text: First record of<unk>  was made in 1883 in Breslau, Germany, where a physician named Alfred Buchwald first delineated it.<unk>  is one of the tertiary presentations of European lyme borreliosis with Borrelia afzelii known as the most predominant responsible microorganism. Transmission of this infection probably occur via ixodes tick (such as Ixodes ricinus), mosquito and horsefly bite. These vectors themselves get infected by feeding on an infected animal reservoir. Immune reaction against borrelia leads to infiltration of CD3+ and CD4+ cells in the dermis. Some conditions such as lymphocytic meningoradiculitis, lichen sclerosus et atrophicus, morphea and other tick borne diseases have been associated with<unk> . Thinning of skin, visible veins, swelling and wrinkles are some of the features can be noticed on gross pathology. Light and electron microscopic study of the skin biopsy shows degeneration of the elastica and collagen fibers.<unk>  must be differentiated from chronic venous insufficiency, chronic arterial insufficiency, superficial thrombophlebitis, frostbite, morphea, and granuloma annulare.<unk>  is a rare disease. The prevalence of<unk>  is estimated to include 10% of cases with lyme disease in Europe. The incidence of<unk>  increases with age.<unk>  affects women more than men and the majority of<unk>  cases are reported in northern, central and eastern Europe. Common risk factors in the development of<unk>  include tick exposure, female gender and residents of northern, central and eastern Europe. The course of<unk>  is chronic and could lasts for several years and it can progress slowly overtime. In first phase (the inflammatory phase) skin changes appear as blue and red discoloration with boggy infiltration. These inflammatory skin lesions can become atrophic without treatment (atrophic phase). Superimposed bacterial infection, sclerotic skin changes, malignancies, arthropathy and peripheral neuropathy are some of the common complications of<unk> is. The general pognosis is good with proper and rapid treatment in acute inflammatory stage of<unk> , nevertheless late treatment can cause some irreversible changes. Skin examination of<unk> 's patients include blue, red or brown discoloration, hypopigmentation, indurated plaques and wrinkles. High anti-spirochetal antibody levels (such as IgG, IgM and IgA) has been detected at indirect immunofluorescence and enzyme linked immunosorbent assay (ELISA). Antibiotic therapy is recommended in patients with<unk> . Up to four weeks treatment with antibiotics such as amoxicillin, doxycycline, ceftriaxone, cefotaxime and penicillin G has been recommended for<unk> 's treatment. Since transmission of borrelia infection occurs by ticks, mosquitos and horse flies bites, primary prevention could be achieved by bite avoidance.
option_0: Acrodermatitis chronica atrophicans
option_1: Acrodermatitis continua
option_2: Chondrodermatitis nodularis chronica helicis
option_3: Alopecia mucinosa
option_4: Seborrheic dermatitis
option_5: Xerotic eczema
option_6: Pityriasis rosea
option_7: Pityriasis amiantacea