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PubMed1985

Erythema chronicum migrans Afzelius and acrodermatitis chronica atrophicans. Early and late manifestations of Ixodes ricinus-borne Borrelia spirochetes.

In the present thesis consecutive patients, 231 with ECMA, 41 with ACA and 20 with facial palsy (Bell's palsy), have been studied. It has been shown that spirochetes, transmitted by the tick Ixodes ricinus, are involved in the etiology of ECMA and ACA. This has been shown through the isolation and cultivation of spirochetes from ticks and from the skin of patients with ECMA and ACA. The spirochetes have morphological characteristics similar to those of the genus Borrelia. No antigenic differences have been found between ECMA and ACA strains by the use of four different monoclonal antibodies against Borrelia burgdorferi. In serological studies, with the indirect IF test and with the ELISA, elevated antibody titers against these spirochetes were found in sera from patients with ECMA and ACA. Significantly increasing titers were found in sera from patients who developed extracutaneous complications and decreasing titers as a response to therapy. The serological tests are of good diagnostic help for patients with ACA and in many of the patients with ECMA-related extracutaneous complications, but in the present study only 15-28% of the patients with uncomplicated ECMA were seropositive. The study has shown that a tick bite and/or an untreated ECMA may be followed by symptoms from the nervous system (facial palsy, meningoradiculitis), the joints and from the heart as well. It has also been shown that ACA may sometimes be preceded by an untreated ECMA and that manifestations from the nervous system and/or the joints may precede or accompany ACA. There may be a long period of latency (several years) between a spontaneously healing ECMA and the development of ACA lesions. In ACA patients with abnormalities of joints or bones the concordance in site of the cutaneous involvement and changes in the underlying joints or bones may in these cases be consistent with a progressive localized spirochetal infection. Lichen sclerosus et atrophicus-like lesions found in patients with ACA indicate that a Borrelia infection may result in lichen sclerosus et atrophicus-like reactions. The recognition of ACA may be difficult and a combination of clinical, histopathological and serological findings may be necessary to secure the diagnosis. Clinical differences between ECMA-related disorders in Sweden an Lyme disease in the United States have been found and there may also be antigenic differences between the spirochetes involved.(ABSTRACT TRUNCATED AT 400 WORDS)

Acrodermatitis↗
PubMed1979

[Positive side-effects of antibiotic and antimicrobial drugs in therapy (author's transl)].

Since about 1950 especially, dermatologists world-wide have been utilizing the positive side-effects, discovered by chance, of all groups of antibiotic and antimicrobial drugs. These drugs are used to treat certain non-microbially induced dermatoses, without any knowledge of the mechanisms involved. A short history is given and the most important drugs and the indications for their use are described. The following drugs are undoubtedly effective and sometimes even the therapy of choice: tetracyclines in acne vulgaris and rosacea (including rosacea keratitis); penicillin G in acrodermatitis atrophicans and cold urticaria; dapsone in dermatitis herpetiformis and - as a powerful adjuvant - in acne vulgaris and rosacea. Before the discovery of the socalled immunodepressive drugs, tetracycline was the only alternative to - or at least a highly effective adjuvant of - cortisone in dermatomyositis and chloroquine in localised and systemic lupus erythematosus. Finally, clioquinole was life-saving in acrodermatitis continua in children until this condition was recently identified as a zinc-deficiency syndrome. Therapeutical mechanisms have been found only in the case of acne, rosacea and dermatitis herpetiformis. In most other diseases the nature of the therapeutical effectiveness of antibiotic and antimicrobial drugs still remains a mystery.

Acne Vulgaris↗
PubMed1984

[Lyme disease--another tick-borne disease in Austria].

Infection with tick-borne spirochetes (e.g. Borrelia burgdorferi) may lead to the development of erythema chronicum migrans, acrodermatitis atrophicans, meningopolyneuritis Bannwarth, and a special type of reactive arthritis named Lyme disease after the American endemic area. Since these diseases occur also in Austria, their clinical features are described in this review; a clear distinction must be made between the neurological manifestation of Lyme disease and those of tick-bite mediated early summer meningoencephalitis. Serological tests can prove that an infection with Borrelia burgdorferi has occurred. The treatment of choice is tetracyclines in the early stages of the disease.

Acrodermatitis↗