One very specific cause of Lyme disease hair loss is the skin condition that occurs, usually late, in Lyme disease called acrodermatitis chronica atrophicans. More commonly found in European Lyme disease sufferers, particularly elderly patients, this skin condition is not sufficient for a diagnosis of Lyme disease itself (unlike the Lyme disease rash), and requires serologic Lyme disease tests prior to being attributed to the condition. Histopathologic confirmation is also necessary for diagnosis with acrodermatitis chronica atrophicans. Oral doxycycline, or an alternative Lyme disease antibiotic, is used to treat cutaneous manifestations of Lyme disease. Four weeks of antibiotic therapy are usual for this particularly condition which typically presents as a gradual loss of hair and progressive fibrosing skin process.
Borrelia afzelii is thought the main culprit behind this Lyme disease hair loss which is not usually documented in Borrelia burgdorferi infections. The skin becomes tissue-paper-like and commonly affects the extremities and extensor surfaces. The most common sites are the foot, lower leg, the hand or forearm, and the olecranon area. The skin rash and loss of hair may also occur on the buttocks, upper arm, shoulder, or thigh however.
ACA Symptom Progression
Earlier stages include inflammation and a bluish-red discoloration of the skin leading to sclerotic skin plaques and atrophy at a later stage with hair loss also occurring later in some patients. Swelling of the feet is often only noticed as a patient is buying shoes and discovers their size has changed. Many patients do not remember a specific tick bite but often live in tick-endemic areas.
Unilateral acrodermatitis chronica atrophicans is most common but bilateral cases do occur. Patients may have an exaggerated reaction to pain (allodynia) as a feature of this Lyme disease symptom. As the hair is lost on the skin, so are the sebaceous and sweat glands to some extent. The skin becomes very dry and wrinkles easily and even minor trauma may fail to heal properly and result in large ulcerations. Acrodermatitis chronic atrophicans is the only manifestation of Lyme disease hair loss documented so far, with other pathologies or causes thought to be at work in most other cases.