestation of Lyme borreliosis, manifesting as inflammatory and atrophic lesions on acral skin. Although ACA rarely has been reported in the United States, it may be seen in approximately 10% of European cases of Lyme borreliosis, most commonly associated with the genospecies Borrelia afzelii. We report a presumptive case of ACA involving an American woman from Pennsylvania with convincing clinical, histopathologic, and serologic findings. We also provide an overview of the history, epidemiology, pathogenesis, clinical and histopathologic presentation, and treatment of ACA.