Clinical features and specific immunological response to Borrelia afzelii in patients with acrodermatitis chronica atrophicans.

Acrodermatitis chronica atrophicans (ACA) occurs mostly in Europe. Borrelia afzelii is considered to be responsible for this manifestation of Lyme borreliosis. The aim of the study was to observe the clinical features of the ACA and evaluate the specific immunological response to Borrelia afzelii. Nine patients from an endemic Lyme borreliosis region in northeastern Poland were studied. The serum samples were tested routinely with IFA and EIA and, following testing, with immunoblots using Borrelia afzelii antigens. ACA was located mainly on the skin of the arms, forearms, thighs and chest. The only extracutaneal manifestation of Lyme borreliosis was paresis of the brachial plexus observed in one patient. Analysis of the immunoblot-banding pattern revealed positive reactions in all patients against flagellar antigen (41 kDa). Interpretation of the immunoblots revealed positive IgG results in all cases and IgM in five of them. Concluding, ACA develops not only on the extremities, but also on the trunk. The immunoblot technique using Borrelia afzelii antigens is of value in the diagnosis of ACA.