Chronic atrophic akrodermatit
Chronic atrophic akrodermatit – the pathological change of skin of atrophic character corresponding to the third stage of borreliosis. The first clinical symptom of pathological process is the cyanotic eritema developing against the background of unpleasant subjective feelings, insignificant morbidity of skin, artralgiya. Eventually in the field of a spot there are atrophy phenomena, the cyanotic shade of skin is replaced whitish, epidermis and shit become thinner, begin to gather easily in folds, are shelled. The diagnosis is made on the basis of the anamnesis, by the clinics given to histology, RNIF, IFA, PTsR, an immunoblotting. Treatment – antibiotic treatment, physical therapy, vitamin therapy.
Chronic atrophic akrodermatit
Chronic atrophic akrodermatit – the specific atrophic damage of skin which is distinctive feature of the third stage of infectious tick-borne borreliosis. For the first time the tick-borne infection caused by spirokhety Borrelia burgdorferi became known in 1975 when in the State of Connecticut (USA) registered and described the outbreak of this disease, however chronic atrophic akrodermatit, corresponding to the third stage of a disease, was known long before it thanks to works of the researcher Bukhvald who described displays of this pathology in 1883. In the middle of the XX century in connection with rapid development of serological diagnostics the third stage of a tick-borne infection including its skin manifestations was in detail studied. At this stage chronic atrophic akrodermatit connected with borreliosis.
Pathological process is widespread mainly in the countries of the Northern hemisphere where there are natural tanks of tick-borne encephalitis. Chronic atrophic akrodermatit more often meets at elderly women. Unlike the borreliosis having seasonality arises at all seasons of the year. Relevance of a problem at the present stage is connected with growth of incidence of borreliosis and need of confirmation of the reason of a chronic atrophic akrodermatit for the purpose of purpose of adequate and productive therapy.
Reasons of a chronic atrophic akrodermatit
The only authentically installed causative agent of a disease is the borreliya which is transferred to the person at a sting of a tick of Ixodes ricinus. Some dermatologists consider that chronic atrophic akrodermatit can develop against the background of failures of neuroendocrine system though, most likely, these system violations are the same manifestations of the third stage of a disease of Lyme, as well as itself chronic atrophic akrodermatit. Other authors carry a disease to the autoimmune pathology which arose at infection of an organism with causative agents of syphilis, tuberculosis, malaria. As triggers of pathological process sometimes consider a trauma or temperature Holodova a factor. However modern ideas of the mechanism of emergence of a chronic atrophic akrodermatit after all are connected with borreliosis.
Skin manifestations of the third stage of a disease of Lyme are a consequence of the damaging action of the circulating immune complexes (CIC). Development of a chronic atrophic akrodermatit during the two first stages of borreliosis has latent character, consists in formation and accumulation of these complexes. After a sting of a tick of a spirokhet gets to blood and a lymph, it is carried in all bodies and fabrics, occupies lymph nodes. In them the spirokheta is capable to live and breed for years. A part of the borreliya circulating in blood perishes, throwing out the endotoxin stimulating immune system in a blood-groove. There are immune reactions an anti-gene antibody which result is a formation of the circulating immune complexes which are formed after each meeting of an anti-gene with an antibody.
The CEC begin to exert negative impact on a term, breaking its morphology, changing permeability of vessels and forming inflammatory infiltrates. To the area of the formed infiltrate from blood neutrophils migrate. The live borreliya circulating in blood stimulate synthesis of interleykin that aggravates the inflammation promoting more intensive destruction of structure terms. One stage of borreliosis replaces another, new "portions" constantly are thrown out blood at this time spirokht from lymph nodes. They emit again endotoxin which stimulates formation of the circulating immune complexes. So occurs until the number of the CEC in blood does not become sufficient for hyper stimulation of an inflammation in a term, additional change of permeability of a wall of capillaries of skin with visual skin manifestations. It occurs along with transition of borreliosis to the third stage and demonstrates process synchronization.
Symptoms of a chronic atrophic akrodermatit
Distinctive feature of a chronic atrophic akrodermatit is its staging. In a clinical picture of pathological process allocate several periods. First, eritematozno-infiltrative (preatrophic) is characterized by emergence of a bright spontaneous eritema with a cyanotic shade against the background of edematous skin which diffuzno infiltrirutsya over time, creating a basis of future atrophy. Skin manifestations mainly on extremities are localized. Rashes are followed by prodromalny feelings, decrease in skin sensitivity, artralgiya, reduction of sokratitelny ability of muscles.
Then there comes the transition (progressive and atrophic) period of distribution of process with increase of the ekssudativno-inflammatory phenomena which in the subsequent gradually abate. Skin loses moisture, its elasticity is shelled, decreases. It easily gathers in folds, becomes so thin that through it begin to illuminate vessels. The third period (stationary and atrophic) is characterized by development not only skin atrophies, but also a dermatoskleroz. Skin gets a brown shade, in the centers of a chronic atrophic akrodermatit there is a diskhromiya – hypopigmentation and an apigmentation alternates with a hyperpegmentation.
Skin appendages are involved in process, secretion grease is broken and sweat glands, pushkovy hair drop out, nails are deformed. Distinctive feature of skin pathology at a chronic atrophic akrodermatit are not only rashes, but also violation of tactile sensitivity of skin with preservation of a temperature and painful component. There is also atypical option of a chronic atrophic akrodermatit with not changed skin sensitivity and an immovability terms in the chronic centers of pathology as a sklerodermiya. Sometimes at development of a disease the dense circumarticular poddermalny knots of different size with a clear boundary possessing a tendency to grouping are formed. Small knots (to 5 cm in the diameter) – flat, large (to 30 cm in the diameter) – spherical. Ability of such knots is considered as a sign of their ozlokachestvleniye. Most often formation of knots is combined with pathology of joints.
Diagnostics and treatment of a chronic atrophic akrodermatit
The clinical diagnosis is exposed by the dermatologist and the infectiologist. The bases for diagnosis are the anamnesis, a clinical picture and serological tests. The histology is connected for differentiation of pathological process. Consultations of narrow experts are necessary for an exception of system pathology. RNIF (reaction of indirect immunofluorescence) use for definition of a caption of borreliozny antibodies. IFA (the immunofermental analysis) allows to establish existence of borreliya in the patient's blood. PTsR and an immunoblotting give the chance to count exact quantity of borreliya in blood unit of volume. Differentiate chronic atrophic akrodermatit with other kinds of an atrophy and a sklerodermiya.
Efficiency of therapy depends on a stage of pathological process and timeliness of the begun treatment. Therapy of a chronic atrophic akrodermatit pathogenetic, is carried out by courses of antibiotics which total dose calculates taking into account results of serological testing and weight of patients. At the same time apply vitamin therapy and medicines of iron. If somatic pathology is revealed, carry out its correction. At a chronic atrophic akrodermatit physiotherapy is effective: Ural federal district, , galvanization, UVCh, a diathermy, hydrosulphuric heat mineral baths, mud wrappings, applications with ozokerite, paraffin, massage. The ointments containing vitamins and vazoaktivny medicines are outwardly shown. After consultation with the surgeon perhaps surgical removal of hypodermic knots. The forecast at adequate treatment favorable.