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The course of ACA is long-standing, from a few to several years, and it leads to extensive atrophy of the skin and, in some patients, to the limitation of upper and lower limb joint mobility.The outlook is good if the acute inflammatory stage of ACA is treated adequately. The therapeutic outcome is difficult to assess in patients with the chronic atrophic phase, in which many changes are only partially reversible.
Physicians should use serologic and histologic examination to confirm the diagnosis of ACA. Treatment consists of antibiotics including doxycycline and penicillin for up to four weeks in the acute case.
The diagnosis of an individual with acrodermatitis enteropathica includes each of the following:
- Plasma zinc level (lab)
- Light microscopy (skin biopsy)
- Electron microscopy (histology)
The differential diagnoses are: acrodermatitis enteropathica, erythema infectiosum, erythema multiforme, hand-foot-and-mouth disease, Henoch–Schönlein purpura, Kawasaki disease, lichen planus, papular urticaria, papular purpuric gloves and socks syndrome, and scabies.
The diagnosis of Gianotti–Crosti syndrome is clinical. A validated diagnostic criteria is as follows:
A patient is diagnosed as having Gianotti–Crosti syndrome if:
1. On at least one occasion or clinical encounter, he/she exhibits all the positive clinical features,
2. On all occasions or clinical encounters related to the rash, he/she does not exhibit any of the negative clinical features,
3. None of the differential diagnoses is considered to be more likely than Gianotti–Crosti syndrome on clinical judgment, and
4. If lesional biopsy is performed, the histopathological findings are consistent with Gianotti–Crosti syndrome.
The positive clinical features are:
- Monomorphous, flat-topped, pink-brown papules or papulovesicles 1-10mm in diameter.
- At least three of the following four sites involved – (1) cheeks, (2) buttocks, (3) extensor surfaces of forearms, and (4) extensor surfaces of legs.
- Being symmetrical, and
- Lasting for at least ten days.
The negative clinical features are:
- Extensive truncal lesions, and
- Scaly lesions.
It is not contagious and currently there is no cure for the disease, although the lesions can be treated with ultraviolet therapy as well as topical steroids and antibiotics.
Treatment often involves multiple therapies that address the immune system and bacterial, viral, or dermatological causes.
Acrodermatitis enteropathica without treatment is fatal, and affected individuals may die within a few years. There is no cure for the condition. Treatment includes lifelong dietary zinc supplementation.
The rash caused by ACA is most evident on the extremities. It begins with an inflammatory stage with bluish red discoloration and cutaneous swelling, and concludes several months or years later with an atrophic phase. Sclerotic skin plaques may also develop.As ACA progresses the skin begins to wrinkle.
There is no standard treatment for PLC. Treatments may include ultraviolet phototherapy, topical steroids, sun exposure, oral antibiotics, corticosteroid creams and ointments to treat rash and itching.
One study identified the enzyme bromelain as an effective therapeutic option for PLC.
It is commonly misdiagnosed as chickenpox or rosacea. Pleva is also often misidentified as a form of staph. The most accurate way to diagnose it is by biopsy. This disease has not been known to be life-threatening. However, there may be mutations of the disease that can cause ulcers on the exterior.
The disease often goes undiagnosed for several years, as it is sometimes not recognized and misdiagnosed as thrush or other problems and not correctly diagnosed until the patient is referred to a specialist when the problem does not clear up.
A biopsy of the affected skin can be done to confirm diagnosis. When a biopsy is done, hyperkeratosis, atrophic epidermis, sclerosis of dermis and lymphocyte activity in dermis are histological findings associated with LS. The biopsies are also checked for signs of dysplasia.
It has been noted that clinical diagnosis of LS can be "almost unmistakable" and therefore a biopsy may not be necessary.
Acrodermatitis /ac·ro·der·ma·ti·tis/ is a childhood form of dermatitis selectively affecting the hands and feet and may be accompanied by mild symptoms of fever and malaise. It may also be associated with hepatitis B and other viral infections.
The lesions appear as small coppery-red, flat-topped firm papules that appear in crops and sometimes in long linear strings, often symmetric.
It is a diffuse chronic skin disease usually confined to the limbs, seen mainly in women in Northern, Central, and Eastern Europe, and characterized initially by an erythematous, oedematous, pruritic phase followed by sclerosis and atrophy. It is caused by infection with "Borrelia burgdorferi".
Pityriasis lichenoides chronica (PLC) is probably caused by a hypersensitivity reaction to infectious agents such as the Epstein–Barr virus. Other infectious agents include the adenovirus and Parvovirus B19.
Types include:
- Acrodermatitis enteropathica
- Acropustulosis
- Acrodermatitis chronica atrophicans
- Papular acrodermatitis of childhood
- Dermatitis repens
Lichen planus has a unique microscopic appearance that is similar between cutaneous, mucosal and oral. A Periodic acid-Schiff stain of the biopsy may be used to visualise the specimen. Histological features seen include:
- thickening of the stratum corneum both with nuclei present (parakeratosis) and without (orthokeratosis). Parakeratosis is more common in oral variants of lichen planus.
- thickening of the stratum granulosum
- thickening of the stratum spinosum (acanthosis) with formation of colloid bodies (also known as Civatte bodies, Sabouraud bodies) that may stretch down to the lamina propria.
- liquefactive degeneration of the stratum basale, with separation from the underlying lamina propria, as a result of desmosome loss, creating small spaces (Max Joseph spaces).
- Infiltration of T cells in a band-like pattern into the dermis "hugging" the basal layer.
- Development of a "saw-tooth" appearance of the rete pegs, which is much more common in non-oral forms of lichen planus.
Acropustulosis refers to Acrodermatitis with pustular involvement.
Types include:
- Pustulosis palmaris et plantaris
- Infantile acropustulosis
The differential diagnosis for OLP includes:
- Other oral vesiculo-ulcerative conditions such as Pemphigus vulgaris and Benign mucous membrane pemphigoid
- Lupus erythematosus, with lesions more commonly occur on the palate and appear as centrally ulcerated or erythematous with radiating white striae. In contrast, OLP and lichenoid reactions rarely occur on the palate, and the striae are randomly arranged rather than radial.
- Chronic ulcerative stomatitis
- Frictional keratosis and Morsicatio buccarum (chronic cheek biting)
- Oral leukoplakia
- Oral candidiasis
The main diagnosis technique is observing the area. Then blood tests can be done to determine if there is a pre-existing condition. Family history can be considered because some of the related causes/conditions can be inherited.
Localized pustular psoriasis presents as two distinct conditions that must be considered separate from generalized psoriasis, and without systemic symptoms, these two distinct varieties being pustulosis palmaris et plantaris and acrodermatitis continua.
The exact cause of poikiloderma is unknown; however, extended sun exposure, namely the ultraviolet light emitted by the sun, is the primary factor.
Dermatitis repens (also known as "Acrodermatitis continua," "Acrodermatitis perstans," "Pustular acrodermatitis," "Acrodermatitis continua of Hallopeau," "Acrodermatitis continua suppurativa Hallopeau," "Hallopeau's acrodermatitis,", "Hallopeau's acrodermatitis continua," and "Dermatitis repens Crocker") is a rare, sterile, pustular eruption of the fingers and toes that slowly extends proximally.
Albeit difficult, treatment of poikiloderma involves the delivery of multiple wavelengths of intense pulsed light (IPL) to the affected area.
Types include:
- Poikiloderma vasculare atrophicans
- Poikiloderma of Civatte
- Hereditary sclerosing poikiloderma
Chondrodermatitis nodularis chronica helicis (also known as "Chondrodermatitis nodularis helicis") is a small, nodular, tender, chronic inflammatory lesion occurring on the helix of the ear, occurring most often in men.
PVA usually has an underlying cause, attributed to existing skin diseases and disorders associated with a cutaneous lymphoma or inflammation. Mycosis fungoides is the common lymphoma believed to cause PVA, although it may be considered a precursor when the lymphoma is (hidden) and undiagnosed. Large plaque parapsoriasis is another common causes of PVA. Less common causes include autoimmune-related connective tissue diseases such as lupus, dermatomyositis and scleroderma. Dermatoses and those that are genetically inspired, called genodermatoses, may also be an underlying cause of PVA. Among them, xeroderma pigmentosum and Rothmund-Thomson syndrome (poikiloderma congenita) are thought to be the most prominent. Ingestion of substances containing arsenic, such as arsphenamine, has also been suggested as a least common cause. PVA can also be idiopathic (of unknown cause), as seen in a small number of cases.
There is a bimodal age distribution in the incidence of LS in women. It occurs in females with an average age of diagnosis of 7.6 years in girls and 60 years old in women. The average age of diagnosis in boys is 9–11 years old.
In men, the most common age of incidence is 21-30.
Neuroimaging is controversial in whether it provides specific patterns unique to neuroborreliosis, but may aid in differential diagnosis and in understanding the pathophysiology of the disease. Though controversial, some evidence shows certain neuroimaging tests can provide data that are helpful in the diagnosis of a patient. Magnetic resonance imaging (MRI) and single-photon emission computed tomography (SPECT) are two of the tests that can identify abnormalities in the brain of a patient affected with this disease. Neuroimaging findings in an MRI include lesions in the periventricular white matter, as well as enlarged ventricles and cortical atrophy. The findings are considered somewhat unexceptional because the lesions have been found to be reversible following antibiotic treatment. Images produced using SPECT show numerous areas where an insufficient amount of blood is being delivered the cortex and subcortical white matter. However, SPECT images are known to be nonspecific because they show a heterogeneous pattern in the imaging. The abnormalities seen in the SPECT images are very similar to those seen in people with cerebral vacuities and Creutzfeldt–Jakob disease, which makes them questionable.