eMedicine Specialties > Dermatology > Bacterial Infections

Acrodermatitis Chronica Atrophicans: Treatment & Medication

Author: Bozena Chodynicka, MD, Head, Professor, Department of Dermatology and Venereology, Medical University of Bialystok, Poland
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School; Iwona Flisiak, assistant, MD, Department of Dermatology and Venereology, Medical University of Bialystok, Poland
Contributor Information and Disclosures

Updated: Mar 23, 2009

Treatment

Medical Care

The choice of treatment depends on the coexistence of other signs or symptoms of Lyme borreliosis with acrodermatitis chronica atrophicans. The authors also consider the value of the titer of serologic tests.

  • If the extracutaneous Lyme borreliosis signs are absent and the level of specific antibodies is low, the authors usually recommend oral doxycycline or oral amoxicillin, over 3 weeks.
  • If organic or systemic physical or laboratory signs of Lyme borreliosis are present or if the antibody titer is high, the appropriate treatment should be introduced mainly with ceftriaxone or cefotaxime or aqueous penicillin G given intravenously for 21-28 days.

Consultations

Seek the appropriate consultations (ie, neurologist, ophthalmologist, rheumatologist, cardiologist) if extracutaneous signs and symptoms exist.

Medication

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of this clinical setting.


Amoxicillin (Amoxil, Trimox)

Bactericidal against Borrelia species. Semisynthetic penicillin of aminopenicillins group demonstrating wide spectrum of bactericidal activity related to gram-positive and gram-negative bacteria. Mechanism of action involves bacterial cell wall synthesis inhibition.

Adult

500 mg PO q6h or 1000 mg PO q12h for 21-28 d

Pediatric

2-3 years: 40-60 mg/kg/d PO bid/tid
>4 years: 375-750 mg/d PO tid

Neomycin decreases its absorption; allopurinol increases rash development; reduces efficacy of oral contraceptives

Documented hypersensitivity; infectious mononucleosis; lymphatic leukemia

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment; may cause dyspepsia or rash


Doxycycline (Vibramycin)

Tetracycline antibiotic that inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Used for antibacterial and anti-inflammatory effect and for concern about possible coexistent infection.

Adult

100-200 mg PO qd for 21-28 d

Pediatric

<8 years: Not recommended
>8 years: Administer as in adults

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines


Ceftriaxone (Rocephin)

Bactericidal against Borrelia species. Third-generation cephalosporin with broad-spectrum, gram-negative activity. Lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Adult

2 g IV q24h for 14-21 d
1-2 g IV/IM q12-24h

Pediatric

50-100 mg/kg IV/IM; not to exceed 4 g/d

High doses of probenecid may increase clearance by blocking biliary secretion and displacement of ceftriaxone; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment; caution in women who are breastfeeding and allergy to penicillin; caution in children who are hyperbilirubinemic because of its ability to displace bilirubin; adverse effects include headaches, dizziness, pseudomembranous colitis, nausea, vomiting, and diarrhea


Cefotaxime (Claforan)

Third-generation of semisynthetic cephalosporin with board-spectrum bactericidal activity against gram-negative bacteria and Staphylococcus and Streptococcus species. Resistant to beta-lactamases. Mechanism of action is related to inhibition of bacteria cellular wall component synthesis.

Adult

1-2 g IV q8h for 14-21d

Pediatric

<12 years: 50-100 mg/kg/d IV tid
>12 years: Administer as in adults

Synergic with aminoglycosides, vancomycin, and anticoagulants; may cause false-positive Coombs reaction

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

May cause hypersensitivity reaction, headaches, dizziness, pseudomembranous colitis, nausea, and vomiting; neutropenia and biochemical signs of liver injury are seldom


Penicillin G (Pfizerpen)

Beta-lactam antibiotic. The mechanism of action is related to bacterial cell wall synthesis inhibition in the growth phase as a result of penicillin and bacterial transpeptidase binding.

Adult

4.5-6 million U IV q6h or 3-4 million U IV q4h (18-24 million U/d) for 21 d

Pediatric

50,000-80,000 U/kg/d IV divided q6h

Probenecid and NSAIDs increase blood concentration and extend time of action; penicillin benzathine demonstrates in vivo synergism with aminoglycoside antibiotics, but, in vitro, it causes their inactivation; not to be administered in the same syringe with vancomycin, cephalothin, amphotericin B, or metronidazole; antagonism toward tetracycline, chloramphenicol, and mucolytic drugs; high doses given with digoxin increase toxicity; combination with beta-adrenergic blocking drugs increases risk of anaphylaxis

Documented hypersensitivity; caution in patients with bronchial asthma, renal insufficiency, or circulatory insufficiency; caution in those receiving potassium and diuretics

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Not contraindicated in pregnancy but can lead to fetal hypersensitization, particularly in the second or third trimester; can induce anaphylactic shock, hypersensitivity reactions, arthralgia, fever, eosinophilia, lymphadenopathy, and kidney interstitial inflammation; high doses can lead to hemolytic anemia, leukopenia, and electrolytic disturbances; neurotoxicity; can induce Jarisch-Herxheimer reaction in patients with spirochetosis

More on Acrodermatitis Chronica Atrophicans

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Differential Diagnoses & Workup: Acrodermatitis Chronica Atrophicans
Treatment & Medication: Acrodermatitis Chronica Atrophicans
Follow-up: Acrodermatitis Chronica Atrophicans
Multimedia: Acrodermatitis Chronica Atrophicans
References
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Further Reading

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Keywords

acrodermatitis chronica atrophicans, Herxheimer disease, ACA, European Lyme borreliosis, LB, Lyme disease, borreliosis, Borrelia afzelii, B afzelii, Borrelia garinii, B garinii, Borrelia burgdorferi, B burgdorferi, Ixodes ricinus, I ricinus, Ixodes hexagonus, I hexagonus, Ixodes persulcatus, I persulcatus, Ixodes scapularis, I scapularis, Ixodes pacificus, I pacificus, cutaneous atrophy, erythema migrans, EM, tick bite, tick vector

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Contributor Information and Disclosures

Author

Bozena Chodynicka, MD, Head, Professor, Department of Dermatology and Venereology, Medical University of Bialystok, Poland
Bozena Chodynicka, MD is a member of the following medical societies: Central Neuropsychiatric Association
Disclosure: Nothing to disclose.

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Iwona Flisiak, assistant, MD, Department of Dermatology and Venereology, Medical University of Bialystok, Poland
Disclosure: Nothing to disclose.

Medical Editor

Peter Fritsch, MD, Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria
Peter Fritsch, MD is a member of the following medical societies: American Dermatological Association, International Society of Pediatric Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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