By Gary M. White, MD
Acrodermatitis continua of Hallopeau (ACH) represents a rare variant of pustular psoriasis with a peculiar localization to the distal fingers.
Sterile pustules on one or more fingers and fingertips which rupture leaving tender, eroded skin is characteristic. In the chronic stages, the skin may take on a papulosquamous appearance. In making the diagnosis, one should always take great care through various bacterial cultures to prove that the pustules are sterile as eczema can become secondarily infected, resulting in multiple pustules.
Involvement of the nail apparatus may result in nail dystrophy and even loss of the nail. Osteolysis has occurred.
Rarely, the condition may evolve into generalized pustular psoriasis.
The TNF agents can be effective, e.g., secukinumab, ustekinumab, adalimumab [J Dermatolog Treat. 2014;25:489] or etanercept.
The following also may be tried: high-potency topical steroid ointments, topical calcipotriol, MTX, acitretin, UVB light therapy, acitretin, anakinra combined with acitretin, and low-dose CSA. Anakinra, in a case report, dramatically reduced the pustulation but not the erythrosquamous lesions.
High-dose-rate brachytherapy was successful in one case of severe, recalcitrant ACH [JAMADerm 2017;153;331]
ACH is rare in children. Adalimumab has been used with success.
Patients with pustular psoriasis including acrodermatitis continua of Hallopeau are at increased risk for acute generalized exanthematous pustulosis (AGEP) [Andrew's Diseases of the Skin. Clinical Dermatology 2006]. Sometimes, treatment with antibiotics, particularly cephalexins, can precipitate AGEP [J Dermatol Case Rep 2014:8:42-45] and their use should be avoided if possible.
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